Moving unresponsive patient from chair

[Eleanor Barrett]

Happy new year all,
Does anyone know what is the best way to move an unresponsive patient sitting in a chair to the bed?
Staff suggested to me that it was quicker for 3 staff to man handle the patient between them rather than use equipment available on the ward.

[Anne McMahon]

Hi Eleanor
Depending on the whole picture, you have to use your clinical judgement and assess for a faint, an arrest or other. If its a suspected arrest we teach you call for assistance, pull them to the floor manually, applying a pillow under the head if possible. That situation is life threatening and A,B, C’s come first. If you suspect it is a vaso-vagal or faint you would check ABC’s and if all good get medical assessment if concerned, or wait a few seconds, this may allow patient to come round. Either way we would hoist to the bed once patient stable.
Thanks
Anne

[Michelle Nevil]

Thank you for asking this question!
This is an on going problem for us too and often results in staff injury.
I have asked for advice from our resuscitation educator since this type of transfer is often performed since there is a need to perform CPR.
We both agreed that the best place for the patient is on the floor and so recommend that by carefully using a slide sheet the patient can be slide to the floor and recovery efforts performed on the floor.
When patient is stable to move, they would be moved using a Hovermatt and Hoverjack back to bed.
HOWEVER….is this what happens in practice????
The answer is usually no…..
This month I am attending the CNM meeting to discuss this very scenario.
I feel it requires a team effort to discuss and risk assess and develop a plan BEFORE it happens.
As I am typing this Anne has added her response and I agree wholeheartedly.
Fingers crossed that we can have success spreading this message.

[Mike Fray]

I agree with the general comments suggested here. The UK Resuscitation guidelines has included a general information about the process of moving someone who is in need of CPR as obviously there is no effective way of doing it in sitting.

All options are to as safely as possible transfer the patient to the floor using equipment that is readily available (slide sheets, pillows for protection, etc.) People have suggested many alternatives over the years but there is little published about the optimum approach for life threatening conditions. e.g. Slide sheet under patient, slide sheet under feet to aid slide on floor, kneel in front of chair and lean the patient forward out of the chair, considerations of moving bed or chair or other items etc.

It is clear that a single method is unlikely to be agreed as each event requires an assessment of the individual at that precise moment.

[Eleanor Barrett]

Thank you all. I have canvassed opinion here with the physio team who also suggest get the patient to the floor then deal with the treatment needs. Use equipment to get the person up again afterwards. Now I just need a way of installing this into the practice of some staff! We are not good at doing the stop, aseess, plan, act process. This will be a key theme for the 2020 round of training here!

I wonder if we could link this sort of scenario into CPR training so people think of this when they are involved in CPR? The scenarios I have been given on the basic level of training all involved the adult patient on the floor to start with.

[Jessie Snowdon]

Hi everyone – our Christchurch group discussed this topic tonight and the outcome was we were going to put it on the forum…looks like it is already there! We reviewed two guides (Australia and UK) and a detailed email from the Aussie forum on this topic. From our conversation some of our key thoughts were
– we like the idea of preparing for this i.e if person is likely to faint or medically unstable they should only be sat in a chair that goes flat and/or sides come away
– that we SHOULD be discussing this more and planning for it as staff likely to hurt themselves in emergency situation that they don’t plan for
– in Aged care (where a few of us work) it is likely (but shouldn’t be presumed) that person may be NFR so inappropriate to be doing heroic and dangerous manual handling anyway
We also reflected that we are surprised as a group that we aren’t asked about this more when we do training.

Would love to know of any NZ guidelines or follow up from the earlier discussions. Also agree it ties in really nicely with CPR> When I have done first aid courses in the past they never cover this.

[Eleanor Barrett]

Thanks Jessie for reminding us. Our DHB bases their CPR on the UK resus council guidelines. I have since found a copy of this – an old out of date version had been loaded to our intranet and forgotten. These guidelines have an illustration of the best techniques to use for staff safety.
We have introduced a non-responsive patient in a waiting room as a scenario at the end of the Introduction to M&H day we are running for all new staff. It uses a mannequin and we get the team to do a risk assessment prior to starting and ask them to talk through how they can look after themself. Then we practice, as the mannequin does not mind being pulled to the floor over and again. We don’t bother with going to look for sheets/pillows etc as that is a time delay and the guidelines suggest it gets in the way more than helps. I am hoping later in the year to set up this as a scenario with my M&H educators and the CPR tutors. we will have one attempt with many cameras filming and they can pull me to the floor once only so we can use this for training. Will keep you posted.

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