Chapter 3. Safe Patient Handling, Positioning, and Transfers
To use the principles of body mechanics effectively and safely, health care providers must have the required training to perform a risk assessment, knowledge about transfer assistive devices, and an understanding of the procedures for safe patient handling. In addition, knowing risk factors for positioning, transferring, and ambulation, along with understanding falls prevention, will help prevent injuries to staff and patients. The goal of this chapter has been to help reduce the incidence and severity of injuries related to patient-handling procedures.
- Patients’ conditions and their ability to move will change over the course of their hospital stay. A patient risk assessment must be done prior to all patient-handling procedures.
- MSI can result from any type of handling procedure. The principles of proper body mechanics can be applied to all procedures related to positioning, transferring, and ambulation. Correct posture and keeping the patient close to your centre of gravity is essential to maintain balance during transfers, positioning, and ambulation.
- Educate yourself on standard procedures to protect yourself from injury. Retrain and keep current with new procedures and assistive devices.
- The use of assistive devices can help a patient transfer safely and effectively.
- Always seek additional assistance and help as required.
- Keep yourself healthy with exercise and a proper diet, along with suitable footwear to help prevent injury. If an MSI is suspected, seek help immediately and report the incident.
- Avoid trying to catch a falling patient. If possible, follow the guidelines to lower a falling patient to the floor.
- Be proactive to implement safe strategies and prevent hazards in the workplace related to patient handling.
Suggested Online Resources
1. Agency for Healthcare Research and Quality: Which fall prevention practices do you want to use? These universal fall risk precautions review physiological anticipated, unanticipated, and environmental hazards with a focus on identifying risk factors and prevention strategies.
2. BC Interior Health: Safe patient handling. This website lists excellent resources including brochures and videos about topics related to body mechanics, transfers, positions, and performing risk assessments.
3. BC Patient Safety & Quality Council: 48/6 Model of care. This resource offers a model of care for hospitalized seniors (aged 70 and older) in British Columbia. It is an integrated care initiative that addresses six care areas of functioning through patient screening and assessment (assessments are completed only where screening shows areas of concern) within the first 48 hours of hospital admission.
4. Canadian Fall Prevention Education Collaborative: Canadian falls prevention curriculum. This website provides information and tool kits for preventing falls in the community and acute care settings.
5. Centers for Disease Control and Prevention: Safe patient handling training for schools of nursing. This resource was developed by the World Health Organization to create global awareness. It provides up-to-date algorithms for patient transfers.
6. Provincial Health Services Authority: Patient handling guidelines. These instructional video courses cover numerous topics including mechanical (ceiling) lifts, additional repositioning techniques, transfers, and assisting a patient off the floor.
7. WorkSafeBC: High-risk manual handling of patients in health care. This document provides guidelines for moving patients when health care providers are at high risk of injury.
8. WorkSafeBC: Resources – by industry – health care. This website addresses body mechanics, MSI prevention, and the use of transfer assistive devices in health care.
Accreditation Canada. (2014). From evidence to improvement in Canadian healthcare. Retrieved on Oct 10, 2015, from https://www.accreditation.ca/sites/default/files/falls-joint-report-2014-en.pdf
ATI. (2015a). Positioning. In ATI Nursing Education. Ambulation, transferring and range of motion. Retrieved on Oct 10, 2015, from http://www.atitesting.com/ati_next_gen/skillsmodules/content/ambulation/equipment/positioning.html
ATI. (2015b) Transferring – lying to sitting to standing. In ATI Nursing Education. Ambulation, transferring and range of motion. Retrieved on Oct 10, 2015, from http://www.atitesting.com/ati_next_gen/skillsmodules/content/ambulation/viewing/Transfering-lying-sit.html
ATI. (2015c). Transfer – bed to gurney. Retrieved from ATI Nursing Education. Ambulation, transferring and range of motion. Retrieved on Oct 10, 2015, from http://www.atitesting.com/ati_next_gen/skillsmodules/content/ambulation/viewing/Transfering-bed-gurney.html
Berman, A., & Snyder, S. J. (2016). Skills in clinical nursing (8th ed.). Upper Saddle River, New Jersey: Pearson.
British Columbia Patient Safety Learning System. (2015). Retrieved on April 25, 2015, from http://bcpslscentral.ca/
Canadian Patient Safety Institute. (2015). Reducing falls and injury from falls: Starter kit. Retrieved on Oct 10, 2015, from http://www.patientsafetyinstitute.ca/en/toolsResources/Documents/Interventions/Reducing%20Falls%20and%20Injury%20from%20Falls/Falls%20Getting%20Started%20Kit.pdf
Graf, C. (2006). Functional decline in hospitalized older adults. It’s often a consequence of hospitalization, but it doesn’t have to be. American Journal of Nursing, 101(1), 58-67. Retrieved on April 2, 2015, from http://www.researchgate.net/publication/232182376_Functional_Decline_in_Hospitalized_Older_Adults_Its_often_a_consequence_of_hospitalization_but_it_doesnt_have_to_be
Hook, M. L., & Winchel, S. (2006). Fall related injuries in acute care: Reducing the risk of harm. Clinical Practice, 15(6), 370-377.
Interior Health. (2012). Point of care risk assessment (Developed provincially). Retrieved on Oct 10, 2015, from https://www.interiorhealth.ca/sites/Partners/WHSresources/Documents/Point%20of%20Care%20Risk%20Assessment%20Tool.pdf
Interior Health. (2013). Manual transfer: One person assist with help. Retrieved on Oct 10, 2015, from https://www.interiorhealth.ca/sites/Partners/WHSresources/Documents/Manual%20Transfers%20-%20One%20Person%20Assist%20with%20Help%20SWP.pdf
Kalisch, B. J., Lee, S., & Dabney, B. W. (2013). Outcomes of inpatient mobilization: A literature review. Journal of Clinical Nursing. doi: 10.1111/jocn.12315
National Institute for Occupational Safety and Health (NIOSH). (2010). Safe patient handling training for schools of nursing. Retrieved on Oct 10, 2015, from http://www.cdc.gov/niosh/docs/2009-127/pdfs/2009-127.pdf
Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2014). Clinical nursing skills and techniques. St Louis, MO: Mosby Elsevier.
Potter, P. A., Perry, A. G., Ross-Kerr, J. C., & Wood, M. J. (2010). Canadian fundamentals of nursing (4th ed.). St Louis, MO: Mosby Elsevier.
Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. (2011). Basic nursing (7th Ed.). St Louis, MO: Mosby Elsevier.
Provincial Health Services Authority. (2010). Employee wellness elearning courses: Safe patient handling. Retrieved on April 2, 2015, from http://learn.phsa.ca/phsa/patienthandling/
Sanguineti, V. A., Wild, J. R., & Fain, M. J. (2014). Management of postoperative complications: A general approach. Clinics in Geriatric Medicine, 30(2), 261-270.
Titler, M. G., Shever, L. L., Kanak, M. F., Picone, D. M., & Qin, R. (2011). Factors associated with falls during hospitalization in an older adult population. Research and Theory for Nursing Practice: An International Journal, 25(2), 127-152. doi: 10.1891/1541-65126.96.36.199
Winnipeg Regional Health Authority. (2008). Safe patient handling and movement guidelines. Retrieved on April 2, 2015, from http://www.wrha.mb.ca/professionals/safety/files/Manual.pdf
Workers Compensation Board (WCB). (2001).Understanding the risks of musculoskeletal injury (MSI). An educational guide for workers on sprains, strains and other MSIs. Retrieved on Oct 10, 2015, from http://www.worksafebc.com/publications/Health_and_Safety/by_topic/assets/pdf/msi_workers.pdf
WorkSafeBC. (2006). Transfer assist devices for safer handling of patients. Retrieved on April 2, 2015, from http://www.worksafebc.com/publications/high_resolution_publications/assets/pdf/BK103.pdf
WorkSafeBC. (2010). Patient handling. Retrieved on Oct 10, 2015, from https://www2.worksafebc.com/PDFs/healthcare/patient_handling_bulletins_ALL.pdf
WorkSafeBC. (2013). Preventing musculoskeletal injury (MSI). Retrieved on April 2, 2015, from http://www.worksafebc.com/publications/health_and_safety/by_topic/assets/pdf/msi_employers.pdf