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This fourth of a five-part series on early mobilisation provides a guide to supporting patient transfers from bed to chair using moving and handling equipment

Patients in hospital with reduced mobility may experience difficulty moving in and out of bed. Part 3 of this five-part series explained how to help patients transfer from bed to chair without equipment. This article shows how to guide and support patients to transfer using equipment including hoists, transfer boards and turn discs.

Citation: Rindsland S (2021) Early mobilisation 4: transferring patients safely using equipment. Nursing Times [online]; 117: 7, 27-30.

Author: Sharon Rindsland is moving and handling senior coordinator, East Kent Hospitals University NHS Foundation Trust.

The benefits of early mobility for patient recovery are well established and were discussed in part 1 of this series (Rindsland, 2021a), along with the pivotal role of nurses and other caregivers in mobilising hospitalised patients early as part of a whole-team approach. Nurses engaged in daily patient handling are at almost twice the risk of developing work-related back injuries as those who are not (Soler-Font et al, 2019), and work-related musculoskeletal disorders account for an estimated 40% of all sickness absence in the NHS (NHS Employers, 2019). Use of equipment that helps moving and handling is fundamental to managing the risks associated with patient-handling tasks and ensuring patients’ mobility needs are met (Hutfield and Tracey, 2013).

The Royal College of Nursing stresses that “no-one should routinely manually lift patients”, and that specialist equipment, such as hoists, electric profiling beds and sliding aids, should be used instead of lifting most, or all, of a patient’s weight. Moving and handling legislation and guidance – which can be found on the website of the Health and Safety Executive (HSE) – encourages employers to ensure staff have access to the right equipment (Box 1). Despite this, staff can encounter barriers to equipment use, such as equipment being unavailable when needed or stored a long way from the ward or unit (Box 2), so organisations need to work to overcome these.

Barriers to using moving and handling equipment reported by staff can include:

Underuse of equipment has safety implications and can lead to patients being insufficiently mobilised (Rindsland, 2021a). In Noble and Sweeney’s (2018) survey of staff on barriers to equipment use, lack of time was identified as an underlying theme. Nurses also reported using equipment most often when repositioning patients in bed, and less often when helping patients with out-of-bed activity, such as ambulation, transferring to the bathroom and moving from bed to chair. As many as 78% of the survey respondents said equipment was not available when needed, and it was often reported that equipment was stored a long way from the ward/unit.

The HSE says all healthcare organisations must carry out moving and handling risk assessments to identify where injuries could occur and what to do to prevent them. As detailed in part 2 of this series – Rindsland (2021b) – this includes:

To remember what things they need to consider when conducting risk assessments, staff can use the TILE acronym:

The HSE advises that equipment must only be used after the patient has been fully assessed, in accordance with the patient’s care plan and manufacturer’s instructions, and should meet the needs of the individual, “helping to maintain, wherever possible, independence”, as well as “the safety of the individual and staff”.

This article will highlight the main considerations when transferring patients from bed to chair, where equipment is required. Several key pieces of equipment will be discussed:

When using moving and handling equipment carers should always follow manufacturers’ instructions, as for any medical device. Hoists and slings are subject to extra requirements and staff should refer to local hoisting protocol and the provisions of the Lifting Operations and Lifting Equipment Regulations 1998.

The HSE’s (2011) guidance on safe hoisting also includes general principles that are applicable to other moving and handling equipment. It has been used to help inform the following checklist, which although not exhaustive, includes things staff should consider when using equipment to move patients:

Using hoists can reduce musculoskeletal risks and help mobilise heavier patients or those with greater levels of dependency; however each year a large number of patients are injured in hoisting accidents, some of them fatally (NHS England, 2015; HSE, 2011). Hoisting should, therefore, only be undertaken after approved training, supervised practice and competency assessment, and in line with local policies and protocols (NHSE, 2015; HSE, 2011).

There are many different types of hoist. The patient’s mobility assessment and care plan should specify:

Two types of hoist that are useful when transferring patients from bed to chair are:

Passive sling hoists Mobile sling hoists (Fig 1a) or those fixed overhead (Fig 1b) are suitable for patients who are fully dependent. A passive sling hoist is used to raise a person from a lying or sitting position on the bed, repositioned over the chair and then lowered into the correct sitting position. Sling hoists can be disorientating for patients, and some may fear being dropped when lifted. Carers should prepare patients well beforehand and reassure them throughout the process.

While mobile hoists can be moved around, overhead hoists have the convenience of being available at the point of use, rather than stored away from the ward or unit. Risk assessments are also less likely to specify the need for two carers.

Standing or active hoist (power stand aid) These hoists (Fig 2) are suitable for patients who lack balance or the strength to stand independently, but can bear some weight through their feet and have core strength and balance to support themselves sitting or in a sling. An advantage is that patients can engage in the transfer, which helps to maintain function. However, the person must be able to understand and follow instructions.

Operating a hoist When operating a hoist, always follow the manufacturer’s instructions for use, including compatibility information and guidance on the checks needed. Remember to maintain good posture, as you would for any moving and handling operation (Rindsland, 2021c). To ensure safe and effective transfer:

Transfer aids are used to help patients move from sitting to standing when being transferred from one seated position to another (such as between bed, chair and toilet).Patients must be able to actively participate in the motion and partially weight bear, and have some upper-body strength, core strength and stability. Transfer aids that can be used for bed-to-chair transfers include:

Transfer boards (also known as slide boards) (Fig 6) can help with sit-to-sit transfer, such as moving from the edge of a bed to a chair or from a wheelchair to a toilet. They are suitable for amputees and patients with good sitting balance but very low/no standing balance. The choice of transfer board depends on the patient’s needs and the transfer surface. The move is predominantly an independent transfer (Brooks and Orchard, 2013), so check the patient meets the ability criteria and make sure your instructions are clear. Follow manufacturer’s instructions on the positioning of the chair, adjust surfaces so they are a similar height and minimise the gap between the chair and the bed; use a rota cushion to help foot movement if needed (Brooks and Orchard, 2013).

Equipment is key to reducing moving and handling risks, and meeting the patient’s mobility needs after a full assessment of the patient, but should only be used by trained, competent staff following local policies and protocols. If staff cannot access the appropriate equipment or assistance, or they lack the relevant and up-to-date training, they must raise this with their managers at the point of care, as this should never be a reason for failing to mobilise a patient.

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