Transfers Risk Assessment for Janice James

Janice James was last reviewed on 21/12/2021 and was recommended Full Body Lifter transfers as Janice has reduced grip strength in bilateral hands and
bilateral lower limb weakness (on background of medical conditions: h/o TIAs, Hemiparesis, Recent Rib fractures, etc) posing risk of falls.

Since the change with transferring equipment, we had multiple meetings to address the concerns raised by Janice (please refer to the progress notes). Janice
reports that she feels scared when being lifted up and anxious+++, specifically she is scared when being lifted up and starts rotating/ when staff are moving
the machine. She is scared of having a fall from the lifter and strongly disapproves using the Full Body Lifter for transfers. She has voiced her disapproval
with the family, ED, CD, Physio and Care staff. Staff education sessions were organised, issues were discussed and alternate strategies were suggested and
practised to provide more comfort and easy transfer process for the resident.

Despite the interventions, Janice refused to be transferred using the Full Body Lifter. As an alternative, she was also transferred on a princess chair using a
Pat- slide with 4 x Care staff + Physio. But Janice was extremely anxious during the transfers and held on to the bed or chair while being moved. This poses
an extremely high risk on Janice as well as the care staff transferring her. During the last meeting with Janice and her Husband (John) on 22/12/2021, it was
informed that the change in the transferring equipment is creating distress for the resident and Janice started to strongly refuse showering/ toileting for fear
of being lifted up. Janice’s husband requested to have a risk waiver and to use stand-up lifter (SUL) for transfers to alleviate any psychological distress for
his wife.

Functional deficits identified Risks identified Technique of transfer to minimise Safety strategies suggested
the risks
1) Reduced AROM in arms with Gr 1) Loss of grip while holding the 1)To ensure that there is minimal travel 1) Care staff to ensure resident is
3 to 3/5 strength on left side and SUL machine during transfer. in the SUL, the SUL not to be used for always assisted with hands-on
grip 2 to 2/5 strength on right 2) Buckling of knees/ knees giving travel from bed to toilet. support throughout the transfer
side (h/o Hemiparesis and TIA’s) away during the transfer and risk 2) It is recommended that staff are procedure and provide reassurance.
2) Degenerative changes in of collapse in the SUL machine. prepared with everything in place 2) Minimise the transfer time as
shoulder, fingers, and B/L knees. 3) Risk of twisting ankles/ hurting before commencing transfer, in able and encourage resident to
3) Limited Shoulder ROM on Left metatarsal bones if feet are not order to minimise time spent in participate as able.
side due to rounding of shoulder positioned appropriately or if SUL. 3) Ensure 3 staff members are
limiting shoulder flexion to 90 resident collapses by twisting her 3) Resident to be transferred from involved in transfers, and provide
degrees. Noted to have non- feet. bed/chair onto mobile commode hands on assistance to keep hold of
chair using stand-up lifter and the handles, as well as verbal
verbal signs of pain like
brought to the toilet. prompts.
grimacing and guarding on
 movement beyond available
range. Able to form cylindrical
and power grips on L>R. Poor
grip strength on R side.
4) Weakness in bilateral lower
limbs R>L - Poor AROM in both
lower limbs. (3/5 MMT on left
and 2/5 on right side).
5) Poor strength in bilateral hips
and ankles L>R (3/5 MMT on
left and 2/5 on right side) due to
h/o Hemiparesis and TIA’s.
6) Minimal trunk control with
variable presentation; unable to
sustain unsupported postures for
more than a few minutes.
Occasionally able to maintain
unsupported posture for approx.
5-10 mins depending upon
physical condition and mood.
(h/o L side Rib fractures 4th,5th
and 6th from previous fall).
7) Poor sit to stand ability,
requiring full physical assistance.
8) Poor endurance to sustain weight
bearing positions.
9) Has difficulty with positioning/
controlling feet and unable to
extend the trunk without
maximum physical assistance.
4) Risk of hitting the metal frame
with head/knees when resident
collapses during the transfer.
5) Risk of staff injury in case of
sustained maximum assistance of
resident who is falling or unable
to support themselves/be
properly supported in the SUL.
Ensure a staff member stays with 4) During collapse, staff member
the resident encouraging to hold on with the resident to protect resident’s
to the handles at all times during the head and hips as able. Staff should
transfer. not try to “catch” the resident while
4) Technique: A x 3 + Stand up falling due to high risk of staff
lifter transfers: where one staff injury.
controls the lifter mechanisms, 5) Liaise with RN to report any
second staff to keep hold of the concerns or incidents, and refer to
handles and physically assist with GP or Physio as required.
positioning of the resident on the 6) Janice to be provided strength
stand-up lifter along with clear training exercises as required to
verbal prompts, and third staff to be encourage improved participation
always supporting the back of the during transfers, and minimise risk
resident to ensure complete hands- to staff.
on physical support throughout the
transfer. Staff to ensure resident is
never to be left without hands-on
support during transfer.
a) Explain the transfer procedure to
the resident, and reassure Janice at
each step and as needed to help
minimise anxiety.
b) Sling applied and hooked up to
the lifter ensuring the last hook is
used at all times for securing the
resident (as tolerated by the
resident, due to h/o L Rib fractures)
and then resident is transferred on
the mobile commode chair and
wheeled to the toilet.
c) Ensure foot positioning is
adjusted to shoulder width apart to
gain better base of support.
d) Staff to make sure brakes on
stand-up lifter are applied during set
up/positioning Janice in the lifter to
minimise movement from machine
and thus preventing loss of balance
for resident.
f) Prior to lowering the resident, pull
the trousers down before ensuring
she is sitting right on top of the
commode and minimise soiling with
towels/ tissues.
g) After toilet procedure
completion, resident is wheeled
back on commode, and transferred
back on bed/chair using stand-up
lifter.