Transfer from bed to stretcher, one of the most common transfers, can require the help of one or more coworkers depending on the patient's size and condition and the primary nurse's physical abilities. Techniques for achieving this transfer include the straight lift, carry lift, lift sheet, and sliding board. The nurse must prevent self-injury by using correct posture, good body mechanics, lifting techniques, and appropriate lift devices. Consider the patient's condition (cognitive status, physiologic status, presence of weakness, etc.) prior to transferring and assess if an assistive device is needed. Refer to an algorithm such as Safe patient handling and movement algorithms (http://www.visn8.va.gov).

What you need

Stretcher sliding board or lift sheet if necessary.

Getting ready

• Adjust the bed to the same height as the stretcher.
• Move any obstacles out of the way.
• If a caregiver needs to lift any more than 35 lb, use assistive devices for the transfer.

How you do it

• Tell the patient that you're going to move him from the bed to the stretcher and place him in the supine position.
• Ask team members to remove watches and rings to avoid scratching the patient during transfer.

Four-person straight lift

• Place the stretcher parallel to the bed and lock the wheels of both to ensure patient safety.

Get into position

• Stand at the center of the stretcher and have another team member stand at the patient's head. The two other team members should stand next to the bed, on the other side—one at the center and the other at the patient's feet.
• Slide your arms, palms up, under the patient, while the other team members do the same. In this position, you and the team member directly opposite to you support the patient's buttocks and hips; the team member at the head of the bed supports the patient's head and shoulders; and the one at the foot supports the patient's legs and feet.

One, two, three

• On a count of three, you and your team members lift the patient several inches, move him onto the stretcher, and slide your arms out from under him. Keep movements smooth to minimize patient discomfort and avoid muscle strain by team members.
• Position the patient comfortably on the stretcher, apply safety straps, and raise and secure the side rails.

Four-person carry lift

• Place the stretcher perpendicular to the bed, with the head of the stretcher at the foot of the bed. Lock the bed and stretcher wheels to ensure patient safety.
• Raise the bed to a comfortable working height.

Top to bottom, tallest to shortest

• Line up all four team members on the same side of the bed as the stretcher, with the tallest member at the patient's head and the shortest at his feet. The member at the patient's head is the team leader and gives the lift signals.
• Assuming you're the team leader, tell the team members to flex their knees and slide their hands, palms up, under the patient until he rests securely on their upper arms.
• Make sure the patient is adequately supported at the head and shoulders, buttocks and hips, and legs and feet.

Reduce the strain

• On a count of three, the team members straighten their knees and roll the patient onto his side, against their chests. This reduces strain on the team members and allows them to hold the patient for several minutes if necessary.
• Together, the team members step back, with the member supporting the feet moving the farthest.

On the count of three

• The team members move forward to the stretcher's edge and, on a count of three, lower the patient onto the stretcher by bending at the knees and sliding their arms out from under the patient.
• Position the patient comfortably on the stretcher, apply safety straps, and raise and secure the side rails.

Four-person lift sheet transfer

• Position the bed, stretcher, and team members for the straight lift.

Make it close to the patient

• Instruct the team to hold the edges of the sheet under the patient, grasping them close to the patient to obtain a firm grip, provide stability, and spare the patient feelings of instability.

One smooth, continuous motion

• On a count of three, the team members lift or slide the patient onto the stretcher in one smooth, continuous motion to avoid muscle strain and minimize patient discomfort.
• Position the patient comfortably on the stretcher, apply safety straps, and raise and secure the side rails.

Sliding board transfer

• Place the stretcher parallel to the bed and lock the wheels of both to ensure patient safety.
• Stand next to the bed and instruct a coworker to stand next to the stretcher.
• Reach over the patient and pull the far side of the bedsheet toward you to turn the patient slightly on his side.

Bridging the gap

• Instruct your coworker to place the sliding board beneath the patient, making sure the board bridges the gap between stretcher and bed.
• Ease the patient onto the sliding board and release the sheet.

Making the transfer

• Instruct your coworker to grasp the near side of the sheet at the patient's hips and shoulders and to pull him onto the stretcher in a smooth, continuous motion. Then have her reach over the patient, grasp the far side of the sheet, and logroll the patient toward her.

Getting him settled

• Remove the sliding board as your coworker returns the patient to the supine position.
• Position the patient comfortably on the stretcher, apply safety straps, and raise and secure the side rails.

Practice pointers

Use these pointers for patients in special circumstances.

If the patient is obese

• When transferring from bed to stretcher, lift and move the obese patient, in increments, to the edge of the bed. Then rest for a few seconds and lift him onto the stretcher.
• Depending on the patient's size and condition, lift sheet transfer can require two to seven people.

If the patient can bear weight on his arms or legs

• Two or three coworkers can perform a transfer if the patient can bear weight on his arms or legs. One can support the buttocks and guide the patient, another can stabilize the stretcher by leaning over it and guiding the patient into position, and a third can transfer any attached equipment. If a team member isn't available to guide equipment, move I.V. lines and other tubing first to make sure they're out of the way and not in danger of pulling loose or disconnect tubes if possible.

If the patient is light

• Three coworkers can perform the carry lift if the patient is light, but no matter how many team members are present, one must stabilize the patient's head if he can't support it himself, has cervical instability or injury, or has undergone surgery. (See Documenting bed-stretcher transfer.)