Potential Problems with Patient Transfer Devices
Potential Problems with Patient Transfer Devices
We recently reviewed a well-produced website that sells patient transfer aids and devices including but not limited to Auxiliary Belts, Leg Bands, Rigid Turntables, Unidirectional Slide Sheets and Grooved Transfer Boards.
The products that were presented are not unique to the industry and have been in service in some capacity for years. Concerns arose when the presentation did not portray a realistic patient transfer situation in a typical healthcare environment.
Two members of our faculty, Jeanne Spangler, PT and Bob Niklewicz, PT both of whom are Physical Therapists, have been invited to have a chat regarding the potential problems that are associated with these types of devices.
Jeanne: Transferring a patient is not a simple task. Risk of injury to either the patient or the caregiver, or both, is always present in a patient transfer situation. An assessment of the limitations and abilities of the patient needs to be known and anticipated before transfers are attempted.
Bob: I understand that this was a sales promotional video. As such, it made the transfer task by an individual moving a patient look very simple and easy. The current direction for ergonomics safety in Healthcare is a “Zero” lift strategy. Patients that are unsafe to be transferred by a healthcare provider should be transferred with a mechanical lift or device. This is a separate issue from a transfer-training program produced by physical therapists. Using a mechanical lift or device is one option for reduction of injury but it works best when included as part of an ergonomics program that includes specific transfer training produced by a knowledgeable professional such as a physical therapist.
The products featured may have the most application in a home health or LTAC (Long Term Acute Care) setting where the devices are assigned to a single user and where lift equipment may not be available. However the risk for a back injury may be higher for any caregiver with little or no training in proper transfer technique.
Jeanne: In order to practice good infection control, these products that we are evaluating should be used on a single user as these items are relatively inexpensive. However, the volume needed in a hospital setting is a cost concern. Reusable items are most cost efficient and must be capable of being disinfected.
The “Auxiliary Belt” we looked at is similar to a standard gait/transfer belt.
The Leg Band wrapped the lower legs together to give a fulcrum for the caregiver’s knee during the transfer. The advantage is the large loop handles and wide padded belt are used in lifting the legs onto a bed. The band did secure the legs and could be useful in a home care, SNF (Skilled Nursing Facility), or LTAC facility. Negatives for these two devices include: risk to fragile skin, total joint surgery, wounds or surgery in the abdominal area, and potential back injury of the caregiver.
Bob: One person could not manage a bariatric patient safely with the belt and band alone. The band may not hold the legs far enough apart for safe balance. Cross contamination and cleaning are also an issue if used between multiple people.
Jeanne: The “Leg Band” was wrapped around the lower legs and secured with Velcro, which stabilized the legs. The legs were easier to control with the handles but Body Mechanics were compromised during the transition to supine.
Bob: With a sedated or partial weight bearing patient, the wrap could make it easier to move them. However, with a confused or agitated patient, the wrap could frighten them and possibly make them combative and unsafe. There is potential for the product being soiled if a patient became incontinent of bowel or bladder.
The next item was a “Rigid Turntable”. All versions of this product all share the same basic concept. It takes strength and coordination to perform transfers safely. For larger/taller patients, their feet would have to be close together, which may become a balance problem for the patient to stand on the disc.
Jeanne: Leaving a device on the floor or under the bed adds obstacles for housekeeping and caregivers. Removing it to another location adds to the time of finding it when needed, potential for loss and thus the need for it to be replaced, and with sanitation/disinfection, if it has become soiled in the remote location.
Bob: The equipment of most concern was the “Unidirectional Slide Sheet”. The demonstration patient represented someone who did not have the ability to push themselves backwards into their chair. Yet the demonstration caregiver placed the patient on the sheet, leaving them without support, and walked to the back of the chair to pull the patient backwards. In reality, it would be likely, that the patient would have pitched forward onto the floor.
Jeanne: Next item was a “Grooved Transfer Board”. My concerns are disinfection and weight limits for this device. It functions very much like a standard sliding board. Skin sheer against both the grooved transfer board and the unidirectional sheet can be a risk to compromised skin, especially for those wearing diapers that would slip sideways.
Bob: The remaining equipment included “slide sheets” and a “foldable medical roller”. The issues here are still hygiene and the weight bearing strength of the device. When used correctly the device could be very helpful.
Jeanne: For me, supine transfer devices must be used by several people for safety. The mechanical weight limit for the foldable roller is unknown. The need for mechanical lifts for the type of patient who is unable to offer any assistance for their transfer/movement must be the primary route for safe transfers.
Bob & Jeanne: We hope you have found our concerns helpful when evaluating Patient Transfer devices.
Please keep your eyes peeled for our new Safe Patient Handling online class.
About our authors/faculty members:
Jeanne Spangler, a Physical Therapist with 38 years of experience, is currently the Manager for Out-Patient Rehabilitation and Sports Medicine in Houston. Her duties include patient care, the Ergo Specialist for work-site evaluations, and member of the employee injury review board. The review board focuses on transfer injuries and return to work status evaluations with emphasis on education and mitigation of risk.
Bob Niklewicz is a physical therapist specializing in Ergonomics in the office and industrial settings, acute care, work comp, outpatient rehab as well as Skilled Nursing Facilities. Bob has worked in Northern California as a PT for 40 years.