Moving from one location to another

A transfer is the safe movement of a person from one surface to another.

Planning and organization are required before a patient attempts a transfer. 

All safety precautions associated with the transfer need to be observed.

SAFETY…SAFETY…SAFETY…SAFETY

Transfers are identified in different ways: Number of persons performing transfer

1-person, 2-person, 3-person Description of transfer

Standing, sitting, recumbent, sliding board Manual or mechanical method

stand pivot, step pivot, NDT, sliding board, Hoyer lift, etc.

Amount of assistance client requires Transfer or lift, dependent, max/mod/min assist,

supervision Location of transfer

Bed, Gurney, Chair, W/C, Mat, Floor, Car

Independent Indirect supervision Direct Supervision Verbal Cues, Gestural Cues, Written

Cues Contact Guard Assist, Standby Assist Min assist Mod assist Max assist Dependent or Total assist

The OT/OTA/team collaborate with other disciplines to determine the transfer goal

The OT/OTA teaches pt./ staff/caregiver to perform lift as safely as possible

The OT/OTA teaches the pt. to transfer as independently and as safely as possible.

The OT/OTAs’ primary responsibility during a transfer is to guard and protect the pt to avoid injury to the pt or the themselves.

Transfers occur frequently during OT intervention

Know patients’ sensory, physical, cognitive, and behavioral status.

Be aware of any medical precautions. Know your own abilities and limitations Use good body mechanics. Recognize when and how much

mechanical or human assistance is needed for a safe transfer.

Mechanical devices can keep pts dependent so recommend only if the pt and/or caregiver can not perform the transfer safely without them.

Hoyer or other form of hydraulic, or electrical lifts Cumbersome Dangerous if incorrectly used Costly BUT - May be only safe method to transfer

dependent person MUST know/observe weight limits for specific

device

State of TN mandates specific number of persons to perform lift based on client weight.

1 person = < 50 lbs 2 person = > 50 lbs and < 100 lbs 3 person = >100 lbs and < 150 lbs Mechanical lift = >150 lbs

Term transfer may be used for both Transfer - Client performs all, part, or none

of transfer with assistance provided as needed for safety. No lifting of client occurs.

Lift – Client is dependent for entire movement and is physically lifted from one surface to another.

Transfers involve close personal contact. Many clients are fearful of transfers/potential of

falling/experience pain when held/moved Introduce yourself, explain what you are going to do

in simple terms Have the client repeat back to you what you are

going to do, or give non-verbal consent Tell client before touching their trunk, leg or

buttocks. Stay in contact guard with the client

Use a safety belt, which is also called a gait, guard, ambulation, or transfer belt. Always request pt’s permission to use belt if cognizant Fasten as snugly as possible at or just above patient’s

hips IF belt slides upwards, it is too loose IF patient is obese, pregnant, or has an abdominal or

lower spine incision, fasten belt just beneath rib cage Belt remains on until patient is in a safe, stable position

It is possible to safely transfer a client without a safety belt, however belts are mandated by most facilities/agencies

When giving instructions— Be concise Be direct Use gestures Use simple, action-oriented verbs Demonstrate Encourage pt. to participate mentally and

physically as much as possible. If using someone to assist, tell them exactly

what you need/want them to do or not do

OTA - Make sure long hair is tied back, no dangling or sharp jewelry , name tag will not be in the way, nails are short, and you are wearing non-skid footwear.

Client - Make sure all tubes (catheter, O2,IV, etc.), leads (EKG, BP, etc.), and other items (sheets, bandages, etc.) are properly positioned so as not to become caught or tangled during transfer, and that non-skid surface is on or under feet.

Environment - Make sure transfer area is dry,

without trip or fall hazards, moveable surfaces locked.

Patient/client: Hips scooted ½ way towards front of

seat Feet flat on floor Lean trunk forward (‘nose over toes’)

approx 45 degrees Look in direction of transfer Use 1-2-3 rocking momentum Use hand(s) to push on stationary

surface to assist movement

OT/OTA: Make sure W/C front caster, armrest, and leg

rest are not in the way Never allow pt. to grab around your neck

during a transfer Maintain CGA (contact guard assist) throughout

the transfer until you are sure that pt is safe performing an independent transfer

Do not move away from the pt until they in a safe position.

Once a transfer is started, be prepared to either complete it or return pt. to original position

OT/OTA’s role is to safely lower pt. to nearest surface without injury Bed/Mat – can push patient backwards onto

bed Chair – may be able to gently lower patient to

seat to prevent fall Floor – lower pt. gently to floor – OT/OTA must

use good body mechanics, if necessary, cushion pt. with your body/extremity

Wall - If close enough to a wall, may be able to force a ‘lean’ until balance is regained

Factors that impact independence in transfers: Safety awareness Cognition – ability to motor plan, sequence, and

problem solve Strength of extremities used during transfer Balance Presence of decreased ROM or pain Endurance Motivation Consistency of performance