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PATIENT TRANSFER ASSESSMENT STRETCHER

Student:

Clinical Affiliate: Date:

Evaluation objective: With a patient in an equipped clinical setting, the student will be able to perform patient transfers with 100% accuracy.

EVALUATOR: Please CHECK the appropriate box that corresponds to the student’s performance.

	STRETCHER TO RADIOGRAPHIC TABLE	Yes	No
1.	Evaluates the patient’s condition prior to transfer.
2.	Places stretcher alongside of the table and secures.
3.	Insures that all tubes and lines are not compromised during transfer.
4.	Places patient’s arms across his/her chest.
5.	Properly supports patient’s head, pelvis and lower extremities during transfer.
6.	Assures that a second assistant is on the opposite side of the stretcher to prevent stretcher from moving away from the table.
7.	Communicates with the patient and those helping with the transfer.
8.	Secures sheet or pad and slowly pulls patient to the edge of the stretcher.
9.	Slowly moves the patient onto the radiographic table.
10.	Practices Standard Precautions.

	RADIOGRAPHIC TABLE TO STRETCHER	Yes	No
1.	Moves tube housing and/or fluoroscopic units into a safe position.
2.	Secures sheet or pad and slowly pulls patient to the edge of the table.
3.	Places stretcher alongside of the table and secures.
4.	Insures that all tubes and lines are not compromised during transfer.
5.	Places patient’s arms across his/her chest.
6.	Properly supports patient’s head, pelvis and lower extremities during transfer.
7.	Assures that a second assistant is on the opposite side of the stretcher to prevent stretcher from moving away from the table.
8.	Communicates with the patient and those helping with the transfer.
9.	Slowly moves the patient onto the stretcher.
10.	Practices Standard Precautions.

Comments:

Evaluator's Signature:

Student’s Signature

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