Primum non nocere: First, do no harm – Patient Transfers

Clinical and Education Team on July 05, 2018 at 02:38 pm

Before you read this weeks blog, check out the latest news in dementia, brain injuries and wound care!

Dementia: Dementia is the 2nd leading cause of death in Australia

[SOURCE]

According to researchers, aerobic exercise may be more effective than other forms of exercise when it comes to preserving cognition and slowing Alzheimer’s decline.

Brain Injury: Falls are the leading cause of Traumatic Brain Injury in Australia

[SOURCE: Nick Rushworth, Brain Injury Australia]

Stand by me! Reducing the risk of injurious falls in older adults

Wound Care: Annual treatment cost of Pressure Injuries in Australia is A$983 million

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Pressure Injuries: Preventing heel pressure injuries with positioning

 

And now back to the blog…

The Latin phrase Primum non nocere (meaning ‘First, do no harm) is heavily cited in healthcare, but are we applying it during patient transfers? Let’s explore some of the potential consequences of poorly planned or executed transfers and identify measures to prevent them.

1. Aggravation of Spinal Cord Injury

An often-quoted statistic is that up to 25% of spinal cord injuries (SCI) are aggravated or result in secondary injuries in the prehospital and early hospital based stages of care 1. Although the data relating to that figure is reasonably old (circa 1983), until some contemporary figures prove otherwise, it should serve as a cautionary reminder to do no harm to our patients during the potentially high stress and confusing stages of transfer from ambulance stretcher to emergency department trolley and during early diagnostic imaging when the voices of handovers and medical directions compete with the ‘pings’ patient monitors.

Prevention

  1. Employ closed loop communication between trauma team members and external clinicians such as paramedics or hospital security staff.
  2. Rehearse transfers using devices which some team members may not be familiar with such as various full body vacuum splints or extrication devices. It is invariably human nature when asked ‘do you know how to do a log roll from a ____” to say YES, however a proactive team will rehearse or at the very least talk through the procedure.

2. Skin tear

The risk of skin tears increases with age, with patients aged 65 and over at greatest risk during transfers 2. Although not acutely life threatening, skin tears are painful, potentially disfiguring and if associated with: malnourishment, concomitant infection, co-morbidities (such as Diabetes Mellitus and Peripheral Vascular Disease) or exposure to hospital acquired infections, can result in an increased duration of hospital admission.

Prevention

  1. Reduce friction/shearing with a slide/draw sheet manufactured with Ultra Low Friction (ULF) fabric.
  2. Use one team member to control the feet of the patient during the transfer. Typically, the focus of the transfer is on the area exerting the greatest weight in the torso (being the shoulders and hips). If a team member is not available to assist with the transfer consider a placing a soft product on the patients feet such as slippers etc.

3. Therapeutic tube, monitoring device or other intervention dislodgement

Although tubes, monitoring devices and other interventions should be well secured, it is inexcusable to inadvertently remove them during a transfer at the risk of harming the patient.

Prevention

  1. Conduct a patient sweep, starting at the patient and working back to each therapeutic tube or monitoring device, ensuring that there is enough slack in the tubes/cables to conduct the transfer and if not, consider a multi-stage transfer.
  2. Immediately following the transfer check each tube/device/intervention for correct placement.
  3. The staff member in command of the transfer must use simple closed loop communication with the team members to ensure that what has been said has been understood and everyone involved is ready.

4. Staff Member Injury

Many factors can be the root cause of a staff member sustaining a Work Related Musculoskeletal Disorder (WRMD) during a patient transfer.

Prevention

  1. Don’t risk a WRMD in you or another team member by rushing a patient transfer, even if you are time poor, fatigued or even just feeling lazy. Ask any nurse or paramedic who suffers from chronic pain resulting from a bad/rushed patient transfer and they will assure you – it just is not worth the risk.
  2.  Communicate Communicate Communicate! As already discussed, one staff member must take command and employ simple closed loop communication with everyone who is actively involved without succumbing to distractions. This includes your patient, in order to prevent an inadvertent shift of their center of gravity if they reach out for balance. Barriers to effective patient communication could include: language differences, hearing deficit and altered level of consciousness (regardless of the cause).
  3. Use the basic manual handling principles developed by physiotherapists and occupational therapists for ergonomically sound transfers such as: elevate the bed which the patient is being transferred from to a point which is higher than the ‘target’ bed so that the patient is moving ‘downhill’; don’t allow any team member to reach out unnecessarily – create a multi-stage transfer if required and place a knee up on the bed to prevent ‘long distance’ reaching. Typically the greatest distance to travel during a patient transfer is from hospital bed to hospital bed due to the inherent width. Other transporting devices such as ambulance stretchers and emergency department trolleys are typically much narrower.

Conclusion

The safety of you and your patient depends on your level of confidence in your ability to conduct an effectively planned and executed transfer. If you aren’t confident with a transfer or with an unfamiliar device speak up before it’s too late.

References

1. Bernard M, Gries A, Kremer P, Bottiger B. Spinal cord injury (SCI) – Prehospital management. Resuscitation 2005 (66) p 127-139
2. Pennsylvania Patient Safety Reporting System – Patient Safety Advisory. Skin Tears: The Clinical Challenge. 2006 Sept (3:3) p. 1-8

 

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July 05, 2018

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