Every Occupational Therapist with a mission to implement single handed care packages will have to risk assess, among other tasks, the manoeuvre of a carer to turn a patient in bed alone.
Provided that the carers have received manual handling training, it should be straight forward, but is it?
The manoeuvre to turn a patient alone, when a slide sheet is not used, is performed in the following steps:
- Raise the bed to at least waist height;
- Cross the patient’s arms over their chest;
- Bend the leg towards you;
- Push gently across the hip and the shoulder so that the patient rolls away from you;
- Once the patient is in a side-lying position, ensure that the knees and the ankles of the patient do not rest on each other;
- Place a wedge behind the upper back, support the top leg using a pillow or an appropriate positioning pad, and do the same for the top arm; and
- Check for comfort and re-adjust.
The same manoeuvre when a slide sheet is provided is as follows:
- Insert the slide-sheet under the patient;
- Cross the patient’s arms over the chest;
- Bend the leg that is away from the rolling direction or cross the ankles;
- Move around the bed. The person performing the manoeuvre needs to be positioned at the side of the bed the rolling is being directed;
- Grasp the slide sheet firmly from the other side and pull it towards you and over the patient until you achieve the side-lying position; and
- Move to the other side of the bed and now pull the slide-sheet laterally so that you can bring the patient with that lateral manoeuvre into the middle of the bed.
Things to consider when assessing how to turn a patient alone:
- The dependency of the person and the level of assistance they can offer during the task
- The size of the person (is the width of the bed enough to perform the manoeuvre safely?)
- The weight of the person (is the manual force provided by a single person enough to perform the task safely by avoiding leaving the patient stranded midway or having a fall?)
- Are there side rails installed at the sides of the bed?
- Is the reach and stretch of the carer within safe limits or is the risk of an MSK injury increased?
- Is the slide sheet (when used) fit for purpose? Can it be inserted by a single person?
There is also the problem of inconsistency. During the risk assessment we take into account the competency level of the carer but unless the carer is a family member we cannot ensure that we will have the same carer everyday performing the above task.
High turnover of carers means that the risk level is fluctuating for both the carer and the patient.
If, after considering the factors above, you conclude that the above single handed manoeuvre isn’t viable, before you introduce a second carer, consider the use of a powered in-bed repositioning system that will ensure the consistency, safety and dignity during the task. The VENDLET is the world’s first powered patient turning system – it’s your second (third, fourth…) carer, always at hand.