Nursing Care During Patient Transfer

PURWOKO SUGENG HARIANTO

Introduction

o The intra- and inter-hospital

hospital patient transfer is an
important aspect of patient care
o Patient transfer is not simple
o Patient transfer is comprehensive infrastructure
and process involved before, during, and after
moving a patient from one location to another
o The risk of transferring a critically ill patient is
manifold
Introduction
o The reported prevalence of equipment
equipment-related mishaps
during critical care transport is from 11% to 34% (Day,
2010)
o Mortality rates during transport are low but adverse
events have been stated to be as high as 30% ((Jarden
and Quirke 2010)
o Every emergency nurse has the potential to become
involved with organizing and implementing an
interfacility transfer
o A poorly organized and hastily done patient transfer can
contribute to morbidity and mortality
 Key Elements of A Safe Patients Transfer

Decision to transfer and communication

Pre-transfer
transfer stabilization and preparation
Guidelines
for the Qualified and trained accompanying personnel
Transfer
Appropriate transport equipment

Standard monitoring and documentation

 Decision tree to transport
Transport required to optimize patient outcome? No Patient shouldn’t be transported

Yes

Can test/procedure be performed at the No Perform at bedside. Don’t transport

bedside?

Yes

Benefits of transport outweigh risks? No Patient shouldn’t be transported

Yes

Prepare to transport
Pope, Barbara B : Provide safe passage for patients. Nursing Management; Sep 2003; 34, 9; pg. 41
Communications
Prehospital

Before
transport

During
transport
After
transport
Pre transfer stabilization and
preparation
 A proper and meticulous preparation of patient should
be done before transfer
 The patient should be adequately resuscitated and
stabilized
 During the preparation, patient’s Airway, Breathing,
Circulation and Disability should be checked, and any
associated preventable problems should be corrected
 Use of pre-transfer check list
Pre transfer stabilization and
preparation
 Airway and breathing
 Hemodynamic stabilization:: control of bleeding, correction of
hypovolemia,, insertion of a urinary catheter, and institution of
cardiac monitoring
 Central nervous system stabilization:: maintain normal ICP, control
seizure, and preserve integrity of the spinal cord
 Musculoskeletal stabilization : include prevention of blood loss,
fracture immobilization, wound care, and administration of
analgesia
 Emotional and psychosocial support of the patient and family:
family
Emergency and transport nurses can address these needs by
recognizing the patient’s fears and answering any questions
Pre-transfer
transfer check list
Transport Equipment

The transport ambulance should

have all equipment needed for :
 Airway management
 Oxygenation & ventilation
 Hemodynamic monitoring
 All drugs for resuscitation
Accompanying the patient during
transfer
 Level 0:: not required to be accompanied by any specialised
personnel
 Level 1:: at risk of deterioration, have to be accompanied by a
paramedic or a trained nurse
 Level 2:: require observation or intervention for failure of single
organ system and must be accompanied by trained
and competent personnel
 Level 3:: requirement of advanced respiratory care, have to be
accompanied by a competent doctor along with a
nurse and a paramedic
Kulshrestha A, Singh J. Inter-hospital and intra-hospital
hospital patient transfer: Recent concepts. Indian J Anaesth, 2016;60:451-7.
PHYSIOLOGICAL ALTERATIONS DURING
TRANSPORT
 Noise
 Vibration
 Acceleration and gravitational forces
 Temperature and humidity
 Altitude
 Hypobaric hypoxia
 Expansion of gas in body spaces and in medical
equipment
 Third space fluid loss
 Motion sickness
Nursing Care Required During Transfer

Assessment
o Noise and vibration levels require extensive use of sight
and touch
o Open and inspect the patient’s airway
o Asses spontaneous breathing, chest rise and fall (depth
and symmetry),Skin colour, respiratory rate, Pattern of
breathing, Bilateral breath sounds and Use of accessory
and/or abdominal muscles
o Asses Circulation by palpate pulses, observe skin
moisture, observe color, assess pulse quality,
temperature, and degree of diaphoresis (sweating)
Nursing Care Required During Transfer

Assessment
o Stimulation of patient and observation of response in
relation to level of consciousness
o Measured Pulse, Respiratory Rate, Blood Pressure, oxygen
saturation using portable pulse oximetry, ETCO2 ,
Temperature
o Portable electronic monitoring of heart rate and rhythm
using Cardiac Monitor
o Direct observation of urine output: volume and color
Nursing Care Required During
Transfer
Interventions
o Provide for safety of transport
o Maintain airway patency and ventilatory support
o Ensure adequate oxygenation and perfusion
o Maintain circulation, cardiac output
o Administer medications or procedures as indicated
o Maintain normothermic body temperature
Nursing Care Required During
Transfer
Interventions
 Monitor and record GCS, vital sign, oxygen saturation,
cardiac rhythm and rate
 Check interventions
 Maintain control in coordinating movement of patient
into and out of facilities and transport vehicle
Arrival At Receiving Facility

 Accompany patient into facility and provide interventions as

needed
 Provide receiving team with verbal report and documentation
listed previously
 Maintain close interactions with patient
 Speak to family or friends if they have arrived
 Notify referring facility and patient family of safe arrival of
patient at receiving facility
 Collect equipment used for transport
 Close interactions with receiving facility staff
Documentation

 It confirms adherence to legal mandates

 Ensures compliance with established standards
of care
 Protects the nurse in potential litigious situations
 Documentation related to interfacility transfer
includes
 The pre-hospital record
 ED record
 documentation of care during the transfer
Documentation
The Adverse Events During Transfer

o Medical:
o Cardiovascular: Severe hypotension or hypertension,
arrhythmia, cardiac arrest
o Respiratory : Hypoxia, aspiration, accidentextubation,
bronchospasm
bronchospasm, pneumothorax
o Neurological: Agitation, intracranial hypertension
o Hypothermia
o Equipment malfunction or Technical
o Human error: Drug error
Sethi and Subramanian: Inter-hospital
hospital transfer of the critically ill, Saudi Journal of Anesthesia, 2014
Mitigating The Risks
 Stabilization and preparation of patients before transfer
 Anticipating the adverse events and being prepared
 Comprehensive training of the transport team
members
 Customized transport equipment and knowledge of
their functioning
 Standardized practices and protocols and adhering to
the same
 Checklists and scrupulous performance of all checks

Sethi and Subramanian: Inter-hospital

hospital transfer of the critically ill, Saudi Journal of Anesthesia, 2014
Summary

 Patient transfer requires an organized process

 The transport crew should be trained and skilled to
anticipate and manage any technical and medical
contingencies that may arise during the transfer
 A good organized patien transfer and nursing care
during transfer can reduce the risk and prevent adverse
events
 The overriding concept of any patient transfer should
always be safety
References
 Day,D., (2010). Keeping Patients Safe During Intrahospital Transport. Crit Care Nurse 18-32 30 2010;
10.
 Divatia, J., & Siddiqui,, S. (2016). Transporting critically ill patients: Look before you leap! Indian
Journal of Anesthesia, 60(7)
 Howard, P.K. & Steinmann, R.A., (2010). Sheehy's Emergency Nursing: Principles and Practice. Sixth
Ed. Philadelphia, PA, Elsevier Inc.
 Jarden,, R. J., & Quirke, S. (2010). Improving safety and documentation in intrahospital transport:
Development of an intrahospital transport tool for critically ill patients. Intensive & Critical Care
Nursing, 26(2), 101-7.
 Kulshrestha, A., & Singh, J. (2016). Inter-hospital
hospital and intra
intra-hospital patient transfer: Recent
concepts. Indian Journal of Anesthesia, 60(7)
 Pope, B. B. (2003). Provide safe passage for patients. Nursing Management, 34(9), 41-6.
 Robinson, K. (2007). Emergency nursing core curruculum:
curruculum Emergency patient transfer and
transport. sixth ed. Philadelphia, PA, saunder
 Sethi,, D., & Subramanian, S. (2014). When place and time matter: How to conduct safe inter-
inter
hospital transfer of patients. Saudi Journal of Anaesthesia,
Anaesthesia 8(1), 104-113.
Thank you