What three safety checks should be performed before getting your patient out of bed?

September 21, 2025 •

4 min read

According to the Centers for Disease Control and Prevention (CDC), one out of every four older adults falls each year, and many of these falls occur during transfers. Knowing what three safety checks should be performed before getting your patient out of bed is crucial for preventing injuries and ensuring a safe transfer for both the patient and the caregiver.

Quick Summary

The three critical checks are a comprehensive patient assessment (readiness, strength, and cognition), a thorough environmental assessment for hazards, and a complete equipment readiness check. These actions significantly reduce the risk of falls and other injuries during patient transfers.

Key Points

Assess Patient Readiness: Confirm the patient's physical strength and ability to cooperate, and check for cognitive or medication-related risks before beginning the transfer.
Ensure a Safe Environment: Clear the transfer path of any clutter or obstacles, and ensure all equipment, including the bed and wheelchair, is securely locked.
Prepare and Inspect Equipment: Gather all necessary assistive devices like gait belts and non-slip footwear, and inspect them for proper function and wear.
Use Proper Body Mechanics: Protect yourself from injury by lifting with your legs, keeping your back straight, and pivoting your feet rather than twisting your torso.
Communicate Clearly: Verbally guide the patient through each step of the transfer, and use a consistent cue, like counting to three, to coordinate movements.
Recognize When to Stop: Be prepared to halt the transfer if the patient shows signs of dizziness, pain, or instability, and safely return them to a resting position.

The Three Critical Safety Checks for Patient Transfer

Patient mobility is a key component of rehabilitation and recovery, but it must be managed with extreme care. The risk of falls and injury is high, making a standardized safety protocol essential. By following three fundamental safety checks, caregivers can perform transfers confidently and keep patients safe.

Check 1: Patient Assessment and Readiness

Before attempting any transfer, the caregiver must assess the patient's physical and mental status. This isn't a one-time check but a continuous process that evolves with the patient's condition.

Physical Strength and Ability: Can the patient bear their own weight? Ask them to perform simple movements like wiggling toes or pushing against your hands with their feet. Observe their ability to sit up and maintain balance on the edge of the bed for a short period. This dangling period also helps acclimatize them to an upright position and can reveal issues with dizziness.
Cognitive and Behavioral Assessment: Is the patient alert and oriented? Can they follow simple, one-step directions? It is vital that the patient can understand and cooperate with the transfer process. If the patient is confused, agitated, or unable to follow instructions, the transfer method may need to be altered to a non-weight-bearing transfer with a lift.
Pain Levels and Medications: Pain can impact a patient's mobility, strength, and cooperation. Assess their pain level using a numeric scale and consider if they have taken pain medication recently that might cause drowsiness or lightheadedness. For instance, some medications can increase the risk of orthostatic hypotension (a drop in blood pressure when standing).

Check 2: Environmental Hazard Assessment

The transfer space must be free of any obstacles or potential dangers that could compromise the patient's safety or the caregiver's body mechanics.

Clear the Path: The route from the bed to the chair or other destination must be clear. Remove any clutter, cords, equipment, or furniture that could cause a trip or obstacle. A clear, direct path minimizes the need for complex maneuvers.
Lock All Equipment: Before beginning, ensure the brakes are securely locked on the bed, wheelchair, or any other equipment involved in the transfer. An unlocked wheel can lead to a fall or destabilize the patient. Always test the locks before proceeding.
Adjust Bed Height: Position the bed to a height that is safe for both the patient and the caregiver. The ideal height often allows the caregiver to maintain good body mechanics by avoiding excessive bending or reaching. The bed should be lowered to the patient's knee level before the patient attempts to stand.

Check 3: Equipment and Supplies Readiness

Having the right tools and knowing how to use them is the final critical step. Proper equipment provides support and facilitates a smoother, safer transfer.

Gather Assistive Devices: Depending on the patient's needs, gather all necessary equipment beforehand. This may include a gait belt for secure handling, a walker or cane, or special non-slip footwear. Ensure the patient is wearing appropriate footwear—socks alone are not safe.
Inspect All Equipment: Before use, a quick inspection of all equipment is necessary. Check gait belts for fraying, wheels on walkers for proper function, and assistive devices for stability. For mechanical lifts, confirm the battery is charged and the sling is the correct size and free from damage.
Confirm Sufficient Help: Based on the patient assessment, confirm the appropriate number of caregivers are available. Some transfers, particularly with non-weight-bearing or bariatric patients, require multiple trained individuals and specialized equipment.

Body Mechanics and Communication During Transfer

Beyond the three main checks, proper body mechanics and communication are paramount.

Use Proper Body Mechanics: Always lift with your legs, not your back. Keep your back straight, bend at the knees and hips, and engage your core muscles. Keep the patient close to your body to maintain a low center of gravity. Pivot with your feet, do not twist your torso. For a comprehensive guide on proper lifting techniques and posture, consult this resource from the CDC.
Communicate with the Patient: Verbally guide the patient through each step of the process. Tell them what you are doing before you do it. Use a clear, reassuring tone. Counting to three before initiating a movement can also help coordinate efforts.

A Comparison of Transfer Preparation Steps

To illustrate the importance of a comprehensive approach, here is a comparison of typical versus best-practice preparation.


Aspect	Typical Preparation	Best-Practice Preparation
Patient Readiness	Asks 'Are you ready?'	Assesses pain, strength, balance, and cognition
Environmental Setup	Clears main path	Systematically clears all hazards, locks bed/chair
Equipment	Grabs gait belt if needed	Inspects all equipment, gathers non-slip footwear
Body Mechanics	Relies on back strength	Uses legs to lift, maintains straight back, pivots feet
Communication	Minimal or hurried instruction	Explains each step calmly, uses '1, 2, 3' cue
Contingency Plan	Hopes for the best	Knows when to stop and return the patient to bed

Conclusion

Conducting a safe patient transfer is a multi-faceted process that requires diligent preparation. By consistently performing the three key safety checks—patient assessment, environmental inspection, and equipment readiness—caregivers can drastically reduce the risk of falls and injury. The discipline of these steps protects not only the patient but also ensures the longevity and safety of the caregiver. Taking the extra time to prepare properly is a small investment that yields a massive return in terms of patient well-being and professional care.

Frequently Asked Questions

Initial signs of unreadiness include a lack of responsiveness, inability to follow directions, expressed pain, or visible dizziness and weakness when first brought to a sitting position. If any of these are present, the transfer should be paused or stopped.

Dangling the patient's feet over the edge of the bed for a few minutes allows their body, particularly their circulatory system, to adjust to the upright position. This helps prevent orthostatic hypotension (a sudden drop in blood pressure) which can cause dizziness and falls.

A gait belt is a safety device placed around a patient's waist to provide a secure point of contact for the caregiver. It gives the caregiver a firm grip to assist the patient with standing, walking, or transferring, reducing the risk of a fall.

If a patient begins to fall, do not attempt to hold them upright. Instead, guide them safely to the floor by controlling their descent to protect their head and neck. Use your body to cushion their fall and then call for assistance.

Involving the patient can increase their confidence and cooperation. Provide clear instructions, explain the process step-by-step, and assign them tasks they can safely perform, such as pushing with their legs or holding onto a stable surface.

Not necessarily. The best method depends on the patient's assessment. For some, a walker or simply a secure, supervised walk may be appropriate. The choice of equipment should always be based on the individual's needs and capabilities to promote independence while ensuring safety.

Safe footwear includes non-slip or anti-skid shoes or slippers. Socks alone should be avoided unless they have integrated rubber or silicone grips on the soles to prevent sliding.