Enhancing Safe Transfers: Strategies For Stroke Patient Care

Stroke patients often require transfers between facilities, and within the same facility, for further treatment or to return home. The safety of these transfers is paramount, and unexpected events can be reduced when medically qualified personnel accompany the patient. Before a transfer, several steps should be taken to ensure safety, including performing hand hygiene, checking the patient's chart, confirming the patient's identification, and assessing the airway, breathing, circulation, and disability. Additionally, the use of proper equipment, such as gait belts and transfer sheets, and correct body mechanics during the transfer are crucial to prevent injuries to both the patient and the caregiver. Clear and accessible written policies and procedures that promote a culture of safety are also essential for safe patient transfers.

Safe patient handling and mobility (SPHM) programs can improve patient and staff safety, as well as reduce costs related to injuries

Safe Patient Handling and Mobility (SPHM) programs can improve patient and staff safety and reduce costs related to injuries. SPHM involves the use of assistive devices, such as ceiling and floor-based lifts, to ensure patients can be mobilised safely and that caregivers avoid performing high-risk manual handling tasks. SPHM technology can be used to mobilise patients easily, gently, and progressively without risking injury to patients or caregivers.

Implementing SPHM programs can bring multiple benefits to both patients and caregivers. Firstly, SPHM can help prevent work-related musculoskeletal disorders (WMSDs) among healthcare workers. Patient handling, which includes manual lifting, moving, and repositioning of patients, is the single greatest WMSD risk factor for healthcare workers. By using SPHM technology, caregivers can reduce the risk of injury and strain to themselves and their patients. This is especially important given the high rates of work-related injuries in the healthcare sector.

Secondly, SPHM programs can improve patient recovery. While originally conceived to protect caregivers, SPHM programs have evolved as a viable intervention strategy for enhancing patient recovery. SPHM equipment can be used to increase patient effort in rehabilitation programs, allowing therapists to work with patients of different weights and diagnoses. It can also enable earlier and more frequent mobilisation of patients, which is beneficial for optimising patient functional recovery.

Finally, SPHM programs can reduce costs related to injuries. Investigations of SPHM programs have demonstrated decreased injury incidence and severity, as well as reduced workers' compensation and costs related to lost work time injuries. By preventing injuries and reducing recovery times, SPHM programs can help reduce the economic burden associated with workplace injuries in the healthcare sector.

SPHM programs can also improve patient outcomes and facility safety

Safe Patient Handling and Mobility (SPHM) programs can improve patient outcomes and facility safety. SPHM technology can be used to mobilise patients easily, gently, and progressively without risking injury to patients or caregivers. Using SPHM technology in early and progressive mobility programs promotes the preservation of patient functional status and improves clinical outcomes. SPHM technology can also help preserve independence and mobility to improve quality of life outside of healthcare facilities.

SPHM programs include ergonomic assessments of patient rooms and facilities, clinical and patient assessment algorithms to select the right equipment and number of staff for each patient handling and mobility task, unit peer leaders who function as safe patient handling experts and staff trainers, and the use of safety huddles to share information between staff that will keep staff and patients safe.

SPHM programs have been shown to decrease injury incidence and severity and reduce workers' compensation and costs related to lost work time injuries in healthcare personnel. They can also be used to increase patient effort in rehabilitation programs, allowing therapists to work with patients to provide a higher therapeutic dose of activity. SPHM technologies can also be used to mobilise patients earlier and at a higher frequency than would normally be possible.

Use a gait belt for transfers

Gait belts are an important tool for increasing safety during transfers with stroke patients. They are especially useful for patients with mobility issues, helping them to walk or transfer safely and reducing the risk of falls.

Gait belts provide a physical support that helps patients maintain their natural walking posture and improve their balance. The belt allows the caregiver to hold onto the patient without having to lift them, which is beneficial for both parties. The belt also provides a secure grip for the caregiver, helping to prevent slips or falls.

• Always ensure there is clothing between the patient’s skin and the belt to prevent abrasion.
• Securely fasten the gait belt buckle when putting the belt on the patient.
• The patient should always be close to the caregiver during transfers.
• Always transfer the patient to their stronger side.
• Choose the right type of gait belt—consider length, width, material, buckle type, and whether handles are needed for additional support.
• Ensure the size of the gait belt is appropriate for the patient’s waist circumference—it should be snug but not too tight or too loose.
• Keep the gait belt clean and in good condition.
• Ensure the patient is comfortable while using the gait belt.
• Communicate with the patient to ensure you are in sync and understand each other’s needs.
• Be aware of gait belt alternatives, such as mechanical lifts, which may be more suitable for certain cases.
• Incorporate a gait belt training program to ensure optimal safety.

Assess the patient's height, weight, ability to support weight, balance, and ability to follow directions

To increase safety for transfers with stroke patients, it is crucial to assess the patient's height, weight, ability to support their weight, balance, and ability to follow directions. Here is a detailed guide on how to conduct these assessments:

Height and Weight Assessment:

• Review the patient's notes and identify the need for measuring their height and weight. This is essential for nutritional screening and calculating their Body Mass Index (BMI).
• Discuss the procedure with the patient and obtain their verbal informed consent.
• Assess the patient's mobility and ability to stand unassisted. Ensure they can stand upright before taking measurements.
• For height measurement, use a metric stadiometer, usually attached to a wall, and calibrated according to local policy.
• Ask the patient to remove their shoes and any heavy outdoor clothing.
• Position the patient with their back against the measuring rod, ensuring their feet are together, facing forward, and their heels touching the heel plate or wall.
• Adjust the headplate until it touches the top of their head.
• Record the patient's height to the nearest centimetre.
• For weight measurement, select appropriate weighing equipment based on the patient's clinical condition and mobility.
• Ensure the equipment is clean, on a flat surface, and has brakes applied.
• Ask the patient to remove heavy clothing and shoes. Record the type of clothing they are wearing for future reference.
• Empty any urinary catheter bags, stoma appliances, or drainage devices before taking the measurement.
• Set the equipment to zero and help the patient onto the scale, instructing them to remain still.
• Ensure the patient's clothing isn't touching any fixed part of the scale.
• Record the patient's weight in kilograms to the nearest 0.1 kg in their medical records.

Ability to Support Weight and Balance:

• Evaluate the patient's musculoskeletal function, including strength, range of motion, posture, pain, and the presence of abnormal tone.
• Test muscle strength using a 1-5 scale with 5 indicating full strength.
• Assess functional strength with tests like standing on one leg or performing a semi-squat to indicate balance deficits.
• Evaluate the patient's functional mobility and gait using tools such as the Timed Up and Go Test (TUG), Berg Balance Scale (BBS), or Functional Reach Test.
• The TUG measures the time taken for a person to rise from a chair, walk a certain distance, and return. A score of over 14 seconds indicates a high risk of falls.
• The BBS consists of 14 static and dynamic tasks assessing functional activities, with a score range of 0-56. A declining score indicates an increased risk of falls.
• The Functional Reach Test measures the maximal distance a person can reach forward beyond arm's length while maintaining their balance.
• Assess the patient's movement strategies, such as the ankle strategy (adjusting foot position) or the hip strategy (adjusting posture) to maintain balance.
• Evaluate the sensory system, including somatosensory input (touch, pressure, proprioception), visual system, and vestibular input, as they play a critical role in maintaining balance.

Ability to Follow Directions:

• Communicate instructions clearly and concisely to the patient.
• Observe the patient's ability to understand and follow the provided directions.
• Provide additional explanations or demonstrations if needed.
• Assess the patient's comprehension and compliance with the given instructions.

Use a slide board for transfers

Using a slide board is a safe and comfortable method for transferring stroke patients. This technique is preferred by both clinicians and patients for its ease of use and safety. A sliding transfer board is a rigid, flat board made of wood or plastic that acts as a bridge to allow individuals to move from one seated surface to another. This method is especially useful for patients with paraplegia, lower-extremity amputation, and decreased balance or strength in the lower extremities.

Before using a slide board, there are several safety considerations to keep in mind. Firstly, check the weight limit of the board to ensure it can support the patient's weight. Secondly, assess the risk of pressure wounds and ensure there is no skin breakdown. Finally, check the height difference between the two surfaces being transferred to and from; a larger difference will make the transfer more difficult.

When setting up the transfer, bring the two surfaces as close together as possible and position them at an angle to each other. Remove any footrests or armrests if possible. The patient should then move to the front of the surface they are seated on and tilt to one side to lift their buttocks, allowing the caregiver to place the slide board underneath.

During the transfer, the caregiver should place one knee between the patient's knees and the other near the front of the wheelchair. They should then hold the patient's transfer belt and slowly slide them across the board. If the patient is wearing clothing that may stick to the surface, place a plastic bag over it to reduce friction.

Using a slide board is a safe and effective method for transferring stroke patients, providing independence for the patient and reducing exertion for the caregiver.

Frequently asked questions