When assisting a patient with movement, the primary goal is preventing harm to both the individual receiving care and the caregiver. Unsafe patient handling practices are a significant source of injury in care settings. Avoiding common mistakes during transfers and repositioning reduces musculoskeletal injuries for the caregiver and prevents falls, skin damage, and joint trauma for the patient.
Ignoring Caregiver Body Mechanics and Capacity
Caregivers must avoid techniques that compromise their own physical safety, which often lead to back and shoulder injuries. A primary mistake is lifting a patient solely with the back muscles. Caregivers must avoid bending over at the waist or keeping the knees straight. Instead, bend at the hips and knees, allowing the powerful leg muscles to perform the lift.
The act of twisting the spine while lifting or carrying a patient is particularly dangerous and must be avoided. The spine is most vulnerable to strain when rotational forces are applied during a lift. To change direction, pivot the entire body by turning the feet, ensuring the back remains straight and neutral.
Caregivers must avoid attempting to move a patient who exceeds their comfortable lifting capacity, which is often cited as a maximum of about 35 pounds of the patient’s weight under ideal circumstances. Overexertion is a leading cause of injury in healthcare settings, and attempting a solo lift when the patient is too heavy or uncooperative significantly increases risk. If the required assistance level is too high, the caregiver must seek help from a second person or use specialized mechanical aids. Also, avoid sudden or jerky movements, as these compromise posture and can cause both the caregiver and the patient to lose balance.
Failing to Secure the Environment or Equipment
A common error leading to patient falls is initiating a transfer before the environment and equipment are fully secured. Avoid starting any movement before all wheeled equipment, such as wheelchairs or beds, has its wheel locks or brakes fully engaged. If wheels are not locked, the equipment can roll away unexpectedly, creating an unstable gap.
Caregivers must avoid transferring a patient across surfaces that are unstable, wet, or cluttered. The path of movement must be free from obstacles, and transfer surfaces must be level and secure. Moving a patient in dim lighting or over slippery floors significantly increases the risk of an accident.
Avoid large gaps between transfer surfaces, such as the bed and the chair, to minimize the distance the patient travels. Caregivers should also avoid leaving necessary transfer aids, like a gait belt or transfer board, out of immediate reach, as fumbling mid-transfer compromises stability and focus. Finally, avoid using socks or slippers without good treads; the patient’s feet must be equipped with non-slip footwear.
Applying Direct Force to Limbs or Joints
Directly causing trauma to the patient by improper handling of limbs or skin must be avoided during all transfers. Caregivers should never pull or yank on the patient’s arms, wrists, or shoulders to lift them. This action places extreme stress on vulnerable joints and can result in serious injuries, including shoulder dislocation or painful skin tears.
Another dangerous practice to avoid is allowing the patient to brace themselves by wrapping their arms around the caregiver’s neck. This creates a severe choking or leverage hazard for the caregiver and can cause them to lose balance. Instead, the patient should be instructed to hold the caregiver’s waist or clasp their own hands close to their chest.
Caregivers must avoid dragging the patient across a surface, such as a bed sheet or a transfer board, without lifting them slightly first. Dragging causes shearing, a skin injury where the top layers of skin and underlying tissue are pulled in opposite directions. This can damage blood vessels and lead to deep tissue injury or pressure ulcer formation. For repositioning, a proper assist device like a draw sheet or slide sheet should be used to lift and move the patient, avoiding friction and shear.
Neglecting Patient Assessment and Communication
Ignoring the patient’s status or failing to communicate is a procedural lapse to avoid. Caregivers should never attempt to move a patient without first clearly explaining the steps of the transfer. Telling the patient what to expect, such as a count of “one, two, three, lift,” allows them to participate to their full capacity and reduces confusion or sudden, uncoordinated movements.
Avoid transferring a patient who is actively expressing severe pain, dizziness, or sudden weakness. A patient’s refusal or sudden change in physical status, such as becoming confused or light-headed, can indicate a medical change that makes the transfer unsafe. The procedure should be paused if the patient reports feeling unwell, and their status should be reassessed.
The caregiver must avoid ignoring patient feedback or rushing the process when the patient needs time to adjust their balance or position. Rushing can lead to errors and accidents, as patient safety requires patience and accuracy. Ignoring a patient’s expressed fears also undermines the cooperative effort necessary for a smooth transfer.