Skill 9-2

Transferring a Patient From the Bed to a Stretcher

Considerable care must be taken when moving someone from one surface to another, such as from a bed to a stretcher or from a stretcher to a bed, to prevent injury to the patient or caregivers. The patient is at risk for injuries from friction and shearing forces while being moved. Knowledge of correct body alignment, SPHM, and assistive devices to transfer the patient are crucial to achieve patient movement and avoid injury. Use a decision-making tool to help make decisions about SPHM. One suggested decision-making strategy is outlined in Fundamentals Review 9-4 and includes suggestions for associated SPHM equipment. Another example of a decision-making tool is provided in Figure 1. Be familiar with the proper way to use lateral-assist devices, based on the manufacturer's directions. Refer to facility policy and procedures and specific manufacturer guidelines related to other available devices and equipment. Fundamentals Review 9-3 reviews examples of equipment and assistive devices that are available to aid in patient movement and handling. Refer to Box 9-1 in Skill 9-1 for additional considerations related to mobility and safe handling of people with dementia.

Delegation Considerations

The transfer of a patient from bed to stretcher may be delegated to assistive personnel (AP) as well as to licensed practical/vocational nurses (LPN/LVNs). The decision to delegate must be based on careful analysis of the patient's needs and circumstances as well as the qualifications of the person to whom the task is being delegated. Refer to the Delegation Guidelines in Appendix A.

Equipment

Transport stretcher
Ceiling lift or full-body lift
Lateral-assist device, such as a transfer board, roller board, or air or mechanical lateral-assist device and cover sheet
Bath blanket
Regular blanket
At least two assistants, depending on assessment and data
Nonsterile gloves and/or other PPE, as indicated

Assessment

Assess the situation to determine the need to transfer the patient. Check the health record for any conditions or prescribed interventions that may influence the patient's ability to move or to be transferred. Perform a pain assessment before the time for the activity. If the patient reports pain, administer the prescribed medication in sufficient time to allow for the full effect of the analgesic. Assess for tubes, IV lines, incisions, or equipment that may alter the positioning procedure. Assess the patient's level of consciousness, ability to understand and follow directions, and ability to assist with the transfer. Use available decision-making tools or algorithms to aid in assessment and decision making. Assess the patient's ability to assist with moving and the need for assistive devices. Determine the need for bariatric equipment.

Actual or Potential Health Problems and Needs

Many actual or potential health problems or issues may require the use of this skill as part of related interventions. An appropriate health problem or issue may include:

Activity intolerance
Deconditioning
Injury risk

Outcome Identification and Planning

The expected outcome to achieve when transferring a patient from the bed to a stretcher is that the patient is transferred without injury to the patient or nurse.

Implementation

Action	Rationale
1. Identify any movement limitations, conditions that may influence the patient's ability to move or be positioned, and the ability of the patient to assist with the transfer. Consult a patient handling algorithm, if available, to plan an appropriate approach to moving the patient. Assess for tubes, IV lines, incisions, or equipment that may alter the positioning procedure. Gather transfer aids or supports as necessary.	Reviewing the health record and plan of care validates the correct patient and correct procedure. Checking for interfering equipment helps reduce the risk for injury. Identification of limitations and ability along with use of an algorithm helps to prevent injury and aids in determining the best plan for patient movement. Having aids readily available promotes efficient time management.
2. Perform hand hygiene and put on PPE, if indicated.	Hand hygiene and PPE prevent the spread of microorganisms. PPE is required based on transmission precautions.
3. Identify the patient. Explain the procedure to the patient.	Patient identification validates the correct patient and correct procedure. Discussion and explanation help allay anxiety and prepare the patient for what to expect.
4. Close the curtains around the bed and close the door to the room, if possible. Adjust the head of the bed to a flat position or as low as the patient can tolerate. Raise the bed to a height that is even with the transport stretcher (VHACEOSH, 2016). Lower the side rails, if in place.	Closing the door or curtains provides for privacy. Proper bed height and lowering side rails make transfer easier and decrease the risk for injury.
5. Place the bath blanket over the patient and remove the top covers from underneath. Remove all pillows from under the patient's head, back or legs.	Bath blanket provides privacy and warmth. Removing pillows from under the patient facilitates movement.
6. If not already in place, position a friction-reducing sheet or lifting/repositioning sheet or other transfer device under the patient, based on assessment.	Friction-reducing/lifting/repositioning sheets and other transfer devices aid in preventing shearing and in reducing friction and the force required to move the patient.
7. Follow manufacturer's directions to utilize the ceiling lift or full-body lifting device with the repositioning or supine sling or air-assisted transfer device (Figure 2). Refer to the Skill Variation at the end of Skill 9-1 for guidelines related to use of a full-body sling lift.	Use of SPHM equipment is necessary to reduce risk of injury to patient and care providers (Fragala et al., 2016; OSHA and Joint Commission Resources Alliance, 2017; VA Mobile Health, n.d.).
8. Position the stretcher next (and parallel) to the bed. Lock the wheels on the stretcher and the bed.	Positioning equipment makes the transfer easier and decreases the risk for injury. Locking the wheels keeps the bed and stretcher from moving.
9. At a minimum, one caregiver should be positioned on the stretcher side of the bed, and another should stand on the side of the bed without the stretcher. Depending on the transfer device, other care givers should be positioned accordingly.	Team coordination provides for patient safety during transfer.
10. Use the friction-reducing sheet to roll the patient away from the stretcher (Figure 3). Place the transfer device under the patient (Figure 4).	The transfer board or other lateral-assist device reduces friction, easing the workload to move patient.
11. At a signal given by one of the caregivers and based on the manufacturer's directions for use of the device, move the patient from the bed to the stretcher (Figure 5).	Working in unison distributes the work of moving the patient and facilitates the transfer.
12. Once the patient is transferred to the stretcher (Figure 6), remove the SPHM device or leave in place for future use, based on device type and facility policy. Provide a pillow and other supports as indicated. Secure the patient and raise the side rails. To ensure the patient's comfort, cover the patient with blanket and remove the bath blanket from underneath.	Positioning in proper alignment with supports ensures that the patient will be able to maintain the desired position and will be comfortable. Side rails promote safety. Blanket promotes comfort and warmth.
13. Clean transfer aids, per facility policy, if not indicated for single-patient use. Remove gloves and any other PPE, if used. Perform hand hygiene.	Proper cleaning of equipment between patient use prevents the spread of microorganisms. Proper removal of PPE reduces the risk for infection transmission and contamination of other items. Hand hygiene prevents the spread of microorganisms.

Evaluation

The expected outcome has been met when the patient has been transferred to the stretcher without injury to the patient or nurse.

Documentation

Guidelines

Document the time and method of transport, and patient's destination, according to facility policy. Document the completed assessment algorithm for patient handling and movement decision and the use of transfer aids and number of staff required for transfer.

Sample Documentation

Developing Clinical Reasoning and Clinical Judgment

Unexpected Situations and Associated Interventions

Your patient needs to be transported to another department by stretcher. The patient is very heavy and somewhat confused, so you are concerned about his ability to cooperate with the transfer: Consult a Bariatric Algorithm. Confirm that the patient handling equipment and stretcher meet weight, width, and height requirements of the patient (VHA CEOSH, 2015). Obtain the assistance of additional caregivers; bariatric patients and use of expanded capacity equipment requires more caregivers (VHA CEOSH, 2015). Use bariatric equipment and devices to move the patient (VHA CEOSH, 2015).

Special Considerations

If the patient is unconscious or weakened, additional caregivers are needed to support the extremities and the head to reduce risk of further injury.
Some mechanical lateral-transfer aids are motorized, and others use a hand crank. If a mechanical lateral-assist device is used, follow the manufacturer's directions for safe movement of the patient. Be familiar with weight restrictions for individual pieces of equipment.
Keep in mind that the transfer of patients is often delegated to assistive personnel. Before moving patients, all personnel need to complete instructions about this skill and must be able to provide return demonstrations of transfer skills. When a patient is being transferred, communicate clearly any mobility restrictions or special care needs.
Bariatric patients require additional caregivers and expanded capacity devices (VA Mobile Health, n.d.; VHACEOSH, 2016). Institute Bariatric Algorithms for any patient who weighs more than 300 lb, or is 100 lb over ideal weight, or who has a BMI over 40 (VHA CEOSH, 2015).

EVIDENCE FOR PRACTICE

Safe Patient Handling and Mobility

VA Mobile Health. (n.d.). Safe patient handling. (Version 1.3.3). [Mobile app]. U. S. Department of Veteran Affairs. https://mobile.va.gov/app/safe-patient-handling

VHA Center for Engineering & Occupational Safety and Health (CEOSH). (2015). Bariatric safe patient handling and mobility guidebook: A resource guide for care of persons of size. https://www.asphp.org/wp-content/uploads/2011/05/Baraiatrice-SPHM-guidebook-care-of-Person-of-Size.pdf

Refer to details in Skill 9-1, Evidence for Practice.

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Skill 9-2

EVIDENCE FOR PRACTICE