Chapter 3. Safer Patient Handling, Positioning, Transfers and Ambulation
To prevent and minimize MSI injuries related to patient handling activities, a risk assessment must be done to determine a patient’s ability to move, the need for assistance, and the most appropriate means of assistance (Provincial Health Services Authority [PHSA], 2010). There are four important areas to assess:
- The patient
- The environment
- The healthcare provider
- The organization of the work
Checklist 24 outlines these four areas of assessment and what to consider prior to positioning, ambulation, and transfers.
Disclaimer: Always review and follow your hospital policy regarding this specific skill.
|1. Assess your patient.||There are three areas to assess:
1. Is the patient cooperative and able to follow directions?
Ask patient to squeeze your hands. Is the behaviour predictable (non-aggressive, fearful, or fatigued)? Is the patient able to follow directions with cues?
2. Can the patient bear weight?
Ask patient to lift buttocks off the bed (also known as “bridging”) and hold the position for five seconds. The healthcare provider may give cues on how to lift buttocks off the bed.
After bridging, ask the patient to perform a straight leg raise by lifting one leg up off the bed and holding it for five seconds while the other leg is kept bent. Repeat with the opposite leg.
3. Can the patient sit up on the side of the bed without support? Can the patient sit forward on a chair or the edge of the bed without support?
Risk assessment also involves knowing any activity restrictions associated with recent surgery or injury.
|2. Assess your environment.||Is there adequate space?
Is available equipment in proper working order?
Have all hazards been removed?
|3. Assess yourself and readiness to perform procedures.||Complete all required training according to health agency regulations.
Wear non-slip footwear.
Maintain a neutral spine; do not twist or side bend; and use proper body mechanics when moving or positioning patients.
Designate a leader if working in a team to mobilize or position a patient.
Always use proper weight-shift techniques (side to side, front to back, and up and down).
|4. Assess your work organization.||Ensure adequate number of caregivers.
Ensure there is enough time to perform the procedure.
Take rest breaks and vary activities to promote optimal back health.
If patient is complex or bariatric, consult additional resources, seek assistance, and use assistive devices.
|Data sources: Interior Health, 2013; National Institute of Occupational Safety and Health, 2010; PHSA, 2010; WorkSafeBC, 2010|
The following are useful resources to help you further develop your understanding of assessment and decision making around patient handling activities.
Critical Thinking Exercises
- Name five things the healthcare worker should assess about themselves when considering their own ability to perform a patient-handling procedure?
- Vision and hearing impairments, as well as language barriers, are risk factors when performing patient-handling procedures. What additional patient risk factors should be considered?