safe transfers

7/26/2019 Safe Transfers

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BestPracticesinSafeTransfersand

MobilitytoDecreaseFallRiskAugust 20,2013 10a.m.CST

C A P T U R ECollaboration and Proactive Teamwork Used to

ReduceFalls

DawnM.Venema,PT,PhDJillHassel,DPT

KatherineJ.Jones,PT,PhD


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Acknowledgement

Thisprojectissupportedbygrantnumber

R18HS021429fromtheAgencyforHealthcare

ResearchandQuality.Thecontentissolelythe

responsibilityoftheauthorsanddoesnot

necessarilyrepresenttheofficialviewsofthe

AgencyforHealthcareResearchandQuality.


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DescribecurrentCAPTUREFallseventreport

statistics

regarding

types

and

effects

of

falls

Discusshowprinciplesofbalancerelatetofalls

Explainstrategiestoreducepatientfallrisk

during assistedtransfersandambulation

Explain

strategies

to

improve

patient

stability

in

sitting

LearningObjectives


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Introduction

Part1:Introduction


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Total Reported Falls in CAPTURE Falls

through July 2013 = 154

Unassisted

76%(N = 117)

Assisted

24%

(N = 37)

Harm

32%(N = 49)

No Harm

68%

(N = 105)

Introduction


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Relationship Between Harm and Assistance

Assisted Falls

N = 37

Harm

19%(N = 7)

No Harm81%

(N = 30)

Unassisted Falls

N = 117

Harm36%

(N = 42)No Harm

64%

(N = 75)

Introduction


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Five of the 49 harmful falls resulted in

moderate* or severe** harm.

ALL five of these falls were unassisted.

*moderate harm = Bodily orpsychological injury adversely affecting

functional ability or quality of life, but not

at the level of severe harm

**severe harm = Bodily or psychologicalinjury (including pain or disfigurement)

that interferes significantly with

functional ability or quality of life

Introduction


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BasicPrinciplesofBalance*

*also

known

as

Postural

Control

Part2:BasicsPrinciplesofBalance


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BaseofSupport(BOS)

Theareaonwhichthebodyrests; Theareathatprovidessupportforthebody

LargerBOS=MoreStability

BasicsPrinciplesofBalance

NarrowBaseOfSupport

Photo Credit: myisoslim.com

WideBaseOfSupport


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CenterofMass(COM)**alsoknownascenterofgravity(COG)

The

point

at

which

the

mass

of

the

body

is

centered Inanerectstandingposture,theCOMislocatedat

thesacrum

COMpositionmoveswithchangesinbodyposition


Photo Credit: www.acefitness.org


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Themaximumdistancean

individualisableorwilling

tomovetheircenterofmass

inanydirectionwithoutloss

ofbalanceorchangingthe

baseofsupport


PhotoCredit:www.mygroupfit.com

Limits of Stability (LOS)


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Balance

Balance

is

the

condition

in

which

all

the

forces

acting

onthebodyarebalancedinsuchawaythatthecenter

ofmass(COM)stayswithinthelimitsofstability(LOS),

whichisdependentuponthebaseofsupport(BOS)


PhotoCredit:www.ycgf.org


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BalanceSimplified

HowDoWeMaintainourCenterofMass

withinourLimitsofStability?

Sensory

Input

Motor

Output



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PhotoCredit:

www.resourcesonbalance.com


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SafeTransferandMobility

Techniques

Disclaimer:Thetransfertechniques

shown mayneedtobemodifiedfor

specificpatientdiagnoses

Part3:SafeTransferandMobilityTechniques


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BasicBodyMechanicsPrinciples:Thesaferyouare,thesaferyourpatientwillbe.

Adjusttheheightofthebedasneeded

Useawidebaseofsupport

Maintainthenaturalcurvesofyourback

Bendat yourhipsandkneesinstead

Getyourcenterofmassclosetoyourpatientscenterof

mass

BodyMechanics


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Moveorpivotyourfeettoturn;

donottwistatyourback

Alwaysletyourpatientassistas

muchaspossible

Performtransferinasmoothmotion

Ifmorethan1personisassisting,

communicate

BasicBodyMechanicsPrinciples:Thesaferyouare,thesaferyourpatientwillbe.

BodyMechanics


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PTDocumentation: LevelofAssistance

Dependent: Patientrequirestotalassistance

MaxAssist:Patientdoes25%,Caregiverdoes75%

ModAssist:Patientdoes50%,Caregiverdoes50%

MinAssist: Patientdoes75%,Caregiverdoes25%

LevelofAssistance

PhotoCredit:krames.sjmctx.com


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ContactGuardAssist(CGA):Caregiverhashandsonpt justin

case,givesverbalcuesbutdoesnotphysicallyassist

StandByAssist(SBA):Caregiverisnearbyandreadytoassist

butdoesnottouchtheptMaygiveverbalcues

ModifiedIndependent:Pt isabletocompletethetransfer

withoutacaregiverpresentbutrequiresadaptiveequipment

tocompletethetask

Independent:Pt isabletocompletedthetransferwithouta

caregiverpresentandwithouttheuseofadaptiveequipment

LevelofAssistance

PTDocumentation: LevelofAssistance


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University of Nebraska Medical Center

VideoMenuforToday

SupinetoSit

GaitBeltApplication

StandPivotTransferBedto ChairWithoutAssistiveDevice(1Assist)

StandPivotTransferChairtoBedWithAssistiveDevice(1Assist)

WheelchairManagement

SquatPivotTransferBedto/fromChair(2Assist)

AssistedAmbulation

Ambulation:ControllingaLossofBalance

AssistedFalltoaChair

AssistedFalltoFloor


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SupineToSitTransfer:1PersonAssist

Video


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SupineToSitTransfer: Safety

Iftwoassistisneeded,onecanhandlelegs,theother

canhandletrunk

Gathernecessaryequipmentprior tosittingup(gaitbelt,

nonslipsocks,walker,etc.)

Lowerbedoncept issittingsothatpts feetcontactfloor

Keep1handonthept onceinsitting

Watchforpotentialdizziness,orthostatic

hypotension(TakeorthostaticBPsifneeded)

Alsomaintainpt modestywithproperdraping


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GaitBeltApplication

Video


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GaitBeltHelpfulHints

GaitBeltApplication

Purposeistocontrolpatientscenterofmassduring

mobility,controldescentifafalloccurs,andreduce

chanceofgrabbingpatient's upperextremities

Placethebeltlowandsnug

Threadtheendthroughbothsidesofthebuckle

teethsidefirst.

Mayneedtoadjusttightnessonceinstanding

Holdfrombottomedgeofthebelt


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GaitBeltHelpfulHints

GaitBeltApplication

Agoodwaytoensureagaitbeltisusedwithevery

transferistohaveitinaspecificplaceineveryroomso

itiseasytofind

Thesegaitbeltsarereadyforuse!!


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BedToChairTransfer:1PersonAssist

Video


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ChairToBedTransfer:WithDevice

Video


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BedChairTransfer:Safety

Minimizedistancebetweenchairandbed

Patient

should

wear

non

slip

socks

or

shoes Useagaitbelt

Patientshouldinitiatestandwithwidebaseof

support,feetunderneaththeircenterofmass

Transfertowardsthepatientsstrongerside

Patientshouldmakecontactwithsurfacebefore

sitting


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BedChairTransfer:W/C Management

Video


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W/CManagement:Safety

Lockthebrakes

Swingaway/removeleg

reststopositionchairin

closeproximitytosurface

pt istransferringto/from

Iflegrestscantbe

removed,elevatethefootplatesforthetransfer

Removearmrestifneeded


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BedToChairTransfer:2PersonAssist

Video


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ChairToBedTransfer:2PersonAssist

Video


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BedChairTransfer:2PersonAssist

Techniqueshownisasquatpivot

One

caregiver

in

front,

one

behind

allows

for

closer

proximityofchair

Bestdoneintoawheelchairorchairwherearmrest

canberemoved

Caregiverinfrontshiftshis/herbodyweightbackward

aspt leansforward,whichelevatesthepts hips

Caregiverbehindhelpssteerpelvis


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CorrectChairPositioning

Photo

Credit:

http://media

cache

ak1.pinimg.com/originals/60/02/b0/600

2b026e8fae7fe37e78156db05faee.jpg

h i i i i


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CorrectChairPositioning

PhotoCredit:www.longevityforyou.com

PosteriorPelvicTilt Vs. AnteriorPelvicTilt

Ch i Fi C id i


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ChairFitConsiderations

Seatheight: Canpatientsfeettouchthefloor?

Seatdepth: Howdoesthiscomparetopatient

height/femurlength? Canpatientsfeettouchthe

floor? Whatisthepositionofthepatientspelvis

(anteriorvs.posteriortilt)?

Seatwidth: Ispatientslumpingtooneside?

Elevatinglegs: Maybeindicatedmedicallyorfor

comfort.Mayalsoposeafallhazard.

Ch i Ch t i ti


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ChairCharacteristics

Chairwithpoor

characteristics

Chairwithgood

characteristics


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Chair with Good Characteristics

Elevating arm rest

facilitates transfers

from bed to chair

A i t d A b l ti


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AssistedAmbulation

Video

A b l ti C t lli L f B l


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Ambulation:ControllingaLossofBalance

Video

A b l ti A i t d F ll t Ch i


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Ambulation:AssistedFalltoaChair

Video

Ambulation Assisted Fall to the Floor


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Ambulation:AssistedFalltotheFloor

Video

Ambulation and Assisted Falls: Safety


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AmbulationandAssistedFalls:Safety

Guardonweakerside(ifthereisasymmetry

ofstrength)

Maintainawidebaseofsupportyourself

Usethegaitbelttocontrolmovementof

patientscenterofmassintheeventofafall

Usethegaitbelttodirectthepts centerofmass

backovertheirbaseofsupport

Pullpatienttowardsyouoranotherstableobject,

and/orretarddescent

Summary


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InfallsreportedbyCAPTUREFallshospitals,there

wasasmallerpercentageofharmfulfallswhenthe

fallswereassistedvs.unassisted.

Balance=maintainingonescenterofmasswithin

oneslimitsofstabilityand/orbaseofsupport.It

requiressensoryinputandmotoroutput.

Useproperbodymechanicswhenassistingpatients

withtransfersandgait. Ifyouarestable,youcan

helpyourpatientstaystable.

Ifindoubt,askforhelp!

Summary

Acknowledgements: Videos


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Stephen Smith: Instructional

Technologist/Videographer, College of Nursing, UNMC

Winifred Finegan: Standardized Patient, UNMC

Zach Douglas, Physical Therapy Student, UNMC

Acknowledgements: Videos

PhotoCredit:www.teambuildingtechniques.com


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ThankYou

References/Resources


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References/Resources

FairchildS.PiersonandFairchildsPrinciplesand

TechniquesofPatientCare.St.Louis,MO:Elsevier

Saunders;2013.

OSullivanSB,SchmitzTJ.PhysicalRehabilitation.5th ed.

Philadelphia,PA:F.A.DavisCompany;2007.

U.S.DepartmentofVeteransAffairs includes

informationonpatientcareergonomics,algorithmsfor

safepatienthandling,bariatrictoolkit,andmore:

http://www.visn8.va.gov/patientsafetycenter/safePtHan

dling/

Contact Information


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ContactInformation

DawnVenema,PT,PhD

[email protected]

UniversityofNebraskaMedicalCenter


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Pleasecompletethewebinar

evaluationbyclickingonthelink

below:

https://www.research.net/s/capturefalls-eval8

We value your input!

University of Nebraska Medical Center

UniversityofNebraskaMedicalCenter


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C A P T U R ECollaboration and Proactive Teamwork Used to Reduce Falls

http://unmc.edu/patient-safety/capture_falls.htm

safe transfers

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