Introduction to Transfers
PTA 101 Introduction to Clinical Practice 1

Instructional Use Statement

The following information is used for instructional purposes for students enrolled in the Physical Therapist Assistant Program at Lane Community College. It is not intended for commercial use or distribution or commercial purposes. It is not intended to serve as medical advice or treatment.

Contact howardc@lanecc.edu for permissions.

Lesson Objectives

1. Describe levels of assist that may be provided during a transfer

2. Describe the method to perform various transfer techniques under a variety of weight bearing conditions

3. Describe general principles for optimizing patient safety during transfers

4. Document levels of assistance in a simulated patient case.

5. Interpret level of patient independence with transfers using the Functional Independence Measure (FIM).

What is a Transfer?

A transfer is an activity where a patient moves from one surface to another OR from one position to another

Elements of a Transfer

• Type: Mechanical lift (e.g., Hoyer lift), 2-to-3 person lift, squat-pivot, slide board, stand-pivot, supine-to/from-sit, sit-to-stand, supine-to/from sidelying

• Assistance: Rated by amount of physical assistance, cueing, and/or supervision provided by a therapist/caregiver during the activity
• Safety considerations: judgement, sequencing/planning, environmental considerations, gait belt, additional personnel/assistants
• Equipment requirements: wheelchair, walker, cane, trapeze bar, electric bed, transfer pole

Planning the Transfer

Listen to a quick instruction from Christina (approximately 3 minutes)

1. Read the medical record

1. Arousal, attention, cognition assessment
2. Precautions and contraindications (weight bearing status, post-surgical status, vital sign parameters for activity, etc.)
3. Other relevant medical conditions: e.g., skin/bandages, corsets/braces, infectious diseases
4. Transfer type and level of assist on eval and in recent past (with PT or other members of health care team where applicable).
2. Approach the patient
1. Introduce yourself as: (your name), "Student Physical Therapist Assistant" or "Student PT Assistant" from Lane Community College
2. Generally describe the transfer activity. Avoid jargon, over explanation. Keep it simple: "I'd like to work with you on improving your ability to move around in bed".
3. Interview the patient to screen for their abilities. For example, ask:
1. How did you get into the wheelchair?
2. Do you feel dizzy or light headed when you stand up?
3. How do you get to the bathroom?
4. How much help do you need?
4. Briefly confirm their mobility status and ability to participate by completing a brief assessment
1. For example, ask pt to move arms, legs, reach across, perform weight shifts in sitting, etc.)
2. Check for postural hypotension
3. Balance
4. Patient motivation
5. Pain
5. Select and collect equipment - Listen to a 1 minute tip from Christina
1. Equipment should coincide with information in the PT evaluation, your gross motor assessment, patient subjective information (pain, endurance, etc)
2. Essential equipment for all transfers into upright postures is a GAIT BELT
3. Equipment for monitoring vital signs should be gathered and ACCESSIBLE during the transfer activity
1. transfer belt (aka gait belt)
2. non-skid footwear
3. appropriate draping material: robe, sheet, etc.
4. wheelchair with brakes, elevating or removable leg rests as appropriate (or stretcher)
5. equipment (slide board, Hoyer lift, etc., as needed)
6. support garments (back support, leg brace, slings. etc.) as needed
6. Prepare the environment and equipment
1. Assist patient as needed with clothing, splinting, etc. prior to initiating transfer
2. Coordinate support or additional staff as needed prior to initiating transfer
3. Appoint a therapist as the "lead" and set roles and responsibilities for assisting with transfer, including reviewing the sequence of activities/events for a successful transfer
4. Adjust bed/mat heights for maximum safety (therapist/patient)
5. Check bed, bedrails, mat and/or wheelchair locks/parts for security
6. Inspect floor and immediate transfer surface for obstacles, spills, and adequate slack in lines and tubes
7. Pull curtain where applicable to offer privacy
7. Confirm your patient understands the activity
1. Ask he/she to repeat the steps of the transfer
2. Consider breaking down transfer into smaller component parts to confirm understanding of task sequence.
8. Use good body mechanics
1. Wide base of support, feet positioned to allow for easy transition of weight from one foot to the other.
2. Be prepared to keep your center of gravity as close to client's center of gravity as possible.
3. Leg muscles and weight shifting are the key elements of a safe transfer.
4. Ask for a second person to assist depending on the size and status of the patient.
5. Respect your own lifting limitations: work within your comfort zone.

Video Summarizing Transfer Elements and Planning the Transfer - Listen to a 30 second tip from Christina

Special Considerations

Certain diagnoses and post-operative conditions have specific precautions and contraindications for mobility and transfer type. Specific examples include

Transfer techniques

Selecting the most appropriate transfer type is based on the goals in the plan of care. Progressive transfer training includes an understanding oof the patient's general strength (particularly in the lower extremities), ability to follow instructions, medical condition (such as post-operative precautions and weight bearing status), equipment, and safety.

Transfers are described by the position used and weight shift (e.g., standing or squat pivot; sit to stand)

Safest and best practice is to follow OSHA guidelines when providing patient assistance. The following videos demonstrate techniques to provide transfer assistance when lifting equipment is not available or accessible.

 Dependent transfer x 1 - total quad lift

Two person lift transfer

Assisted standing pivot - Mod to Max A (Full knee block)

Slide board

Assisted standing pivot - min to mod A

Max A Supine to Sit

Assisted supine to sit

Documentation Elements

Transfer type, level of assistance, cues, equipment, and outcome should all be noted in the medical record as an objective finding.

These elements are objective because they are performed and measured in a standardized way and are repeatable.

PTAs, PTs and rehabilitation personnel work as a team to provide consistent care with functional mobility tasks. Consistency in terminology is critical to ensuring continuity of care, patient safety, goal setting, and progressions.

In every day documentation, progress reports, and discharge summaries, level of assist is documented based on the amount of physical work a patient can perform during the transfer

For example: as a PTA you may read this in the objective findings (O) of the evaluation:

O: mod A stand-pivot w/c to bed with cues for pacing and safety.

ACTIVE LEARNING EXERCISE: Try to describe this in a paragraph format. Write out a summary of this objective finding using language that a patient's family member can understand. Share your family-verson on the CAN YOU HELP ME forum for feedback.

There is one short answer question on the PNP FIM quiz like this active learning exercise, and documentation is a progressive skill you will apply in lab and lecture exams.

Transfers are assumed to be performed by one person unless otherwise stated. If additional personnel or equipment is required for patient safety, this should be reflected in the documentation. For example: "O: Min A x 2 slide board transfer w/c to car", includes transfer type, personnel, level of assistance, and equipment.

Functional Independence Measure (FIM)

In acute rehabilitation and skilled nursing facilities, multidisciplinary teams periodically evaluate and document patient status using a numeric scale, known as the Functional Independence Measure (FIM). FIM Assessment categories include:

• self-care
• sphincters
• mobility (including transfers (bed/wheelchair, tub, toilet), locomotion (walking/wheelchair, stairs)
• communication
• psychosocial
• cognition

FIMs are used most often for patients with neurological conditions. Quantitative changes in FIM levels confirm the patient is making progress toward functional goals and assist with appropriate discharge planning. PTs and PTAs are often consulted to assess and document mobility FIM levels.

FIM levels are not used as a part of daily documentation. FIM is used as a standardized measure to look at the whole patient, and is completed periodically as an interprofessional team. Standardized measures for both FIM levels and transfer assistance lend consistency and continuity in systems of measurement.

Assist Level and FIM Level Categorization

Here's a quick tip from Christina about FIM levels

End of Lesson

Self-Assessments for FIM levels are included in your PNP FIM quiz in Moodle