Limiting the use of lateral patient transfer products

Andrea S Baptiste
MA (OT) CIE
Ergonomist
Biomechanist
Nursing Research
Patient Safety Center
James A Haley VA Hospital
Tampa, FL
USA

Friction-reducing devices (FRDs) or slide sheets that help move patients from a bed to a stretcher are becoming more popular as technology develops. There are many commercial lateral transfer products available; however, caregivers often try to expand their use to accommodate more. Some use transfer products to reposition a patient in a seated position or turn a patient on their side. But in patient care it is essential to recognise the limitations of such products to prevent the risk of patient and caregiver injury.

Literature on lateral transfer devices
Although some research has been carried out into lateral patient transfer aids, few comparative ­evaluations have been published. Some studies have evaluated the effect biomechanical forces have on the spine during patient transfers with and without assistive devices.(1–4) Such research has proven that using FRDs with extended pull straps greatly reduces the risk of lower-back injury associated with lateral transfers.(1) Pull straps enable the caregiver to stand more erect, thus reducing the forward reach that is detrimental to the lumbar spine. Eliminating this reach allows the caregiver to maintain a good posture by using their arms and body weight to pull the patient across the bed and stretcher. A ­limitation is the storage and cleaning of FRDs. However they are cost-effective, easy to clean and can be stored in the patient’s room. They also save time, offer patient comfort and most importantly reduce the risk of ­musculoskeletal injury to caregivers. Only a handful of studies exist on the perceived exertion of caregivers or how comfortable patients are during transfers.(5-8)

Case study
A study by Pellino et al compared manual transfer with mechanically assisted transfer using either a draw sheet, slide board, air-assisted device or mechanical lateral transfer aid. Scientists studied perceived physical stress to the transfer personnel, time spent, the number of staff needed and patient comfort. Results indicated that caregivers perceived less physical effort using a mechanical transfer device than a manual one. It also required less personnel and saved five minutes, and patients felt more secure. Most studies focus on lateral patient movement, and there is a gap in research regarding safe techniques and devices to turn a patient to the side or reposition them in bed. Restrictions may include the product’s dimensions, weight capacity, grab points (handles versus extended pull straps) and intended use. For example, a FRD designed for use in bed is not appropriate for moving a patient up in a chair. Clinical judgement must be used to decide which ­product is best for the patient. Caregivers tend to adopt awkward postures when repositioning a patient or turning a patient in bed. Manufacturing companies have started to address this issue by ­developing technological solutions to assist in this high-risk task. The caregiver has poor posture and has an increased risk of shoulder, wrist and lower-back injury when manually repositioning a patient in bed (see Figure 1).

[[HHE07_fig1_C6]]

New technological solutions for turning
Ceiling lift system with a turning sling (see Figure 2):

• Position the sheet under the patient.
• Attach one side of the sheet to the spreader bar.
• Operate the lift to turn the patient to the side.
• Note: Use straps instead of a sheet to allow access to gluteal area.

[[HHE07_fig2_C8]]

Clips with a ceiling lift system or floor-based lift (see Figure 3):

• Open clips and attach sheet into both clips on one side.
• Attach clips to ceiling lift.
• Operate lift to turn patient to the side.

[[HHE07_fig3_C8]]

Patient repositioning system (see Figure 4):

• Wrap crossbar into sheet.
• Open trapeze then bring device to the side of the bed.
• Open support base for stability.
• Attach grippers to crossbar.
• Pull free end of belt to create initial tension.
• Lock gearbox with handle for one direction.
• Turn crank to lift one side of sheet, thus turning patient to the side.

[[HHE07_fig4_C8]]

Additional support is available to add stability to the legs. This manual device can be powered using the bed. If the bed is lowered, you can rotate the patient automatically.

There are many products available for lateral transfers, but there are few solutions for ­repositioning and turning patients in bed. Proper product evaluation is necessary to determine the safety of the technique required by the caregiver when utilising any new product.

References

1. Lloyd B. AAOHN 2006;54(3):113-9.
2. Marras WS, et al. Ergonomics 1999;42:904-26.
3. McGill SM, et al. Ergonomics 2005;48(8):915-29.
4. Daynard D, et al. ­Appl Ergonomics 2001;32:199-214.
5. Owen B. AORN 2005;72(6):1033-6.
6. Pellino T, et al. Orthop Nurs 2006;25:4-10.
7. Evanoff B, et al. Am J Ind Med 2003;44(5):451-7.
8. Baptiste A. AAOHN J 2006;54(4):173-80.

Resource
Patient Safety Center
www.visn8.med.va.gov/patientsafetycenter/safePtHandling