12.8.12: Procedure- Transfer from Wheelchair to Toilet
When transferring a patient from a wheelchair to toilet, Home Health Aides/Personal Care Aides should position the wheelchair chair next to the toilet, or at an angle facing the toilet. When transferring a patient from the toilet to the wheelchair, reverse the procedure, following the same safety rules. Home Health Aides/Personal Care Aides should always use proper body mechanics to ensure the safety of themselves and their patient. Remember to offer toileting at least every two hours, and more frequently as needed.
- Explain the procedure to the patient.
- Wash your hands and don gloves.
- If you are required to measure the patient’s output, place the measuring tool, or hat in the toilet.
- Follow the guidelines in the procedure “Transfer to a Wheelchair , Chair , or Commode”.
- Place the wheelchair at an angle, facing the toilet or commode. Alternatively, you may position the wheelchair so it is parallel (next to) the toilet.
- Ensure wheelchair locks are on. Raise or remove footrests.
- Stand in front of, and facing, the patient. Place your feet about 12 inches apart. Put the foot closest to the toilet in front of you, with your other leg slightly behind. Use your thigh muscles to provide a strong base of support. Keep your back aligned with your hips. Slightly bend your knees. Remember to avoid twisting your body as you move.
- Brace your knees against the patient’s knees and block their feet with yours. Alternatively, you can place one knee and foot against the patient’s weakest leg. Your other foot should be slightly behind you. You may also straddle both your legs around the patient’s weakest leg.
- Assist the patient to a stand and pivot backward until the patient’s back is toward the toilet or commode. Follow the procedures, “ Helping a Patient to Stand ”, and “ Transfer to a Wheelchair , Chair , or Commode”.
- Place your hands on the patient’s waist, or if using a gait belt, grasp the gait belt securely.
- Instruct the patient to hold onto the grab bars near the toilet for support and balance.
- Instruct the patient not to sit until they feel the toilet or commode at the back of their knees.
- Instruct the patient to take small steps until they feel the toilet/commode behind their knees. If the wheelchair is parallel to the toilet, they should take small steps to the side, moving in the direction of the toilet. If the wheelchair is at an angle to the toilet, they should take small steps backwards.
- If the patient is able, support them while they remove their pants/underwear. If unable, assist with removing pants/underwear. Have the patient hold onto the grab bars in the bathroom for support. Make sure that clothing is not caught at the patient’s feet in a manner so that they could trip.
- When the patient’s knees are touching the toilet/commode, ask them to put their hands on the armrests of the commode or on the support bars of the toilet. If using a gait belt, hold onto the gait belt securely. Gently assist with or lower them into a sitting position.
- Stay in front of the patient and check they are not experiencing dizziness, weakness, or shortness of breath. Make sure to record and report any conditions observed or statements made by the patient to indicate this.
- Allow for privacy. If the patient is weak, or requests, you should stay with them.
- Assist with cleaning the patient when they are done using the restroom.
- Assist with transfer back to wheelchair/chair. Reverse the procedures used to assist the patient during transfer to the toilet. Ensure that wheelchair brake locks are on and feet are resting in the foot rests, with the leg rests appropriately positioned.
- Teach the patient to wash their hands at the sink if able. If too weak to stand, you should provide a warm, soapy washcloth or hand sanitizer for the patient to use.
- If the patient begins to fall during a transfer, widen your stance. Bring the patient’s body close to you to provide support. Bend your knees and using the strength of your thighs, lower the patient to the ground.Home Health Aides/Personal Care Aides should report the near fall or any actual falls immediately to their supervisor. Do not attempt to get the patient up alone. The agency may require the patient gets evaluated by a nurse before helping the patient back up. Report any injuries or concerns. Home Health Aides/Personal Care Aides will also likely be required to complete an incident report, and should seek direction from their supervisor about completing the incident report.
- Remove gloves if wearing and wash your hands.
- Document the procedure and any observations or changes in condition.