Skill 9-4

Transferring a Patient Using a Powered Full-Body Sling Lift

A powered full-body sling lift may be used to reposition and transfer patients based on results of assessment through screening or use of an assessment tool to assess the patient's status and the need for SPHM devices (VA Mobile Health, n.d.; VHACDOSH, 2016). One suggested decision-making strategy is outlined in Fundamentals Review 9-4; this tool includes suggestions for associated SPHM equipment. A powered full-body sling lift may be used to reposition a patient in bed and/or move a patient in or out of bed, into and out of a chair, and to a commode or stretcher (refer to Fundamentals Review 9-3). A full-body sling is placed under the patient's body, including head and torso, and then the sling is attached to the lift. The device slowly lifts the patient. Some devices can be lowered to the floor to pick up a patient who has fallen. These devices are available on portable bases and ceiling-mounted tracks. Each manufacturer's device is slightly different, so review the instructions for your particular device. Refer to facility policy and procedures and specific manufacturer guidelines related to other available devices and equipment. Box 9-1 in Skill 9-1 outlines general guidelines related to mobility and safe handling of people with dementia.

Delegation Considerations

The transfer of a patient from bed to a chair 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

Powered full-body sling lift
Sheet or pad to cover the sling, if sling is not dedicated to only one patient
Chair or wheelchair
One or more caregivers for assistance, based on assessment
Nonsterile gloves and/or other PPE, as indicated

Assessment

Assess the situation to determine the need to use the lift. Review the health record and care plan for conditions that may influence the patient's ability to move or to be transferred. Use available algorithms to aid in assessment and decision making. Determine the need for bariatric equipment. Assess for tubes, IV lines, incisions, or equipment that may alter the transfer procedure. Assess the patient's level of consciousness and ability to understand and follow directions. Assess the patient's comfort level; if needed, medicate, as prescribed, with analgesics. Assess the condition of the equipment to ensure proper functioning before using with the patient. 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:

Injury risk
Deconditioning
Fall risk

Outcome Identification and Planning

The expected outcome to achieve when transferring a patient using a powered full-body sling lift is that the transfer is accomplished without injury to the patient or nurse.

Implementation

Action	Rationale
1. Review the health record and care plan for conditions that may influence the patient's ability to move or to be positioned. 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 care plan validates the correct patient and correct procedure. Checking for equipment and limitations reduces the risk for injury during the transfer. 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 allay anxiety and prepare the patient for what to expect.
4. If needed, move the equipment to make room for the chair. Close the curtains around the bed and close the door to the room, if possible.	Moving equipment out of the way provides a clear path and facilitates the transfer. Closing the door or curtains provides for privacy.
5. Adjust the bed to a comfortable working height (VHACEOSH, 2016). Lock the bed brakes.	Having the bed at the proper height prevents back and muscle strain. Locking the brakes prevents bed movement and ensures patient safety.
6. Lower the side rail, if in use, on the side of the bed you are working. If the sling is for use with more than one patient, place a cover or pad on the sling. Place the sling evenly under the patient. Roll the patient to one side and place half of the sling with the sheet or pad on it under the patient from shoulders to mid-thigh (Figure 1). Raise the rail and move to the other side. Lower the rail, if necessary. Roll the patient to the other side and pull the sling under the patient (Figure 2). Raise the side rail.	Lowering the side rail prevents strain on the nurse's back. Covering the sling prevents transmission of microorganisms. Some facilities, such as long-term care institutions, provide each patient with own transport sling. Rolling the patient positions the patient on the sling with minimal movement. Even distribution of the patient's weight in the sling provides for patient comfort and safety.
7. Bring the chair to the side of the bed. Lock the wheels, if present.	Bringing the chair close to the bed minimizes the distance needed for transfer. Locking the wheels prevents chair movement and ensures patient safety.
8. Lower the side rail on the chair side of the bed. Roll the base of the lift under the side of the bed nearest to the chair. Center the frame over the patient. Lock the wheels of the lift.	Lowering the rail allows for ease of transfer. 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.). Positioning on the side of the bed close to the chair reduces the distance necessary for transfer. Centering the frame helps maintain the balance of the lift. Locking the lift's wheels prevents the lift from rolling.
9. Using the base-adjustment lever, widen the stance of the base (Figure 3).	A wider stance provides greater stability and prevents tipping.
10. Lower the arms on the lift frame close enough to attach the sling to the frame (Figure 4).	Lowering the arms is necessary to allow for the attachment of the sling's hooks.
11. Attach the straps on the sling to the hooks on the frame (Figure 5). Short straps attach behind the patient's back and long straps attach at the other end of the sling. Check the patient to make sure the straps are not pressing into the skin. Some lifts have straps or chains with hooks that attach to holes in the sling. Check the manufacturer's instructions for each lift.	Connecting the straps or chains permits attachment of the sling to the lift. Checking the patient's skin for pressure from the hooks prevents injury.
12. Check all equipment, lines, and drains attached to the patient so that they are not interfering with the device. Have the patient fold their arms across the chest.	Ensuring that equipment and lines are free of the device prevents dislodgement and possible injury.
13. With a person standing on each side of the lift, tell the patient that they will be lifted from the bed. Support injured limbs as necessary. Engage the pump to raise the patient about 6 inches above the bed (Figure 6).	Having the necessary people available provides for safety. Supporting injured limbs helps maintain stability. Informing the patient about what will occur reassures the patient and reduces fear.
14. Unlock the wheels of the lift. Carefully wheel the patient straight back and away from the bed. Support the patient's limbs, as needed.	Moving in this manner promotes stability and safety.
15. Position the patient over the chair with the base of the lift straddling the chair (Figure 7). Lock the wheels of the lift.	Proper positioning of the patient and device promotes stability and safety.
16. Gently lower the patient to the chair until the hooks or straps are slightly loosened from the sling or frame (Figure 8). Guide the patient into the chair with your hands as the sling lowers.	Gently lowering the patient in this manner places the patient fully in the chair and reduces the risk for injury.
17. Disconnect the hooks or strap from the frame. Keep the sling in place under the patient.	Disconnecting the hooks or straps allows the patient to be supported by the chair and promotes comfort. The sling will need to be reattached to the lift to move the patient back to bed.
18. Adjust the patient's position, using pillows, if necessary. Check the patient's alignment in the chair. Cover the patient with a blanket, if necessary. Make sure call bell and other essential items are within easy reach. When it is time for the patient to return to bed, reattach the hooks or straps and reverse the steps.	Pillows and proper alignment provide for patient safety and comfort. Having the call bell and other essential items readily available helps promote safety. Reattaching the hooks or straps allows the lift to support the patient for transfer back to bed.
19. 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 transfer was accomplished without injury to the patient or nurse.

Documentation

Guidelines

Document the activity, transfer, any other pertinent observations, the patient's tolerance of the procedure, and the length of time in the chair. 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

You are preparing to move a patient using a powered full-body sling lift. After you apply the sling and attach it to the frame, the patient becomes anxious and tells you they are afraid: Acknowledge the patient's feelings and explain the procedure again. Reassure the patient about the safety of the device. Obtain an additional person to support the patient during the move by holding her hand or supporting her head. If possible, plan the transfer when a family member/caregiver or friend is present to offer support.

Special Considerations

The duration of time spent in slings should be limited to reduce risk for pressure injuries, especially for vulnerable populations (Peterson et al., 2015).
The transfer of patients is often delegated to assistive personnel. Before moving patients, all personnel need to complete instructions and must be able to provide return demonstrations of transfer skills. Before the transfer, 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 id 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 9-4

EVIDENCE FOR PRACTICE