Patient Transfer & Transport

Concorde Career College, Portland

ST210

Patient Identification

Right Patient for the Right Procedure by the Right Doctor

Patient Preparation

• Patient’s physical, emotional status is assessed and recorded

• Vital signs assessed and recorded

• Patient is wearing a clean gown– Undergarments removed

Patient Preparation (continued)

• Jewelry removed– Wedding band taped in place if facility

policy allows– Religious symbol can be carried;

removed before anesthesia

• Dentures, removable bridges removed• Contact lenses, eyeglasses, hearing

aids removed

Patient Preparation (continued)

• Eye, extremity, breast prostheses removed

• Wig, hair piece removed• Hairpins removed to prevent scalp injury• If ordered by physician, antiembolic

stockings are applied to lower extremities

Patient Preparation (continued)

• Be sure patient has voided and if not, have them do so– Time is recorded on preoperative checklist

• Patient’s personal property must be safeguarded– Give to family member for safekeeping– Place valuables in facility safe

Preoperative Medications

• If ordered, preoperative medications are given– Antibiotic– Preanesthetic medications

• After receiving preoperative medications; the gurney is placed in lowest position with side rails raised

• Patient cautioned to remain in gurney

Identification

• Check surgery schedule to gather necessary information– Patient’s name– Facility identification number– Surgeon’s name– Surgical procedure

Identification (continued)• Prior to taking patient to OR

– Introduce yourself and state your purpose– Compare patient’s name to surgery schedule

• Ask patient to state their name • Check patient’s ID/wristband• Check nameplate on end of gurney

– Confirm name of surgeon– Confirm surgical procedure and side of surgery– Check for allergy wristband if necessary

Identification (continued)

• Check chart for completeness– Name on outside– History and physical– Results of diagnostic examinations– Signed consent– Allergy status

• Be sure preoperative checklist is complete and signed by RN

• Transport patient

Patient Transportation

Safe Transportation To and From the OR

Stretcher (Gurney)

• Most common means of transporting adult and adolescent patients– Occasionally used as OR table (i.e.

cataract extraction

Ward Bed (Patient’s Bed)

• Uses– Traction prevents transfer to gurney– Large patient– Unconscious patient– Postoperative traction or stability devices

will be needed• Following orthopedic procedures (i.e. total hip)

Crib

• Uses– Patient is less than 5 years old– Sides are high to contain patient– Sides can be padded to prevent patient

injury– Side rails can be lowered to deliver

preoperative and postoperative patient care

Wheelchair

• Uses– Patients who will have local or no

anesthesia– Patients undergoing a diagnostic

procedure such as cystoscopy or sigmoidoscopy

– DO NOT use wheelchairs for patients who are sedated

Parts of a Standard Gurney• Swivel wheels

– Seem to have a mind of their own

• Wheel locks• Frame• Shelf• Mattress - Velcro® attachment to frame• IV pole• Side rails - adjustable• Safety straps (seat belt)

Procedure and Safety Rules

• Clean sheets, pillow with pillow case

• Warm blanket(s)

• IV pole

• Introduce self and state purpose

• Identify patient

• Review chart

Procedure and Safety Rules (continued)

• Verify patient allergy status• Be sure patient has recently voided

– Leave room as patient gets up from bed to go to the bathroom unless they need assistance

– Remember, hospital gowns are not very flattering; tend to be more embarrassing for females

– Ask patient, when done to climb back into bed and cover up

Procedure and Safety Rules (continued)

• Explain all procedures to the patient to alleviate anxiety

• Lay warm blanket over bed covers

• Pull down bed covers, maintain patient dignity

• Place gurney next to patient’s bed

• LOCK THE WHEELS!!!!

Procedure and Safety Rules (continued)• Move IV bag, Foley catheter, etc to gurney

– Place IV pole at foot end of gurney to prevent injury to patient’s head should the item fall

• Policy at many facilities requires two individuals to be in attendance when patient transfers to the gurney– One person steadies gurney with body– Second steadies bed to keep from separating

Procedure and Safety Rules (continued)• Assist patient as needed

• Keep patient covered, if possible

• Raise the side rails; be certain patient’s body parts are out of the way (i.e., fingers)

Procedure and Safety Rules (continued)• Instruct patient to keep hands, fingers,

elbows inside of side rails during transportation

• Ask patient if they would be more comfortable with head of gurney raised

• Ask patient if they would like a pillow under their knees

• Push patient from head end so their feet go first

Procedure and Safety Rules (continued)

• Walk at a moderate pace that allows for control of gurney at all times

• Rapid movements may cause dizziness and nausea for patient, especially if they have received preoperative medications

• Inform patient when you will be going over bumps, rough areas, inclines, declines

Procedure and Safety Rules (continued)• If you approach a door that must be

opened and secured, lock gurney wheels before doing so

• When entering elevator, go in head first so feet are facing doors

• Conversation on a case-by-case basis; situational; comes with experience

• Family or friends may accompany patient

Procedure and Safety Rules (continued)

• Monitor patient for unusual physical signs (labored breathing, unusual restlessness, clutching chest, etc)

• Monitor patient’s emotional state• If transporting baby, pediatric, or

adolescent patient, parent(s) or legal guardian should accompany patient

Procedure and Safety Rules (continued)

• Pediatric patient transported in crib– May be active– Let parents help ensure patient safety during

transportation– Watch for potential head injuries– Take your time– Pad the sides of the crib if necessary– Child may bring favorite toy

Transfer to Table

• Properly identify patient• OR table and gurney locked

– Mattress secured to OR table

• Minimum of 2 people assist an awake patient during transfer

• Person on “gurney side” helps patient move to OR table

• Person on “OR table side” prevents patient from falling off the narrow table

Transfer to Table

• Minimum 4 persons to move unconsciousness, obese, or weak patients– Move on the count of three– Anesthetist controls timing– Anesthetist controls head and neck at all

times– Surgeon is responsible for stabilizing un-

splinted fractures during move

Transfer to Table

• Anesthetized patient is moved slowly to allow circulatory system to adjust

• Body parts not to extend beyond table edges, rest on metal parts, or unpadded surfaces

• Body exposure kept to minimum– Prevent hypothermia– Maintain patient’s dignity (especially awake

patient)

Transfer to Table

• Protect arms– Prevent accidental IV removal– Avoid hyperextension of arm board

• Be sure patient does not have crossed legs – Uncrossed to avoid neurovascular

compromise

Transfer to OR Table

• Lab Demo