Chapter 3. Safer Patient Handling, Positioning, Transfers and Ambulation
To use the principles of body mechanics effectively and safely, healthcare 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 are 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 a 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
- Agency for Healthcare Research and Quality: Which Fall Prevention Practices Do You Want to Use? (2013). These universal fall risk precautions review physiological, anticipated, unanticipated, and environmental hazards with a focus on identifying risk factors and prevention strategies.
- BC Interior Health: Safe Patient Handling (n.d.). This website lists excellent resources, including brochures and videos, about topics related to body mechanics, transfers, positions, and performing risk assessments.
- BC Patient Safety & Quality Council: Hospital Care for Seniors: 48/6 Approach (2012). 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.
- Canadian Fall Prevention Education Collaborative: Canadian Fall Prevention Curriculum (2017). This website provides information and tool kits for preventing falls in the community and acute care settings.
- Centers for Disease Control and Prevention: Safe Patient Handling Training for Schools of Nursing (2009). This resource was developed by the World Health Organization to create global awareness. It provides up-to-date algorithms for patient transfers.
- Provincial Health Services Authority: Safe Patient Handling (2010). These instructional video courses cover numerous topics including mechanical (ceiling) lifts, additional re-positioning techniques, transfers, and assisting a patient off the floor.
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British Columbia Patient Safety Learning System (BCPSLS) Central. (2015). Retrieved from http://bcpslscentral.ca/.
Canadian Patient Safety Institute. (2015). Reducing falls and injury from falls: Getting started kit. Retrieved from http://www.patientsafetyinstitute.ca/en/toolsResources/Documents/Interventions/Reducing%20Falls%20and%20Injury%20from%20Falls/Falls%20Getting%20Started%20Kit.pdf.
Cleveland Clinic. (2018a). Walkers. Retrieved from https://my.clevelandclinic.org/health/articles/15542-walkers.
Cleveland Clinic. (2018b). Crutches. Retrieved from https://my.clevelandclinic.org/health/articles/15543-crutches.
Cleveland Cinic. (2018c). Canes. Retrieved from https://my.clevelandclinic.org/health/articles/15541-canes.
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 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.
Handicare. (2018). How to choose the proper sling. Retrieved https://www.handicare.ca/blog/2018/08/24/how-to-choose-the-proper-sling/
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HoverTech International. (2016). HoverMatt air transfer system. Retrieved from http://www.hovermatt.com/hovermatt.html.
Interior Health. (2012). Point-of-care risk assessment. Retrieved 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 from https://www.interiorhealth.ca/sites/Partners/WHSresources/Documents/Manual%20Transfers%20-%20One%20Person%20Assist%20with%20Help%20SWP.pdf.
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National Institute for Occupational Safety and Health (NIOSH). (2010). Safe patient handling training for schools of nursing. Retrieved from http://www.cdc.gov/niosh/docs/2009-127/pdfs/2009-127.pdf.
Peninsula Health. (1999). Falls risk assessment tool (FRAT). Retrieved from https://www2.health.vic.gov.au/about/publications/policiesandguidelines/falls-risk-assessment-tool.
Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2018). Clinical nursing skills and techniques (9th ed.). St. Louis, MO: Elsevier-Mosby.
Potter, P. A., Perry, A. G., Stockert, P., Hall, A., Astle, B., & Duggleby, W. (2017). Canadian fundamentals of nursing (6th ed.). Milton, ON: Mosby.
Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. (2011). Basic nursing (7th ed.). St. Louis, MO: Elsevier-Mosby.
Provincial Health Services Authority (PHSA). (2010). Workplace health – Safe patient handling [Online courses]. Retrieved from http://learn.phsa.ca/phsa/patienthandling/.
Registered Nursing. (n.d.). Ergonomic principles: NCLEX-RN. Retrieved from https://www.registerednursing.org/nclex/ergonomic-principles/.
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. https://doi.org/10.1016/j.cger.2014.01.005.
South Island Alliance. (n.d.). Level of assistance definitions. Retrieved from https://www.sialliance.health.nz/UserFiles/SouthIslandAlliance/File/LEVEL%20OF%20ASSISTANCE%20DEFINITIONS%202016.pdf.
Stewart, D. (2018). Ceiling lift sling information. Retrieved from https://mobilitybasics.ca/ceiling-lifts/slings.
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. https://doi.org/10.1891/1541-65184.108.40.206.
Winnipeg Regional Health Authority (WRHA). (2015). Safe patient handling assessment form. Retrieved from http://www.wrha.mb.ca/professionals/safety/files/SafePatientHandling/SafePatientHandlingAssessmentForm.pdf.
Winnipeg Regional Health Authority (WRHA). (2008). Patient assessment procedures and screening tool. Retrieved from http://www.wrha.mb.ca/professionals/safety/files/SafePatientHandling/PatientAssessmentProcedure.pdf.
WorkSafeBC. (2006). Handle with care: Patient handling and the application of ergonomics (MSI) requirements. Retrieved from https://www.worksafebc.com/en/resources/health-safety/books-guides/handle-with-care-patient-handling-application-ergonomics-musculoskeletal-msi-requirements?lang=en&origin=s&returnurl=https%3A%2F%2Fwww.worksafebc.com%2Fen%2Fsearch%23q%3Dtransfer%2520assist%2520devices%2520for%2520safer%26sort%3Drelevancy%26f%3Alanguage-facet%3D%5BEnglish%5D.
WorkSafeBC. (2008). Understanding the risks of musculoskeletal injury (MSI): An educational guide for workers on sprains, strains, and other MSIs. Retrieved from http://www.worksafebc.com/publications/Health_and_Safety/by_topic/assets/pdf/msi_workers.pdf.
WorkSafeBC. (2010). Patient handling. Retrieved from https://www.worksafebc.com/en/health-safety/industries/health-care-social-services/topics/patient-handling.
WorkSafeBC. (2013). Preventing musculoskeletal injury (MSI). Retrieved from http://www.worksafebc.com/publications/health_and_safety/by_topic/assets/pdf/msi_employers.pdf.
World Health Organization. (2018). Assistive devices and technology. Retrieved from https://www.who.int/disabilities/technology/en/.