Sundowning and the risk of a patient fall

[jm_emt]

Patient care plans usually designate how to transfer patients who need assistance sometimes describing them as one-person or two-person "transfer assist" patients. However a patient who is fresh, alert, and orientated most of the time often becomes disorientated and unable to follow directions or communicate effectively with the caregiver (often later in the day).

Such a patient would clearly be designated as a candidate for using a patient lift to transfer them in these circumstances (regardless of what the care plan says).

The SPH&M flowchart from VISN8 concludes that full body lifts should be used when a patient is not cooperative or cannot follow directions. (reference: http://www.visn8.va.gov/VISN8/PatientSafetyCenter/safePtHandling/SafePatientHandlingAssessment_Algorithms_121112.doc )

My question is: How do nurses handle transfer for these patients whose moods and skills vary so much based on time of day, level of consciousness, most recent medication, etc.?

It seems like a new ad-hoc assessment must be done every time these patient must be transferred. This seems like a big patient safety issue that is difficult to address.

[spowell16]

I would hope to think that someone would be smart enough to not attempt to transfer anyone that was having a behavior issue, such as agitation or anxiety. If this behavior occured during transfer then you would abort transfer after making sure that the patient was safe. There have been occurences when a someone has had to safely go to the floor with the patient to avoid the pt hurting himself and/or someone else.

[BuckyBadgerRN, ASN, RN]

I'm not sure of your intent on a website meant for nurses---and I don't believe you are one? You come across as some kind of lift salesman, thinly disguised as someone with a patients best interests in mind....

[quiltynurse56, LPN, LVN]

Answer: We base how the transfer is done based on moods and skills that vary based on the time of day, LOC and recent meds. We assess what is going on with the person and base our decision on that. Sometimes it is a matter of letting them have time and returning. There are many things we can and often do when it comes to these issues.

[Here.I.Stand, BSN, RN]

I always transfer based on my own assessment; I don't blindly follow the care plan. There are too many variables -- pt is more fatigued than usual, or I was sick and not at 100% strength, or the person who put 1 assist on the care plan is a foot taller than me...

I would never put a belligerent pt in a lift though. They could fall. Nor would I transfer them...I don't want to get hit. I'd wait until they were calm.

[Here.I.Stand, BSN, RN]

Oh, and my answer reflects real-world practice, not so much NCLEX or school correct.