Caregiver charts for the transfer of bariatric patients

baratric patients

Caregivers sometimes feel like they carry the weight of the world on their shoulders, especially if they have to transfer an overweight patient. Maybe the following tables can be the proverbial lever that Archimedes spoke of. 

  1. Transfer to and from bed/chair, chair/toilet, chair/chair

Can patient bear weight?

Fully

Stand by for safety as needed.

 

 

 

 

Partially or no

Is patient cooperative?

Partially or no

Bariatric floor-based or ceiling lift (minimum 3 caregivers).

 

 

Fully

Does patient have upper-extremity strength?

No

Bariatric stand-assist lift (minimum 2 caregivers) or Bariatric floor-based or ceiling lift (minimum 2 caregivers.

 

Fully

Use seated bariatric transfer aid; may use sliding board until the patient is proficient in completing transfer independently (minimum 2 caregivers).

 

·         Chair with arms that recess or are detachable required for seated transfer aid.

·         Bariatric toileting slings may be used for toileting.

·         Bariatric bathing mesh slings may be used for bathing.

·         A standard porcelain toilet generally has a weight limit of 350 lbs. A patient may require a bariatric commode chair or steel toilet.

·         Older lifts may require more effort to place the sling under the patient, which in turn may take at least 3 caregivers.

 

  1. Lateral transfer to and from bed/stretcher/trolley

Can patient assist?

Partially able or no

Fully

Mechanical lateral transfer device, bariatric ceiling lift with supine sling or air assisted friction-reducing device (minimum 3 caregivers).

Stand by for safety as needed (minimum 2 caregivers).

 

·         Destination surface should be approximately ½ inches for all lateral moves.

·         Avoid shearing force.

·         Ensure the bed is the correct width so that excessive reaching by caregiver is not needed.

·         A bariatric ceiling lift with supine sling should be used with specialty beds that may interfere with lateral transfers.

·         Make sure the bed or stretcher does not move with the weight of the patient transferring.

·         Employ a bariatric stretcher or trolley if the patient surpasses the weight capacity of conventional equipment.

 

  1. Reposition in bed: Side to side, up in bed

Can patient assist?

Fully

Caregiver assistance not required; patient may/ may not use weight-specific positioning aid.

 

 

Partially or no

Is patient cooperative?

Fully

Bariatric ceiling lift with supine sling, air-assisted device or friction-reducing aid (minimum 2 to 3 caregivers).

 

 

Partially or no

Bariatric ceiling lift with supine sling, air-assisted device or friction-reducing aid (minimum 3 caregivers).

 

·         Place the bed flat or in a Trendelenburg position (if tolerated and not contraindicated by doctor) to aid in gravity when pulling a patient up in bed. Side rail should be down.

·         Avoid shearing force.

·         Bed should be adjusted to elbow height.

·         Move patient as early as possible to avoid weakness from bed rest, promote independence, and decrease the amount of high-risk tasks.

·         A friction-reducing device covered with drawsheet under the patient at all times can reduce risk to staff during transfers, so long as it does not negate the pressure relief properties of the mattress overlay.

·         Reposition the patient firmly in bed with a sealed, high-density foam wedge. Slip-resistant texture materials include Dycem.

 

  1. Reposition in chair: Wheelchair, chair, or dependency chair.

Can patient assist?

Fully

Stand by for safety as needed.

 

 

Partially or no

Is patient cooperative?

Fully

Bariatric ceiling lift, floor-based lift, repositioning device or seated friction- reducing device (minimum 2 caregivers).

 

 

Partially or no

Bariatric ceiling lift, floor-based lift, repositioning device or seated friction-reducing device (minimum 3 caregivers).

 

·         Make the most of chair functions such as chair that reclines, or use an arm rest to enable repositioning.

·         Ensure chair wheels are locked.

·         Leaving the sling under the patient at all times may reduce risk to staff during transfers, but first consider the skin risk to patient and the risk of removing or replacing the sling for latter moves.

 

  1. Patient-handling duties that require access to body parts (limb, abdominal mass, gluteal area).

Can patient sustain limb position to assist in making body part accessible?

Fully

Partially or no

Proceed with patient handling task

·         Assemble multidisciplinary team to develop safe solutions such as:

·         Modifying use of a full body sling to raise limbs for bathing or wound care.

·         Using drawsheet with handles for one caregiver in each side to raise abdominal mass to access the perineal area.

·         Using air-assisted lateral transfer aid to blow air or a hair dryer on a cool setting to enable drying a patient between skin folds.

·         Using sealed high-density foam wedge to firmly reposition the patient on side.

 

·         A multidisciplinary team has to problem-solve tasks, communicate to all caregivers, refine as required, and perform consistently.

·         An abdominal binder may be used if the patient’s abdomen hinders a patient handling task.

 

  1. Transporting (stretcher)

 

Is powered transport device available?

Is patient cooperative?

Yes

Yes

Minimum 2 caregivers

No

Minimum

3 caregivers

No

Yes

No

Minimum 4 caregivers

 

·         Stretcher must have the capacity to maintain a high Fowler’s position if the patient has respiratory distress.

·         New equipment is frequently easier to propel.

·         Secure patient in stretcher if uncooperative.

 

  1. Toileting tasks

 

Is patient cooperative?

Can patient bear weight and ambulate?

Does patient have upper- extremity strength?

Can toilet accommodate patient's weight?

Stand by for safety to escort to toilet (minimum of 1-2 caregivers).

Yes

Yes

 

Yes

Use full-body sling lift with a toileting sling to transfer to bedside commode (minimum 3 caregivers).

No

No

No

 

Use stand-assist lift and transfer patient onto bedside commode (minimum 2 caregivers).

Yes

Partial

Yes

 

Stand by for safety to escort to toilet or bedside commode (minimum 1-2 caregivers).

Yes

Yes

 

No

 

·         Make sure bathroom doorway is wide enough to accommodate entry of mechanical lift device and patient.

·         Ensure equipment complies with weight requisites and has proper size for patient.

·         Standard toilets are typically rated to 350lbs maximum capacity.

 

  1. Transfer patient up from the floor

 

 

 

 

 

 

 

 

Is patient injured?

 

 

 

 

 

 

 

 

 

Yes

 

 

 

 

 

 

Check for fracture or spinal cord injury. Does patient need immobilization technique?

 

 

 

Yes

·         Start CPR and wait for emergency response team before moving patient if patient is in cardiac arrest.

·         Use 2 friction-reduction sheets to transfer onto spinal board if necessary.

·         Get low stretcher.

·         Lift patient on spinal board onto low-lying stretcher (6 caregivers).

 

 

 

 

No

Can patient assist?

No

Total lift device needed (2 or more caregivers).

Hover Jack w/friction-reducing sheets (2 caregivers).

 

Yes

Caregiver is to hold chair for patient to use to raise self using own strength. Don’t tug on or lift patient.

No

 

 

·         Don’t lift the patient off the floor.

·         Patient should not lean on caregiver for base of support.

·         Immobilization technique: use spinal precautions if lift can’t be used due to suspect hip, pelvic, or vertebral fractures.

·         Use a floor-based lift that goes all the way down to the floor.

Notes

·         More often than not, there is little a caregiver can do other than try to move objects out of the way, protect the patient’s head and seek assistance if a bariatric patient is about to fall.

·         Transfer toward stronger side if patient has partial weight-bearing capacity.

·         Standard equipment is usually limited to 250-350lbs. Make sure you use bariatric equipment if necessary.

·         A team of caregivers should have a clearly defined leader.

·         A patient should be considered as fully dependent if the caregivers are required to lift more than 35lbs of his or her weight.