Key principles of transfers

Any type of transfer, including independent or assisted transfers, can impact skin integrity. A transfer with adequate clearance of obstacles, such as the wheels and bed surface, can eliminate any risk of shear and friction.

Mastering independent transfers requires skills, good technique and lots of practice. For people who require assisted transfers, mastering a good technique is just as important and clinicians should consider training those providing care.

Transfers become more difficult when:

  • There are considerable height differences to overcome and/or increased distances to traverse. For example, car transfers, toilet transfers and floor or couch-to-chair transfers.
  • There is reduced surface availability for good hand positionings, such as toilet or commode transfers.
  • The person is between two mobile objects, where both surfaces can become unstable, such as a wheelchair and a shower commode. This is extremely high risk and not recommended.

Considerations for assisted horizontal transfers

When transferring someone from a horizontal position, the following considerations can reduce the risk of falls and injuries.

  • Position the wheelchair close to the transfer surface, to reduce the transfer gap.
  • Align the front castors to be forward-facing, in front of the stem and in line with the back wheel, to increase the stability of the wheelchair.
  • A transfer board is to be used as a bridge – not as an aid for sliding. Sliding will increase shear and friction.
  • Encourage moving forward, to assist with clearing the wheel. Cover the wheel, if necessary, and sit in front of the person, if needed, when assisting with the transfer.
  • Encourage hand placement close to the weight/load and close to the final position after the transfer.
  • Make sure weight is transferred forward, enabling a good lift and clearance for the transfer.

Hoist considerations

  • Boom height will determine clearance from the bed. Make sure the person’s head does not hit the boom.
  • Mast clearance allows space, so the person’s feet don’t knock the motor/ mast when lifting and lowering.
  • A yoke-style or two-point frame lends itself to a large variety of slings with loops. Shearing from the sling can occur as weight is taken, especially during the transition from a lying to a sitting position.
  • A pivot frame design can assist with positioning the person more rearward and upright into the shower commode or wheelchair. Pivot frame hoist slings are hoist-specific in design and cannot be interchanged. Pivot frames can also have powered actuators which allow for a controlled transition between lying and sitting.

Sling considerations

  • Ensuring the right sling fit and size selection is crucial. Measure from the person’s coccyx to the top of the head, for slings with head support. Centre the sling over the spine. If the person’s body touches or falls outside the binding, change to a larger and wider sling. This will prevent friction and physical skin trauma, as well as minimise the risk of a person falling or rolling out of the side of an undersized sling.
  • Different styles have different levels of contact with the skin. A key-purpose sling has greater coverage than a hygiene or toileting sling.
  • Different fabric options, such as mesh, fabric or ‘parachute’ material, offer different friction coefficients. Mesh is generally not recommended, due to high friction.
  • Support the leg when inserting and removing the sling leg straps, to prevent shear and friction.
  • Never tug or pull on the sling to reposition the person in the chair. Hoist the person up again to reposition.
  • Never use a wet sling.

7 steps for safe hoist transfers

Hoisting a person into a wheelchair or shower commode can present many risks for falls and injuries. These 7 steps provide best practice guidance to ensure safe hoist transfers.

Step 1: Hoist transfer into a wheelchair

  • Before hoisting, check that the cushion is working and is correctly placed on the wheelchair.
  • Make sure the person is centred in the sling. Rolling is the best manual handling technique for sling application.
  • Sit the person up in bed after the sling is applied, to reduce friction, and slide into the sling from a supine position. This is also more comfortable for the person.
  • Clear the bed before pivoting the person around, to clear the feet from the bed.
  • Wearing shoes or protective footwear can reduce potential injury to the feet from the hoist motor/mast.

Step 2: Check person is rearward in the wheelchair and commode

Posture

Poor seated posture can increase risk of shearing if the person slides forward in the wheelchair.

Photo by: AliMed

Posture

Good seated posture with pelvis in neutral will promote healthy skin integrity.

Photo by: AliMed

Step 3: Remove the sling

  • For safety, always stand in front of the person.
  • Once the person is correctly positioned, the sling can be removed. Lean the person forward, to remove the sling, pull down and rearrange any clothing as needed, to decrease wrinkles and creases. If required, a further adjustment can be made by leaning forward in the chair and pushing against the knees to get back into the chair.
  • Remove the legs from the sling by lifting one leg at a time.

Step 4: Check pelvis is level

Make sure the pelvis is level in sitting by placing thumbs on the front of the pelvic bones (anterior superior iliac spine – ASIS) and check:

  • The space down each side of the person is even.
  • The ASISs are at the same height.
  • That the person is not rotated (one hip forward and one backward)
Step 4

Step 5: Check trunk, head and shoulders are centred and level

  • Assistance with this is required only for people who do not have full control of their trunk or have impaired balance.
  • If someone is independent with their balance and trunk support, they can check their posture in the mirror and readjust as needed.
  • After placing the arms into the arm troughs on the chair, place hands on either side of the rib cage/trunk and reposition as needed by gently pushing on the side to correct.
  • The head needs to be centred on the headrest. If the head and shoulders cannot be centred, then re-check the pelvis (ASIS).

Step 6: Check feet and leg positioning

  • Make sure the feet are centred and flat on the footplates. If the person is not wearing shoes, make sure there is padding under the feet e.g. a folded towel.

Step 7: Attach straps and supports

  • When all of the steps above are completed, apply straps and supports for safety, as required. A chest strap is highly recommended for someone who has impaired sitting balance. A thigh strap may be used to prevent the legs from rolling out. These will be assessed and provided by a clinician, as required.