It’s not what you do, it’s how you do it that keeps patients safe
by Dawn Wiggins

One of the top occupational hazards for health care professionals might surprise you. Beyond the more obvious biological or stress-related or chemical dangers, health care workers often face ergonomic hazards from improper patient transfers.   

Transferring a person in and out of a wheelchair, gurney or bed can put undue stress on the back, arms and shoulders; it can put the patient in danger as well.

Learning the correct way to transfer a patient will prevent undue wear and tear on your body and will keep patients as safe and comfortable as possible.

Best Practices

Transfers commonly occur around the use of beds, wheelchairs, chairs, bathtubs, cars and toilets. Helpful equipment for transfers includes lifts, walkers, grab bars, trapeze bars and sliding boards.

Before getting into technique, here are a few helpful bits of common sense and basic body mechanics.

  • Transfer your patient only when necessary. The more you transfer, the more opportunities there are for mishaps.
  • Get as close as possible to wherever you plan on making the transfer.
  • Get your center of mass as close as possible to your patient’s center of mass. Stand up straight with good posture, making sure you aren’t too stiff and your knees aren’t locked. Spread your feet slightly beyond shoulder width so you have a broad base of support. Keep your center of gravity as low as possible.
  • If at all possible, try to transfer “downhill,” rather than “uphill,” and do so at a modest height (adjusting the height of the bed or chair as needed).
  • Maintain the natural curve of your back and only bend at your knees and hips. Do not put unnecessary pressure on your back.
  • Move or pivot your feet when turning. Do not twist at your back.
  • Patient collaboration is always a great idea—have the patient assist as much as possible.
  • If more than one person is making the transfer, make sure to communicate.
  • Make sure to maintain modesty; if the patient is wearing a hospital gown, then see to it that the gown stays on or over private body parts.
  • Watch out for potential dizziness or hypotension and communicate with the patient to make sure they’re doing okay.

Additional Notes on Technique

If you’re transferring from anything with wheels, make sure to lock the wheels. You don’t want your patient to be “the one who got away.”

If your patient is in a wheelchair, have them scoot to the edge of the chair, and, if they are able, have them put their feet on the floor. If there is a rotating or movable arm rest on the chair, move it or remove it from the side that you will be making the transfer.

Next, have your patient lean their trunk forward. When transferring, your patient’s head should move in the opposite direction of their hips. This will help with movement and with clearing any obstacles during the transfer.

To protect the patient’s shoulders, have them keep their arms as close to their body as possible (somewhere in the range of 30 to 45 degrees). This helps keep the patient’s weight centralized, making it easier to lift them. To protect the patient’s wrists, have them grab a bar or grip an edge. You don’t want to them to lay their hands flat and put weight on their palms. This is a dangerous position and can lead to carpal tunnel syndrome.

Ready for Liftoff

Before and during liftoff, coach your patient, making sure they are working with you to clear any obstacles and taking great care that they do not bump or rub against anything. You want to avoid shearing and the development of bed sores.

If you and the patient feel like you can’t make the transfer in one smooth movement, then perform the transfer in small, calculated steps. You can also use a transfer board if needed. Just be sure to take extra care sliding the patient to the transfer board because this kind of movement can damage a person’s skin. You’ll want to use a towel or pad on the board if you think bare skin will come in contact with the board during the transfer.

Equipment for Transfer

There is equipment to make transfers safer, but you must use it properly so as not to injure yourself with improper technique.

If you’re going to use a mechanical lift, know that they are meant to move in a straight front-and-back motion. If you have to turn, do not make yourself the center of gravity by planting your feet and twisting your body. Rather, make the lift the center of gravity by coming to one side, pinning your elbows inward. Hold one handle and walk with the mechanical lift to turn it, and then drive the empty wheelchair or other chair to the lift. Do not drive the lift around with someone in it (as fun as it may look, it’s very dangerous).

For transferring to shower chairs, it’s important to know the difference between regular shower benches and the swivel sliding bench. Look for video resources for more information or read manufacturer guidelines.

For car transfers, get the patient as close as possible to the car seat they’ll be moving to while still leaving enough room for the two of you to move. The person making the transfer should stand inside the open door. Do not work against gravity, and make sure the transfer isn’t being made uphill or on an incline. Angle the wheelchair 45 to 90 degrees toward the car and lock the brakes. From there, you can use a sliding board or return to the technique described earlier.

No matter where you transfer, communication and preparation are the two most important factors to consider. Communication leads to collaboration; you need your patient’s help to make a transfer that’s safe for both of you. Preparation is also crucial because you don’t want to make a transfer without having the support of a colleague, equipment or proper body placement.

With proper preparation and communication, you’ll ensure your own safety and the safety of your patient when making a transfer.

Dawn Wiggins, RPN, is a registered nursing professional in the province of Ontario, Canada with more than 25 years of front line health care experience. She leads a dynamic team of health care experts dedicated to one thing—making a positive impact in the lives of people living with dementia and their care partners. Wiggins has a wealth of experience in acute care, long-term care, psychiatric care, homecare, rehabiliation and palliative care. Wiggins has built and managed world-class dementia care neighborhoods at the institutional level.