caregiver’s quick notes to safe resident...

Caregiver Making a Difference Through Safer Transfers for All

Caregiver’s Quick Notes to Safe Resident Transfers

Argent- A Division of West Bend 1 of 19 LC430A- Caregivers Quick Notes to Safe Resident Handling- Rev 2-16

For any resident-handling task, there are several preparatory tasks that should be performed before the start of the resident handling. Those tasks are listed below and will be referred to throughout the guide as “pre-transfer tasks.” The intent of this guide is to provide a review of the training you received from your care mentor. This is a quick reference, not a comprehensive training guide. All caregivers must be trained by care mentor and sign the “Competency Acknowledgement” before completing any transfer. Pre-Transfer Tasks Before maneuvering the resident, the caregiver should plan the transfer procedure. This includes:

• Inspecting the lift and sling to ensure it is in good condition.

• Introducing staff members to the resident and communicating with the resident throughout the process. Inform the resident of the transfer procedures that will be completed. Be sure to give the resident time to process and follow the directions. Use one-step instructions

• Moving equipment, or the patient’s/resident’s personal belongings that may cause a trip/fall hazard. • Ensuring the resident is wearing nonslip footwear.

• Ensuring the bed, commode, shower chair, or wheelchair are locked before beginning the transfer. If there are

foot pedals on the wheelchair, they should be folded and turned to the side or removed if possible.

• Planning the transfer ahead of time to avoid confusion when working with another staff member. Only one staff member should give directions to the resident.

• Making sure that skin surfaces that will come into contact with slings or friction-reducing devices are sufficiently

covered with clothing or using a draw sheet between the device and the resident.

• During all preparations, engaging in a decision-making process to screen the resident’s ability to participate in the transfer at that given moment. This screening should be on-going during each step of the transfer process.

o This decision should be based on the resident’s: state of alertness; ability to follow directions; ability to cooperate; ability to maintain trunk control in sitting and standing; ability to bear weight; and ability to control movement with the legs.

o This is a progressive screening that should be considered before completing each transfer in order to provide the safest transfer for the resident.



Moving a Resident to and Away from a Dining Table

A. Moving resident away from the table: a. (Figure 2): Stand next to the chair with legs in a staggered stance. b. (Figure 1): Position your hip/thigh against the back of the chair and place your leading leg in the direction

you want to move (away from the table). Use your hip and thigh to move the resident’s chair by shifting your weight forward, toward the leading leg. You may need to repeat the position and movement several times.

B. Moving resident to the table:

a. (Figure 3): Assume the same power stance with your hip/thigh against the back of the chair. The leading foot should be positioned closer to the table you are moving toward. Place one foot to the side of the chair, and shift weight forward to help move the chair and the individual. You may need to repeat the position and movement several times.

b. Another option for pushing a resident in is to stand behind the individual and place one thigh against the back of the chair (figure 4). With feet in a power stance, shift weight forward and help the individual to the table using your legs to push the chair.

Figure 1

Power stance with staggered feet.

Figure 3 Moving resident toward table using the power stance.

Figure 2 Moving resident away from table using the power stance.

Figure 4 Moving resident toward table using the power stance from behind the chair.



Repositioning/Boosting (bed)

• Raise bed with caregivers standing on each side of the bed. When possible, place the bed in the Trendelenburg position (feet raised higher than head). Firm air mattress if needed.

• Ask the resident to reach across midline to the direction you want them to roll (away from you initially). If possible, have them use the bed rail to assist. Ask them if they can cross their ankles or help them bring one knee up and across their body. Tuck FRD under draw sheet.

• Ask the resident to reach to the opposite side, using the bed rail if available.

The opposite knee is bent to help roll. Pull FRD from underneath the resident so it is flat on the bed.

• Place pillow at headboard. If the resident can assist, ask them to bend their knees and tuck their chin. Instruct the resident to push on the same count as the caregivers.

• If the resident cannot help, one caregiver on each side of the bed pulls the FRD/draw sheet toward the head of the bed. Keep hands close to the bed. Do not lift up. Position yourself in a power stance, close to the head of the bed.



Laying-to-Sitting

• Encourage the resident to participate as much as they are able to. Use any tools you can to allow the resident to participate, including bed rails and trapeze, and raise the head of the bed.

• Have the resident reach across midline to the bed rail (if available) on the side of the bed on which you want them to sit. You can also ask them to cross their ankles or bring their opposite knee up and across their body, turning them in the direction of the roll.

• Have the resident bring their feet to the edge of the bed, dangling off the side of the bed. Tell the resident to place their hands onto the mattress in position to push up. Raising the head of the bed will help decrease the distance they have to push.

• Place one hand on the resident’s shoulder against the bed and the other hand on the opposite hips. Apply downward pressure to the hip while gently pulling up on the shoulder to help the resident into an upright, seated position. Remain in front of the resident to ensure they can maintain trunk balance.



Gait Belt Transfer (one person)

A. Ask yourself if the resident can bear weight for as long as it takes to complete the

entire transfer (at least five seconds), if they are predictable and able to follow directions. You should use a decision-making screening process with each step of a manual transfer to ensure it is the safest transfer for your resident. The gait belt is a pulling tool and should NEVER be used as a lifting tool. Some things to consider:

i. state of alertness; ii. ability to follow directions;

iii. ability to cooperate; iv. ability to maintain trunk control in sitting and standing; v. ability to bear weight; and

vi. ability to control movement with the legs.

B. All pre-transfer tasks must be completed before the transfer. Is this the safest transfer for the resident? If not, stop immediately and increase the level of assistance.

C. If the resident is in bed, please refer to the Laying-to-Sitting instructions. If they cannot

sit unsupported, get a lift

D. If seated, ask the resident to scoot forward to the edge of the surface on which they are sitting. Their feet should be flat on the floor. If resident does not have trunk control to sit unsupported, a gait belt should not be used. Get a lift.

E. Apply the gait belt correctly with two fingers of space between the gait belt and

the resident. Educate the resident on the steps of the transfer by providing short, easy-to-understand directions throughout each step of the process. Encourage the resident to participate.

F. Have the resident seated at the edge of the chair with their feet behind their knees

and trunk leaning forward. Hands should be on the armrest, the seat surface, or their own thighs. Not on you.

G. Place one foot (in orange) in between the resident’s feet.

H. Grab the gait belt with palms up, elbows in. I. Rocking to a three count, ask resident to go “nose over

toes.” J. Your hips should be open to the surface to which you are transferring.

K. When the resident is standing, provide support only for stabilizing before having the

resident turn. Allow for blood-pressure normalization (usually 10 seconds) and to further assess the resident’s ability to continue the transfer. If the resident is weak or unstable, immediately lower the resident back into a seated position and stop the transfer. A close transfer should never be more than three steps.



Gait Belt + Assist Transfer (one person and a helper)

A. Ask yourself if can the resident bear weight for as long as it takes to complete the entire transfer, and if they predictable and able to follow directions. You should use a decision-making screening process with each step of a manual transfer to ensure it is the safest transfer for your resident. The gait belt is a pulling tool and should NEVER be used as a lifting tool. Things to consider:





C. One caregiver is the “lead” and the other is the “helper”. Only the lead will touch the gait belt. The helper is the

extra set of hands to help with clothing, peri-cares, or moving furniture.

D. If the resident is in bed, please refer to the Laying-to-Sitting instructions. If they cannot sit unsupported, get a lift.

E. If they are seated, ask the resident to scoot forward to the edge of the surface on which they are sitting. Their feet should be flat on the floor, slightly behind knees.

F. Lead Caregiver:

a) The only set of hands on the gait belt. Pulls in a forward direction. Never lifts or pushes.

b) Gives verbal directions to resident. Gives rocking three count and tells resident to go “nose over toes”.

G. Assisting Caregiver: a) Positions self to the side or behind the resident. b) Assists with peri-cares, ADLs, adjusting clothing, moving chairs. c) Assists with stabilizing the resident’s hips or placing the resident’s hands

onto armrests while reaching for the chair. d) At no time does the assistant caregiver place their hands on the gait belt. e) The assisting caregiver does not give verbal cues through the transfer.



Gait belt with walker

A. Ask yourself if the resident can bear weight for as long as it takes to complete the entire transfer and is predictable and able to follow directions. You should use a decision-making screening process with each step of a manual transfer to ensure it is the safest transfer for your resident. The gait belt is a pulling tool and NEVER be used as a lifting tool. Things to consider:





C. If the resident is in bed, please refer to the Laying-to-Sitting instructions. If they cannot sit unsupported, get a lift.

D. If they are seated, ask the resident to scoot forward to the edge of the surface on which they are sitting. Their feet should be flat on the floor, slightly behind knees.

E. Apply the gait belt correctly with two fingers of space between the gait belt and the

resident. Educate the resident on the steps of the transfer by providing short, easy-to-understand directions throughout each step of the process. Encourage the resident to participate.

F. Stand to the side of the resident, toward the front of the chair. Your front foot should be

in front of theirs.

G. Put one hand on the gait belt with the palm facing up. Put the other hand on the front of the resident’s shoulder. The resident should not pull self up using the walker.

H. Use the rocking three count, tell the resident to go “nose over toes,” and pull forward to a standing position.



Sit-to-Stand Mechanical Lift

A. The sit-to-stand mechanical lifting device may be used for residents who cannot bear weight for the length of the transfer or for less than five seconds, or are unpredictable with their weight-bearing capabilities. Residents must be able to follow directions and have trunk stability to use a sit to stand lift. Always use two caregivers when using any mechanical lift.

B. All pre-transfer tasks should be completed before transferring the resident. Is this the safest transfer for the resident? If not, stop immediately and increase the level of assistance.

C. Each manufacturer has different instructions for locking or unlocking wheels and how to use and apply slings. Please be familiar with the specific lifts in your facility and know how to operate them.

D. Before conducting the current transfer task, caregivers will agree on who will take the lead and who will be the assistant. If the resident is in bed, please refer to the Laying-to-Sitting instructions. If they cannot sit unsupported at the edge of the bed, consider if this is a safe transfer for them.

E. Inspect lift and sling before use. Worn or fraying slings must be removed from service.

F. The lead caregiver maneuvers the lift in front of the resident, places feet on the footplate, and applies the sling. (Lock brakes if required by manufacturer.)

G. Make sure the knee and shin guard are properly positioned for the height of the resident. The guard must touch the resident’s kneecaps. This photo shows the guard is too low. The guard should be raised to at least meet the top of the knee.

H. Secure the sling to the lift using the same level of loops (refer to manufacturer’s

guidelines for the proper loop selection). The lead encourages the resident to grasp onto the handles of the lift and participate in the standing motion. The lead stands at the controls and operates the lift.

I. The lead caregiver is the driver of the lift and should only push/lift forward and backward. The assistant stands at the side of the resident and is responsible for turning the lift. The assistant is able to easily turn the lift by placing a foot on the leg of the equipment and pushing it.



Total Body Lift

A. Total body lifts are used for all non-weight-bearing residents. They can also be used for repositioning in bed or for cares with the use of slings. At least two caregivers must participate for all total body lift transfers.

B. All pre-transfer tasks must be completed before transferring the resident. Is this the safest transfer for the resident? If not, stop immediately and increase the level of assistance.

C. Each manufacturer has different instructions for locking or unlocking wheels and how to use and apply slings. Please be familiar with the specific lifts in your facility and know how to operate them.

D. Two caregivers will agree on who will take the lead and who will be the assistant. The

sling and lift are visually inspected to ensure both are in good condition and safe. Worn or fraying slings must be taken out of service.

E. Raise the bed to the correct height.

F. Ask the resident to reach to the bed rail (if available) in the direction you want them to

roll. Ask them to help as they are able by bringing one knee up and across the body. Roll the resident and tuck the sling under them. Repeat for the other side.

G. The legs of the lift are opened to the widest setting and the lift is brought so the boom arm is centered over the resident. (Lock the brakes if required by manufacturer.)

H. The two caregivers agree on which level of the loops are to be hooked up

to the lift (refer to manufacturer’s guidelines for loop selection). Before moving the resident, both caregivers should ensure the sling is properly secured to the lift. The lead caregiver uses the controls to raise the resident off the bed. The assistant caregiver ensures the sling is secured.

I. The lead caregiver is the driver of the lift. Their job is to push or pull the lift in a

straight plane. They should not attempt to turn the lift from the control end.

J. The assistant stands at the side of the resident and is responsible for turning the lift. Standing at the resident end, turn the lift by placing a foot on the leg of the equipment and pushing it.



Driving Rules:

Lead caregiver pushes and pulls the lift.

Assistant keeps one hand on resident and steers the lift with

their foot.



Assisted Fall

A. If a resident becomes weak and unable to bear weight while ambulating or being transferred, this is a tool to help the resident safely to the floor. This is only to be used when you are able to perform it safely. If you are not near the resident when they are falling, do not attempt to catch the resident and perform this activity.

B. Always use a gait belt and be sure it is applied correctly. Proper hand position is with the caregiver’s palm facing

up. A gait belt is used only to steady and balance an individual, not to help with weight bearing by lifting the resident.

C. If you are close to a wall when the resident is no longer able to bear weight, lean

the resident against the wall and ease them to the floor (figure 1). The caregiver should use a wide base of support in a power stance.

D. If no wall is near, help the individual to the floor by allowing them to slide down your leg ( figure 2). Gently pull the resident close to you, shift your weight to your back leg, and allow the resident to slide down your leg. When you reach the length of your arm without bending the trunk forward, let go of the resident and allow them to continue to slide down your shin and onto your foot.

Figure 2 Sliding resident to the floor using your knee

Figure 1 Sliding resident to the floor using support of the wall



Post-Fall Transfer

A. An assessment is always warranted following a resident’s fall. Following the assessment from a licensed nurse where the resident has been cleared and there is no apparent injury that would prohibit them from being assisted off the floor, there are two techniques that can be used.

B. If the person was previously independent with transfers and can get up on own, the resident can be coached up

from the floor. It should be noted that each step in this process becomes more physically challenging for the resident. If at any time the resident experiences the inability to complete the step with coaching, they should be lowered back to the floor and a mechanical lift should be used. It is recommended that two caregivers are used with this technique.

C. Have the resident roll to their side with their knees bent and their hand positioned on the floor ready to push up (figure 1).

D. Ask the resident to push up into a side-lying position on elbow (figure 2).

E. Have the resident come into a position on their hands and knees (figure 3).

Figure 1 Resident rolling to their side

Figure 2 Resident pushes to side lying

Figure 3 Resident gets to four-point position



F. Bring the chair close to the resident so they can “climb” to a standing position. Coach the resident to reach for the seat with their hands and come into a kneeling position. Have the resident bring one leg up under them so their foot is on floor (figure 4).

G. Have the resident come to a standing position (figure 5). Do not pull or lift. Using verbal cues and hands on to steady the resident are appropriate.

H. Guide the resident to the chair and have them gently sit (figure 6).

Figure 5 Resident pulls self to standing

Figure 4 Resident brings foot underneath

Figure 6 Resident sits in chair



NOTE: If the resident was previously not independent with transfers, or cannot get up on their own, the following procedure should be used:

Use of Mechanical Lift (two caregivers required)

A. Before conducting the transfer task, the two caregivers agree on who will take the “lead” and who will be the “assistant.”

B. The sling and lift are inspected to assure both are in good condition and the correct size.

C. Bend the resident’s knee and roll them on their side. Have them help as they are

able. Tuck the sling under the resident. The opposite knee is bent to help rol to the other side. Pull the sling out so it is flat under the resident.

D. The legs of the lift are opened to the widest setting and the lift is placed so the boom arm is centered over the resident (lock brakes if required by manufacturer). Hook sling to boom. Refer to the manufacturer’s guidelines for sling sizing and loop selection. Before moving the resident, both caregivers must ensure the sling is properly secured to the lift.

E. The lead caregiver is the driver of the lift. Their job is to push or pull the lift in a straight plane. They should not attempt to turn the lift from the control end.



F. The assistant stands at the side of the resident and is responsible for turning the lift by placing a foot on the leg of the equipment and pushing it.

G. Using the sling handles, the assistant guides the resident to the destination.

H. The sling is safely removed from the resident if needed. Some slings can remain under resident. Refer to the manufacturer’s guidelines.



Repositioning in Chair

A. If a resident requires help with repositioning in a chair, a friction-reducing device (FRD) must be used.

B. To place the FRD, gather in hands. Kneel in front of the resident. Start at the front corner of chair and push the fabric under the resident.

C. Move to other side of the resident and pull the FRD out to expose fabric on both sides of the resident.

D. The FRD should be completely under the resident.

E. Using one or two caregivers, lean the resident forward. With a wide base of support, place your hands on their knee. Lean forward and push resident into position. Ask the resident to help if possible.



F. Once repositioning is completed, grab front corner of FRD and gently pull it back and across to the opposite side.

G. Continue to pull the FRD around the back, asking the resident to shift weight if possible.

H. Grab the other front corner and pull it to the back of the chair.

I. Pull the FRD out from behind the resident. It is important to remove the

FRD from the front to the back to ensure you do not pull the resident to the front of the chair again.



One-way or directional friction reducing device

• A one-way or directional friction-reducing device must be placed before the resident sits in the chair.

• For a resident who requires frequent repostioning throughout the day, a one-way friction-reducing device would be benefical.

• ** Staff should have resident seating needs (wheelchair, seat cushion) evaluated to ensure proper devices are used.

A. These friction-reducing devices may remain under the resident all day. It does not have to be removed after repositioning.

B. The resident may be able to reposition while seated on this device.

C. A foot loop allows you to step on the foot loop for easy repositioning. Place your foot on the loop and step down. Repeat as necessary. The loop should be off the floor after repositioning to eliminate a potential trip hazard.



D. You may repeat a few times by placing the strap in the instep of your foot, toe on ground, stepping down. This may take a few actions to complete repositioning.

E. If the foot loop is not an option, most one-way friction-reducing devices are equipped with handles.

F. Staff can also use the resident’s knees for repositioning.

G. Never use resident’s extremities to reposition. This will lead to injuries to the resident or you.


Gait Belt Transfer Safety Tips

Argent- A Division of West Bend 1 of 1 LC430B- Gait Belt Transfer Safety Tips- Rev 2-16

Always make sure your resident/patient is predictable and able to bear weight for the duration of the transfer, typically five seconds or longer when completing a gait belt transfer. If not, this is not a safe transfer for them.

• Take your time. Perform the pre-transfer assessment.

• Before the transfer, take the time to advise your resident/patient of the steps of the transfer.

• Coach your resident/patient through the transfer.

• Only one person’s hands on the gait belt at all times.

• Maintain two points of contact on the resident/patient throughout the transfer. Both hands on the gait belt, or one hand on the gait belt and the other on the front of the shoulder, are acceptable.

• During the transfer, limit your footsteps to three or less during the transfer.

• While transferring, keep palms up while grasping the gait belt, elbows in, and use the proper staggered power stance while transferring.

• Stay close to your resident/patient. This keeps you from reaching outside of your base of support. Place your leading foot between the feet of the resident.

• Coach the resident/patient to position themselves correctly in the chair.

o Scoot to the edge of the chair by either leaning back (bridging) or wiggling to the edge (cheek walk).

o Feet should be under or behind the knees.

o Hands should be on the chair arm rests, the sitting surface, or their own legs. Do not allow the resident to hold on to you.

• Stand closer to the resident’s knees, not back. This encourages pulling instead of lifting or pushing.

• When ready to stand, give a rocking three count, tell the resident to lean forward, “nose over toes,” and pull the resident to a standing position. Never lift.

• If ambulating, give the resident time to stabilize their blood pressure while standing. Ten seconds is usually adequate.

• Do not use the resident’s/patient’s pants or arm to pull them to standing position; this will cause pain and/or injury.

• Do not surprise your resident/patient with the transfer. Keep them informed. It calms fears and anxiety.

Residents/patients who are in pain or scared are more likely to become combative and unpredictable.

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