The goal of any transfer between surfaces such as the bed or chair is to move the resident safely and easily while preventing injury to both the resident and staff. Unfortunately, injuries during transfers can occur, and often it is because nursing home staff do not follow safe practices. Injuries may happen with one and two-person transfers, as well as with mechanical (stand and total care) lifts.
What should the nursing home be doing to ensure safe transfers?
- Provide an annual in-service on safe transfers to staff.
- Evaluate each fall that occurs due to transfer and provide corrective actions.
- Have physical therapy evaluate resident transfer ability upon admission and with each change in condition.
- The resident’s care plan should note the transfer method to be used.
- Avoid lifting residents under the arms as this may cause shoulder joint separation known as subluxation. This type of lift is called the "chicken-wings lift" and is one of the more commonly used methods because of its simplicity and speed of use.
- Use transfer belts with all transfers (look for these in the nursing home - CNAs often wear them around their waists so they are easily accessible to apply to a resident for transfers). The transfer belt is applied around the resident's waist, providing a handle for the CNAs to grasp. By using an underhand grip on the belt instead of lifting beneath the resident's arms, the weight of the resident is supported at his center of gravity and not distributed to shoulder joints, decreasing the risk of injury.
- Encourage resident participation as much as possible during transferring.
- During transfers, the resident should be encouraged to reach for the arms of the chair or bed and push himself up from a surface instead of grabbing onto the caregiver.
- Encourage exercises that promote muscle strength to enable assistance in transfers through activity, restorative nursing, and physical therapy.
What are the causes of injury during transfers that do not involve the use of a mechanical lift?
- Insufficient evaluation of the resident’s transfer ability (most common)
- Staff confusion related to weight-bearing status
- Lack of communication from nurse to CNA regarding transfer ability. Information about transfer ability should be placed on CNA assignment sheets.
- Lack of education regarding safe transfers. CNAs receive limited training in their short course time and most nursing home nurses receive limited training as well. In many nursing homes, physical therapy does not evaluate transfer needs, and the CNA uses whatever lift device or transfer method is easiest at the time, which may not be consistent or even safe.
- Time constraints also place pressure on direct caregivers to hurry in order to complete all assigned tasks before the end of the shift.
What are mechanical lifts and when are they used?
Mechanical lifts are a generally safe alternative for transferring severely impaired residents or those who are too heavy or contracted to be handled safely in other ways. Facilities should have both a stand lift and a total lift available for transfers. There are many brand names used for these types of lifts, so names used in each nursing home will vary. An evaluation by physical therapy should be completed to determine the for need of such lifts. The following are a general set of criteria for their use:
- Used when the resident needs assistance in standing and/or walking from a sitting position.
- The person must be a one-person assist with transfers.
- A total lift is used when the resident needs complete assistance in transferring from a sitting or lying position.
- The resident must be at least a two-person assist.
Residents who can still participate in weight-bearing transfers should not be transferred with a mechanical lift. Weight-bearing prevents osteoporosis, contractures in the feet, and foot drop, so weight-bearing should be maintained as long as possible.
Are there any dangers to the use of mechanical lifts?
Unfortunately, injuries do occur during lift transfers. The following are examples of how this has happened:
- Falling from a lift when one staff member tries to transfer a resident who requires a two-person transfer and the lift tips over. This is often a sign of short staffing.
- Transfer belts applied incorrectly, and they slip during the transfer resulting in falls, significant bruising, and rib fractures.
- Malfunctioning of the lift during the transfer that results in an injury due to lack of lift maintenance.