Save your back, save your budget: safe, simple, and cost-efficient transfer solutions are especially helpful in caring for bariatric residents.

For many long-term care facilities, the challenge of patient handling has gotten tougher. Between shrinking reimbursement rates, bigger residents, and an increase in injuries to nursing staff and residents, nursing home operators are often in a bind to effectively care for their residents while keeping their operating costs down.

Although patient handling is a universal issue affecting residents of all sizes, it is particularly important when caring for bariatric residents because they usually require special equipment and more personnel for even routine handling procedures.

In its "Guidelines for Nursing Homes" at www.osha.gov/ergonomics/guidelines/nursinghome, OSHA identifies six common resident transfers requiring equipment:

1. Sit-to-Stand or Sit-to-Sit

2. Repositioning in Bed or Gerichair

3. Seated Lateral Transfers

4. Prone Lateral Transfers

5. Turning

6. Lifting Resident From the Floor

OSHA's guidelines recommend using powered patient-handling devices whenever possible to minimize caregiver injury. Although there are no substitutes for certain capital investments, such as overhead lift systems or convertible stretcher chairs, a ream of small, relatively inexpensive manual items are available to help with the vast majority of resident moves, including difficult bariatric positioning maneuvers--maneuvers such as lifting from the floor, turning, repositioning, and bed-to-wheelchair transfers.

The focus on injury prevention is especially important now that safe patient handling is a matter of law--at least in Texas as of January 1, 2006. Texas SB 1525 requires hospitals and nursing homes to adopt a policy "to identify, assess, and develop strategies to control risk of injury to patients and nurses associated with the lifting, transferring, repositioning, or movement of a patient" (see www.capitol.state.tx.us/tlo/79R/billtext/SB01525F.HTM). The policy must include an "evaluation of alternative ways to reduce risks associated with patient handling, including evaluation of equipment and the environment" and "restriction, to the extent feasible with existing equipment and aids, of manual patient handling or movement of all or most of a patient's weight to emergency, life-threatening, or otherwise exceptional circumstances."

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Most significantly, the law requires the plan to include "procedures for nurses to refuse to perform or be involved in patient handling or movement that the nurse believes in good faith will expose a patient or a nurse to an unacceptable risk of injury." The law discourages, but does not prohibit, manual moving and lifting of residents. California, Massachusetts, Washington State, and New York all have similar bills pending, and it's clear that such laws will be on the books all across the country over the next few years.

But nursing home residents, especially larger ones, still need to be cared for, despite the risk of injury to nurses. So what's an administrator, DON, or therapist to do?

Many healthcare professionals are now turning to nonmechanical patient-handling products, most of which are small enough to put on a nurse's cart. These products are effectively reducing or eliminating the problems associated with the most common patient-handling issues in long-term care, particularly those with bariatric residents.

These problems may include physical injuries to staff and residents, as well as emotional and psychological injuries--for example, nursing staff may resent larger residents because of the extra care they require, and larger residents may feel humiliated in such an environment. The result is higher turnover of staff and residents.

This article suggests specific pieces of equipment to help reduce injuries among staff and residents, without doing damage to a facility's operating budget. These products make transfers and handling issues easier and less stressful for all involved, and they are especially useful in preserving the resident's comfort and dignity.

Sit-to-Stand or Sit-to-Sit

For partially dependent residents, the ideal piece of equipment is a powered stander, which can also be used as an ambulation aid. But in lieu of powered equipment, nurses or therapists are called on to get partially dependent residents to their feet, usually using a gait belt as a lifting aid.

Unfortunately, traditional gait belts were never meant to be used in lifting. They can chafe residents' skin and force caregivers to pull residents awkwardly upward with their arms and back, causing injury to themselves. And canvas gait belts should never be used with bariatric residents because they can literally "get lost" in the folds of a larger resident's skin, causing discomfort and possibly lacerations.

Instead, OSHA recommends using transfer belts with vertical handles to lift residents or to perform an assisted lift, when such a lift is possible. Strategically placed vertical grips (figure 1) allow a caregiver to raise a resident with a minimum of effort, using the long muscles in her thighs rather than her back muscles as leverage.

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So now you have the resident up and you want to transfer him/her to another seating position. Normally, this involves a little shuffle on the resident's part--something that may be difficult or impossible for him/her to do, especially for the larger resident. That's why a pivot disc (figure 2) is so handy. With a weight capacity of 600 lbs, even larger residents can be safely transferred from bed to wheelchair or wheelchair to toilet with ease. Once the resident's feet are on the disc, he/she can be simply turned in the desired direction (figure 3).

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Repositioning

Pulling residents up in bed or moving them from the side of the bed no longer needs to be a caregiver's curse. By using friction-reducing devices, this task can be accomplished easily without effort, without shearing residents' skin, and without causing them bruising and pain.

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Roller sheets--continuous nylon tubes with or without handgrips--are quickly becoming a tool of choice because of their ease of use, convenience, and multiresident applicability (figure 4). The sheets are easily cleaned with spray-on disinfectant and wiped to prevent cross-contamination, and they can be laundered.

Roller sheets come in a variety of lengths and widths, including extra large to accommodate bariatric residents, and they can be used independently or in sets as needed. Because residents will not be lifted, roller sheets do not have weight capacities. However, residents must fit between the handles at the edges of the sheets for correct use.

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Torso-length sheets are ideal for repositioning, while small sheets can also be used for seated slides, such as onto a car seat or bath bench (figure 5).

What if you could minimize the need for repositioning in the first place and virtually eliminate pulling a resident back into the wheelchair? Unidirectional slides (figure 6) allow movement in only one direction on a bed or wheelchair, preventing residents from sliding down a bed or off their wheelchairs. One-way slides do not come in bariatric sizes per se, but usually come in "bed" and "wheelchair" sizes--the bed size is longer and wider to cover most of the torso of a nonbariatric resident. For obese residents, two slides may need to be placed side by side for better coverage.

A number of "all-in-one" patient-handling products are available that allow caregivers to easily perform many previously difficult moves, including repositioning, lateral transfers, and even bed-to-wheelchair transfers, without lifting the resident.

With Slipp Patient Mover, for example, two staff members can reposition a resident in 5 to 10 seconds using a drawsheet to glide the resident across the top of the device. Slipp works by reducing friction to make efficient use of the patient's weight. It is designed to let the patient (regardless of size) literally "slip" along on a comfortable surface of sealed fluid that reduces normal friction to a minimum.

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Phil-E-Slide, ErgoSafe, and other manufacturers offer flat sheet sets constructed of specialized ultralow friction-reducing fabric that enables an individual to slide across the surface. Two pull straps are included, which may be attached to the integral handgrips on the sheets. This allows caregivers (figure 7) to adopt good posture and use better ergonomics when performing the slide.

Seated Transfer

The mainstay of the seated transfer has long been the wood or plastic transfer board. Because of its low cost and high weight capacity, it will probably remain so. But even the smoothest transfer creates friction, leading to shearing, and so it may not be suitable for every patient.

To minimize friction, place a heavy-duty plastic bag or a small roller sheet on top of the board so that the two slippery surfaces meet. Place the resident on top of the sheet, and guide the slide. The resident will move faster and easier on the board because he/she will be sliding on the bag or roller sheet, not the board itself.

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One transfer board option is the Beasy line of transfer aids that provides frictionless sliding transfers (figure 8). The resident is safely glided on the disc from one surface to another; sizes range from 27 1/2" to 40" and can hold patients weighing 400 to 450 lbs.

Lateral Transfers

Stretcher-to-bed transfers can be easily accomplished using either the Slipp or a lateral transfer sheet set from Phil-E-Slide, Ergo-Safe, or other manufacturers. A variation of the roller sheet, the lateral transfer is done by using pull straps attached to the lateral slide sheet (figure 9), eliminating reaching and manual pulling by staff members.

Turning and Lifting From the Floor

Turning residents can be made easier by using a pair of nylon flat sheets; a repositioning slide tool with handles, such as the ErgoSlide; or a transfer/turner with handles, which can also be used to lift patients from the floor (figure 10). Standard log-rolling techniques are used to get the item under the resident, and the turn or lift can then be completed.

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Conclusion

When it comes to being handled, bariatric residents are no different than anyone else--they want to maintain their dignity, self-sufficiency, and independence as much as possible.

By investing in the proper patient-handling devices like the ones mentioned in this article, nursing homes will find that caring for their larger residents is no more difficult than caring for other residents. These items will more than pay for themselves in lower workers' compensation claims, fewer resident and family complaints, and higher satisfaction ratings among residents.

NOTE: The products mentioned in this article are representative of the wide assortment of options available, and are not endorsed by the author or Nursing Homes/Long Term Care Management magazine. The effectiveness of any patient handling product will depend on a variety of factors, including staff training, resident need, and frequency of use.

Janet White, is President of Bariatrics Unlimited, LLC. For more information, call [phone] or [phone], or visit www.bariatricsontheweb.com. To send comments to the author and editors, e-mail white [e-mail]. To order reprints in quantities of 100 or more, call [phone].