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Chapter 3. Safer Patient Handling, Positioning, Transfers and Ambulation
3.3 Risk Assessment for Safer Patient Handling
Risk Assessment for Safer Patient Handling
To prevent and minimize MSI injuries related to patient handling activities, a risk assessment must be done to determine a patient’s ability to move, the need for assistance, and the most appropriate means of assistance (Provincial Health Services Authority [PHSA], 2010). There are four important areas to assess:
The patient
The environment
The healthcare provider
The organization of the work
Checklist 24 outlines these four areas of assessment and what to consider prior to positioning, ambulation, and transfers.
Checklist 24: Risk Assessment for Safer Patient Handling.
Disclaimer: Always review and follow your hospital policy regarding this specific skill.
Safety considerations:
The assessment process should not override clinical judgment and patient-specific needs as determined by the healthcare team.
An assessment should be performed before each handling procedure.
Seek additional help if a procedure requires two or more persons.
Use assistive devices (gait belts, slider boards, pillows, etc.) to perform the procedure safely.
Assess the patient’s ability to tolerate the movement. Acute pain, shortness of breath, and inability to follow direction will place the healthcare provider and patient at risk for injury.
Always consider the principles of proper body mechanics prior to any procedure, such as raising the head of bed and tucking elbows in to help prevent injuries.
Avoid lifting shoulders when positioning a patient.
Never lift a patient; always use a weight shift to perform the procedure.
When positioning a patient using a sheet, place palms of hands up. A palms-down technique increases risk for injury.
Vision and hearing loss, and language barriers can make communicating with the patient difficult and can result in increased risk for injury.
Ensure the plan of care is updated regularly.
Steps
Additional Considerations
1. Assess your patient.
There are three areas to assess:
1. Is the patient cooperative and able to follow directions?
Ask patient to squeeze your hands. Is the behaviour predictable (non-aggressive, fearful, or fatigued)? Is the patient able to follow directions with cues?
If yes, proceed to next question.
If no, use a mechanical lift for transfers and/or assistive devices for repositioning in bed if patient has some abilities.
2. Can the patient bear weight?
Ask patient to lift buttocks off the bed (also known as “bridging”) and hold the position for five seconds. The healthcare provider may give cues on how to lift buttocks off the bed.
After bridging, ask the patient to perform a straight leg raise by lifting one leg up off the bed and holding it for five seconds while the other leg is kept bent. Repeat with the opposite leg.
If yes, proceed to next questi