Definition
Transfer of a patient is defined as shifting a patient from one department to another department in the same hospital between hospitals.
Purposes
- To receive different forms of therapy and management.
- To have care continued closer to home.
- To have care continued when financial resources prohibit receiving care in the current facility.
- To provide more skilled care and close observation in specialized units.
Elements of Patient Transfer
Mode of Transfer
| Ground transport | Air transport |
| Basic life support ambulanceAdvanced life support ambulanceMobile ICU (MICU) | 1.Fixed wing/airbus ambulance 2.Rotor wing or helicopter ambulance |
Articles
Following are the articles which are to be checked for their availability depending on the type of transfer and facility available.
- Wheelchair or stretcher.
- Nasogastric tube and bag
- Urinary catheter and bag
- Nasal decongestant spray
- Instruments, sutures, dressing, antiseptic lotions, gloves
- Thermal insulation and temperature monitor
- Splints and equipment for spinal and limb immobilization
- Neonatal/pediatric/obstetric transport equipment when applicable
- Dressings bandages, slings, splints and tape
- Cutting shears and portable torch
- Gloves and glasses for staff protection
- Warming blankets
- Plaster cutters
- Portable torch
- Requisition forms
- Records
- Isolate for care of newborns
- Circulatory support equipment:
- Monitor/defibrillator/external pacer combined unit
- Pulse oximeter
- Aneroid sphygmomanometer (not mercury-containing) with a range of cuff sizes
- Vascular cannula, peripheral and central
- IV fluids and pressure infusion set Infusion pumps
- Arterial cannula
- Arterial monitoring device (pressure transducer)
- Syringes and needles (a needleless system would be ideal)
- Pericardiocentesis equipment
- A sharps disposal container and a bag for biological refuse
19. Respiratory support equipment:
- Airways (range of oral and nasopharyngeal airways and a range of laryngeal mask airways)
- Oxygen, masks, nebulizer
- Self-inflating hand-ventilating assembly, with PEEP valve
- Suction equipment of appropriate standard, preferably two-foot powered and electrically operated.
- Portable ventilator with disconnection and high-pressure alarms
- Intubation set (including a range of laryngoscope blades and endotracheal tubes)
- LMA should be available in case of an accidental loss of airway
- Emergency surgical airway set (cricothyrotomy)
- Pleural drainage equipment-intercostal catheters and underwater seal bottles
- Oxygen supply in excess of that estimated for the maximum transport time.
- Handheld capnometer
- Preferably a spirometer to measure to minute ventilation
Procedure
| Nursing action | Rationale | |
| 1 | Assess reason for patient’s transfer in collaboration with physician (e.g., change in condition, resources available at agency, patient or family preference regarding patient’s transfer). | Patients should have access to an agency with the best resources to meet their health care needs. |
| 2 | Inform the nurse-in-charge of the new ward about the transfer. | Prior information will help the staff in the new unit to receive the patient with adequate preparation. |
| 3 | Check the belongings of the patient and keep ready for shifting. | Ensures that patient’s belongings are safe. |
| 4 | Complete patient charts and make it up to date. Keep ready the patients’ record with X-rays, ECG, laboratory reports and the medicine card. | Provides information about the care and treatment provided. |
| 5 | Assess patient’s physical condition and determine the mode of transportation (if patient needs to be shifted to another hospital) | Determines if patient is stable for transfer. Patient’s safety is best assured by using a vehicle equipped with life-support equipment. |
| 6 | Determine patient’s level of understanding regarding purpose of transfer and feelings about the change in care setting. | Transfers are sometimes planned quickly. Patient requires adequate psychological preparation. |
| 7 | Inform patient and his relatives about the purpose of transfer. | Reduces anxiety |
| 8 | Prepare summary of patient’s treatment and condition. Complete the nurse’s record and transfer form. | Provides summary of patient’s nursing care needs and ensures continuity of care. |
| 9 | Anticipate problems patients may develop just before or during transfer and perform necessary nursing therapies, such as nebulization, medicine administration, etc. | Ensures patient’s comfort and safety during transport. |
| 10 | Assist in transferring patient to stretcher or wheelchair using proper body mechanics. | Reduces risk of injury to patient and nurse. |
| 11 | Perform final assessment of patient’s physical stability (check vital signs, airway, etc.). | Minimizes risk of patient developing complications during transfer. |
| 12 | Accompany the patient to the receiving unit or hospital. | |
| 13 | Hand over all documents and belongings of patient to the receiving nurse and ensure that the items given are noted | Ensures completion of transfer procedure. |
| 14 | Complete the needed documentation after transfer according to agency policies. policies | Nurses are legally responsible for documenting the transfer of patients |
Special Considerations
| System affected | Complications | Prevention strategy |
| 1.Pulmonary and airway complication | Oxygen desaturation, Atelectasis, bronchospasm, pneumothorax, Accidental extubation, Airway loss | 1. Provide optimum 2. Sedation and analgesia. 3. Suctioning of ETT. 4. Confirm correct position of ETT. 5. Provision of full oxygen cylinder and a functioning pulse oximeter. |
| 2. Cardiovascular complication | Tachycardia, Hypotension, Hypertension, Arrythmia, Cardiac arrest | 1.adequate resuscitation 2.provision of invasive and non-invasive hemodynamic monitoring |
| 3. Infectious complication | Ventilator-associated pneumonia | 1. Proper aseptic technique 2.Proper communication between receiving and transferring patients. |
| 4. Endocrine complication | Hyperglycemia, Hypoglycemia, Acid-base derangement and interruption in vital infusion | 1.Proper blood gas analysis before and during the procedure. 2.Ensure running and patent lines to continue infusion – blood glucose assessment. |
2. Common drugs which should be available while transferring the patient.
- Amiodarone 150mg/3ml
- Atropine 1mg/10ml
- Calcium chloride or gluconate 1g/10ml
- Dextrose 25% ,10ml
- Dextrose 50%,50ml
- Digoxin 0.5mg/2ml
- Diltiazem 25mg/5ml
- Diphenhydramine 50mg/1ml
- Dopamine 200mg/5ml
- Epinephrine 1 mg/10ml (1:10,000)
- Fosphenytoin, 750 mg/10 ml (500 PE mg/10 mL)
- Furosemide,100 mg/10ml
- Glucagon, 1 mg vial (powder)
- Heparin, 1000 units/1 mL
- Isoproterenol, 1 mg/5 ml
- Labetalol 40mg/8ml
- Lidocaine, 100 mg/10 ml for infiltration
- Lidocaine, 2 g/100 mL preservative free
- Magnesium sulfate, 1 g/2 mL
- Methylprednisolone, 125 mg/2mL
- Mannitol 50g/50ml
- Nitroglycerin injection, 50 mg/10mL
- Nitroglycerin tablets,0.4 mg (bottle)
- Nitroprusside, 50 mg/2 mL
- Norepinephrine 2 mg/mL
- Normal saline, 30 mL for injection
- Phenobarbital, 65 mg/ml or 130 mg/mL
- Phenytoin 100 mg/mL
- Potassium chloride, 20 mEq/10 mL
- Procainamide, 1000 mg/10 mL
- Sodium bicarbonate, 5 mEq/10mL
- Sterile water, 30 mL for injection
- Terbutaline, 1 mg/1 mL
- Verapamil, 5 mg/2 mL)
- Crystalloids: NS and RL 500 mL/1000 mL
- Colloids: Starches and Gelatins 500 mL
The following specialized/controlled medications are added immediately before transport as indicated-
Narcotic analgesics (e.g., morphine, Metoprolol,5 mg /5ml, Naloxone,2 mg/2 mL fentanyl) Naloxone,2 mg/2 mL fentanyl) Sedatives/hypnotics (e.g,lorazepam, midazolam, propofol, ketamine) Neuromuscular blocking agents (e.g., succinylcholine, pancuronium atracurium, rocuronium) prostaglandin E
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
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