Chapter 3. Safer Patient Handling, Positioning, Transfers and Ambulation
3.4 Levels of Assistance
Some patient conditions result in a decreased ability to perform activities of daily living including one’s ability to be mobile. Some patients may require assistance to move around in bed, or to transfer from bed to wheelchair or bed to stretcher. Others may need assistance to ambulate. Changing patient positions in bed and mobilization are also vital to prevent contractures from immobility, maintain muscle strength, prevent pressure injury, and to help body systems function properly for optimal health and healing (Perry et al., 2018). The amount of assistance each patient will require depends on the patient’s previous health status, age, type of illness, and length of stay (Perry et al., 2018).
General Description—Levels of Assistance
Commonly in acute and residential care settings, patients are assessed and assigned with a “level of assistance” designation. The level of assistance required is based on the patient’s ability to transfer, stand, and cooperate in care activities. Terms to describe different levels of assistance are one way for health care providers to communicate with each other how much and what kind of assistance is required.
The terms may differ from one institution to the next and as such it is the healthcare provider’s responsibility is to know the correct terms in the institutions they are working in (South Island Alliance, n.d.). The level of assistance needed is somewhat subjective can change over time. Thus, the need for constant reassessment and communication by and among the healthcare team (South Island Alliance, n.d.).
The level of assistance should be documented where healthcare providers can easily access the information. This might include the patient’s Kardex, above the head of the bed, and/or in the patient’s chart. Table 3.3 describes general levels of assistance and the terminology sometimes used in hospital and community settings to describe them.
Table 3.3 General Levels of Assistance |
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Level of Assistance Terminology |
Criteria |
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| Independent | The patient:
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| Standby Supervision / One Person Assist |
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| Minimal Assist / One Person Assist |
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| Two Person Assist |
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| Total Assist |
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| Data sources: South Island Alliance, n.d.; Winnipeg Regional Health Authority (WRHA), 2008; Worksafe BC, 2006 |
Special considerations:
- The weight, height, and general physical, mental, or emotional condition of the patient all influence the potential for injury to the patient and healthcare worker.
- If the patient is uncooperative or unable to follow commands, there is an increased risk for injury. In these cases, a mechanical lift or assistive device should be used to prevent injury to the healthcare provider and/or patient.
- Any patient-handling injuries must be reported using the British Columbia Patient Safety and Learning System (BCPSLS), a web-based tool used to report and learn about safety events, near misses, and hazards in healthcare settings (BCPSLS Central, 2015).
Critical Thinking Exercises
- A patient requires no assistance from the healthcare provider except for the occasional reminder to lift their feet while walking. What level of activity designation would you give to this patient?
- A patient is assessed as needing a one-person pivot transfer. As the healthcare provider begins the transfer, the patient suddenly becomes uncooperative. What should the healthcare provider do next?