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  • 7217 Hyacinth Court Greendale, WI 53129 Office (414) 529-5175 Fax (414) 529-3433 www.patran.net

    PATRANSLIDESHEETSANINEXPENSIVEWAYTOSTARTASAFE-PATIENT-HANDLINGPROGRAM

    StefanieScott,CSPHASTEFANIESCOTT,CSPHA,ispresidentofJamarHealthProducts,makerofPATRANslidesheets

    ABSTRACT

    Budgetcrunchesandchangestotheleveloffinancialreimbursementformedicaltreatmentandstayshaveput

    economicstrainsonhealthcarefacilities.Thestruggleoverfinancialprioritieshaskeptsomefacilitiesleadersfrom

    allocatingdollarsforsafe-patient-handlingequipmentandpractices.Yet,in-roadscanbemadeinreducingworkers

    compensationclaimsandothercostsrelatedtocaregiverinjurieswithonlyasmallinvestmentbyimplementingsimple

    yetversatileslidesheets.Thesesheetsgreatlyreducefriction,allowingcaregiverstoslideapatientwithouttheneedfor

    liftingorstrenuoustugging.Slidesheetscomeinavarietyofstylesandsizesand,whilenotappropriateinallsituations,

    canbeusefulinnumerousfrequentlyencounteredscenariosfrommovingapatientwithintheirbedtotransferringa

    fallenpatienttoamechanicalliftdevice.

    KeyWords:slidesheets,safe-patienthandlingandmovement,equipment

  • 7217 Hyacinth Court Greendale, WI 53129 Office (414) 529-5175 Fax (414) 529-3433 www.patran.net

    INTRODUCTION

    Ashealthcareadministratorsfindoperatingbudgetsgettingtighter,someperceiveimplementationofasafe

    patienthandlingandmovement(SPHM)programastoocostlytopursue.ButtheAmericanNursesAssociation

    (ANA)andotherhealthcaregroupssaythatsafallacy.1,2

    RepositioningandtransferringpatientsareamongthemostcommonSPHMtasksthatleadtocaregiverinjury.

    Alow-tech,low-costslidesheet(generallycostinglessthan$10perpatient)canassistinmostofthesecases.

    Withnoinstallationoraccessoriesrequired,slidesheets(sometimesreferredtoasfriction-reducingdevices,

    slips,glidesheets,orlateraltransferdevices)allowhealthcareorganizationstostartanSPHMprogramwith

    littlefinancialinvestmentandquicklypreventsomeofthemostfrequentanddebilitatingmusculoskeletal

    injuriesincurredbyhealthcareprofessionals.TheU.S.OccupationalSafetyandHealthAdministration(OSHA)

    estimatesthatthedirectcostsofworkerscompensationclaimsandwagereplacementcombinedwith

    indirectcostslikeemployeeturnover,training,andmoraleresultsinanaveragelossof$27,000to$103,000

    perpatient-handlinginjury.3Withthereturnoninvestment4resultingfromreducedinjury-relatedcosts,a

    casecanbemadetousethesavingstoeventuallyaddmoreextensiveequipmentandgrowtheSPHM

    program.

    HOWTHEYWORK

    Slidesheetscomeinvarioussizesandstyles.Somearelargetubes,othersaresinglesheetsorapairofsheets.

    Typically,theyaremadefromalow-frictionmaterialorfilledwithgel.5Whenplacedunderapatient,

  • 7217 Hyacinth Court Greendale, WI 53129 Office (414) 529-5175 Fax (414) 529-3433 www.patran.net

    caregiverscanslidethepatienttothedesiredlocationratherthanhavingtoliftordragthem.Thus,slide

    sheetsaredesignedtoremovetheneedforexcessiveforceandlimittheneedforextremepostures

    associatedwithmanypatient-handlingtasks.5Anumberofstudieshaveshownthatonlyusingadrawsheetor

    incontinencepadtomoveapatientforroutinebedrepositioningortransfersresultsinspinalloadsand

    exertionlevelsthatnearorexceedtheinjurylevel.6Usingslidesheetsreducestheforcesrequiredforthese

    taskstoasafelevelforthehealthcareworkerwhileatthesametimereducingskinshearforthepatient.The

    forcerequiredcanbeevenfurtherreducedbyusingaslidesheetincombinationwithgravity-assistedbed

    features,suchasputtingthebedintheTrendelenburgposition,whenboostingapatient(ifthereareno

    medicalcontraindications)totheheadofthebed.6

    Whilelog-rollingisonemethodoftenusedtogetapatientontoaslidesheet,othersexist.Tuckingor

    unfoldingthesheetunderapatient,forinstance,providealternativesthathelpcaregiversavoidthereaching

    andpullingoflog-rollingandmaybelessstressfulforspineandtraumapatients.Ademonstrationofthese

    techniquesisavailableatwww.patran.net.Notallstylesofslidesheetaccommodateallmethods.

    Inadditiontorepositioningandlateraltransfertasks,manyslidesheetscanassistwithotherdailyactivities5

    suchasgettingpatientsoutofvehicles,repositioningtheminchairs,movingpatientswhohavefallenin

    awkwardspacestoaplacewhereamechanicalliftcanbeused,orpreservingapatientsdignitybylettinghim

    orheradjusttheseatingonacommode.

    Slidesheetsvarywhenitcomestohowoftentheycanbeused.Somecanbelaundered,allowingusewith

    morethanonepatient.Single-patient-use(oftenreferredtoasdisposable)slidesheets,canbeusedoverand

  • 7217 Hyacinth Court Greendale, WI 53129 Office (414) 529-5175 Fax (414) 529-3433 www.patran.net

    overagainwiththesamepatient,butaredisposedofwhenthatpatientleavesthefacility.Recyclableand

    biodegradableoptionsareavailable.Athirdgroup,thetrulydisposableslidesheets,aremeanttobeused

    oncewithasinglepatient,thendiscarded.

    PATIENTSIZELIMITATIONS

    Oneofthemostcommonlyaskedquestionsaboutslidesheetsiswhattheweightlimitis.Typically,

    manufacturersdontputaweightlimitonslidesheets.Formosttasks,bedlinensareusedontopoftheslide

    sheettoprovidestrengthandcomfort.Itismoreimportanttoconsiderthepatientsbuildandwhetherthe

    slidesheetislargeenoughtobeplacedunderthemainpointsofcontact:theshoulders,pelvis,and,when

    possible,thefeet.5Itmaytakemorethanoneslidesheetplacedsidebysideorabariatric-sizedslidesheetto

    getthepatientsentirebodyfullyontoit.Inaddition,morecaregiversareneededtomovealargerpatient.

    A900-pluspoundpatientwaslaterallytransferredataWisconsinnursinghomeusingPATRANslidesheets,

    anda750-poundpatientwhofellinatightspaceandsoiledhimselfataWisconsinhospitalwasmovedwitha

    PATRANtoaplacewhereliftequipmentcouldbeused.Inbothcasesittookanumberofcaregiversandmore

    thanoneslidesheettomovethepatient,butnomanualliftingoccurred.Thesecasesdemonstratethatslide

    sheetscanbeusedwithpatientsofanysize;however,manySPHMexpertssuggestusinghigher-tech,more

    expensiveequipmentifavailablewhenheavierpatientsareinvolved.5

    Insomefacilities,aslidesheetisassignedtoeverypatientuptoabout300pounds,andhigher-tech,higher-

  • 7217 Hyacinth Court Greendale, WI 53129 Office (414) 529-5175 Fax (414) 529-3433 www.patran.net

    costSPHMequipmentisreservedforlargerpatients.Itisuptoahealthcarefacilitysleaderstosetguidelines

    andpoliciesaboutwhenslidesheetsvs.otherequipmentshouldbeusedbasedonpatientweight,medical

    condition,andabilities.BecausetheNationalInstituteforOccupationalSafetyandHealthrecommendations

    statethatnocaregivershouldliftmorethan35pounds,1SPHMequipmentshouldbeusedinmovingalladult

    patientsandmanypediatricpatients.ItmaybeassumedthatonlyheavierpatientsrequireSPHMequipment,

    butmoreinjuriesoccurwhileliftingaverage-weightpatients,likelybecausecaregiversassumethepatientis

    notlargeenoughtocauseinjury.7,8Inaddition,debilitatingdamagecanoccurovertimefromrepetitive

    handlingtasks.7Astudyconductedin1995foundthatnursesboostpatientsanaverageof10timespershift;

    thenumberhasincreasedasmedicalresearchhasshownthemedicalcontraindicationsofpoorpositioning.9

    Table1demonstrateshowslidesheetscanaddressanumberofbarrierstoasuccessfulSPHMprogram.

    SLIDESHEETSINPHYSICALTHERAPY

    Whilerepositioningpatientsinbedandtransferringpatientsfromonesurfacetoanotherarethemostwell-

    knownusesofslidesheets,manyphysicaltherapists(PT)arefindingtheycanplayaroleinasuccessful

    mobilityprogram.12,13ResearchshowsusingSPHMequipmentforearlyrehabilitationimprovesmuscle

    strength,mentalacuity,andfunctionalmobilitywhilepreservingindependence,whichcanresultinshorter

    hospitalstaysandfewerreadmissionsandthuslowerafacilityscosts.2,13,14

    AcutecarePTsspendmuchoftheirworkdayproblem-solving13howtogetapatientmoving.Accesstoamixof

  • 7217 Hyacinth Court Greendale, WI 53129 Office (414) 529-5175 Fax (414) 529-3433 www.patran.net

    equipment,includingslidesheets,allowsforahigher-levelofinnovation.2AsurveybytheAmericanPhysical

    TherapyAssociationshowedPTsaretypicallyusingSPHMequipmentforbedmobilityandtransfertraining,

    twotasksforwhichslidesheetscanprovideanassist.12Aslidesheetprovidesaslipperysurfacethatwhen

    usedinconjunctionwithbedrailsoratrapezecanaidapatientinstartingtorepositionhimselforherselfor

    toworkonthestrengthandmusclecoordinationittakestogettotheedgeofthebed.15Agrowingnumberof

    PTshavestartedusingslidesheetsandotherSPHMequipmentfortherapeuticexercisessuchasjoint

    mobilization,rangeofmotionandstretchingexercisesandmusclereconditioning.13,16

    EXPANDINGROLE

    AsanSPHMprogramexpands,theroleofslidesheetsmaygrowaswell.Slidesheetscanbeusedalongwith

    higher-techequipment.Forexample,slidesheetscanbeusedtopreventskinshearwhileputtingaliftslingon

    apatientoradjustinganair-assisteddeviceunderapatient.Advancesinpressureredistributingmattresses

    forbedsandchairsassistinrepositioningpatientsbutdonotreplacetheneedforcaregiverinvolvement,

    accordingtotheWoundOstomyContinenceNursesSociety.17Therefore,slidesheetscancomplementtheuse

    ofthesedevices.

    LIMITATIONS

    Slidesheetsdohavelimitations,5asonewouldexpectwithanylow-costitem.Althoughslidesheetsareeasy

  • 7217 Hyacinth Court Greendale, WI 53129 Office (414) 529-5175 Fax (414) 529-3433 www.patran.net

    touse,caregiversmustbetrainedonpropertechnique.Otherwise,theylikelywouldrelyonthelifting

    motionsthathavebecomehabit.Thiswouldeliminatethebenefitsoftheslidesheet.Inaddition,leavinga

    slidesheetunderanunsupervisedpatientmayputthepatientatriskoffallingoutofbed,sothesheetmust

    beremovedbetweenpatient-handlingtasks.Further,slidesheetsdonotbridgegaps,soforsometransfers

    theymayneedtobeusedinconjunctionwithtransferboards.Slidesheetsassistinmostsituationswhen

    patientsneedtobemovedhorizontally,butarenotusefulinmovingapatientvertically.Aliftingdeviceis

    oftenneededtohelpwithliftingandverticalsupporttasks.

    CHOOSINGASLIDESHEET

    Thetermco-efficientoffriction(COF)ameasureofhowdifficultitistomoveonesurfaceoveranotheris

    oftenusedwhendescribingandcomparingslidesheets.However,theAmericanSocietyofTestingand

    MaterialssaysthatCOFnumbersarenotnecessarilyreliablebecauseaslightchangeinvariablesfromthe

    surfacesinvolvedtohowthepatientispositionedonaslidesheetcanchangeresults.18Ifthepatientstotal

    weightisnotontheslidesheet,itnullifiestheresults.Thethinplasticmaterialslidesheetsoftenaremadeof

    isdifficulttotest,leadingtopotentialinaccuracies.AstudyconductedbyJamarHealthProductsInc.,makerof

    PATRANslidesheets,takesalookathowsometypicalmedicalsurfacesimpacttheforcesrequiredtomovea

    patient(Table2).Generally,forallslidesheets,movingapatientonasoftersurfacethatheorshecansink

    intoisgoingtoprovemoredifficultthanmovingapatientonahardsurface.

  • 7217 Hyacinth Court Greendale, WI 53129 Office (414) 529-5175 Fax (414) 529-3433 www.patran.net

    Themoreimportantfactortoconsiderwhenchoosingaslidesheetisthetaskthatneedstobe

    accomplished.19Questionstoconsiderinclude:

    Isadisposablepreferredfortoiletingassistance?

    Isthematerialradio-lucentfortransfersandrepositioningonimagingequipment?

    Willtheslidesheetbeusedforpredominantlyfortransfers,requiringittomoveinjustonedirection,

    orwillitbeusedforavarietyoftasksandneedtomoveinmultipledirections?

    Slidesheetsshouldmeettheorganizationalgoals,aswellasthespatialconstraintsofafacilityandits

    equipment,physicalneedsofthecaregiver,andphysicalandemotionalneedsofpatients.20,21

  • 7217 Hyacinth Court Greendale, WI 53129 Office (414) 529-5175 Fax (414) 529-3433 www.patran.net

    REFERENCES

    1.AmericanNursesAssociation.SafePatientHandlingandMobility(brochure).AmericanNursesAssociationNursingWorldWebsite.2013.Availableathttp://nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Work-Environment/SafePatient/SPHM-Trifold-Brochure.pdf.AccessedJuly13,2015,

    2.FitzpatrickMelissaA.Safepatienthandlingandmobility:Acalltoaction.InCurrentTopicsinSafePatientHandlingandMobility,asupplementtoAmericanNurseToday.2014.Availableathttp://www.americannursetoday.com/wp-content/uploads/2014/07/ant9-Patient-Handling-Supplement-821a_LOW.pdf.AccessedJuly13,2015.

    3.LiY,JonesCB.Aliteraturereviewofnursingturnovercosts.JNursManag.2013;21(3):405-418.

    4.SiddharthanK.Buildingabusinesscaseforsafepatienthandling.Paperpresentedat:8thAnnualSafePatientHandlingandMovementConference:March2008;Orlando,Fla.

    5.WorkersCompensationBoardofBritishColumbia.TransferassistdevicesforthesaferhandlingofpatientsAguideforselectionandsafeuse.WorkSafeBCWebsite.2006.Availableathttp://www.worksafebc.com/publications/health_and_safety/by_topic/assets/pdf/transfer_assist_devices.pdf?_ga=1.70046674.31747898.1436722570.AccessedJuly13,2015.

    6.BartnikLM.Caregiverforcesrequiredforslidingapatientupinbedusinganarrayofslidesheets.TheUniversityofToledoHealthScienceCampusWebsite.2012.Availableathttp://utdr.utoledo.edu/cgi/viewcontent.cgi?article=1142&context=graduate-projects.AccessedJuly13,2015.

    7.CohenMH,NelsonGG,GreenDA,LeibR,MatzMW,ThomasPA.Patienthandlingandmovementassessments:Awhitepaper.Ed.BordenCM.Dallas,Texas:TheFacilityGuidelinesInstitute,2010.

    8.ContiMT.Thehiddencostofmovingpatients.HarvardBusinessReviewWebpage.2013.Availableathttps://hbr.org/2013/09/providing-better-care-at-a-low/.AccessedJuly13,2015.

    9.WiggermannN.Theslidingpatient:Howtorespondtoandpreventmigrationinbed.InCurrentTopicsinSafePatientHandlingandMobility,asupplementtoAmericanNurseToday.2014.Availableathttp://www.americannursetoday.com/sliding-patient-respond-prevent-migration-bed/.AccessedJuly13,2015.

    10.ConradBP,RossiGD,HorodyskiMB,PrasarnML,AlemiY,RechtineGR.Eliminatinglogrollingasaspinetraumaorder.SurgicalNeurologyInternational.2012;3(Suppl3):S188-S197.

    11.MossR,PorterKM,GreavesI.Minimalpatienthandling:afacultyofprehospitalcareconsensusstatement.EmergMedJ.2013;30:1065-1066.

    12.OlkowskiBF,StolfiAM.Safepatienthandlingperceptionsandpractices:asurveyofacutecarephysicaltherapists.PhysTher.2014;94(5):682-95.

  • 7217 Hyacinth Court Greendale, WI 53129 Office (414) 529-5175 Fax (414) 529-3433 www.patran.net

    13.AmericanPhysicalTherapyAssociation.Theroleofphysicaltherapyinsafepatienthandling,positionpaper.APTAWebsite.2012.Availableathttp://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Practice/SafePatientHandling.pdf.AccessedJuly13,2015.

    14.ParkerA,NeedhamD.TheimportanceofearlyrehabilitationandmobilityintheICU.SocietyofCriticalCareMedicinesClinicalConnections,Aug/Sept2013,pages8-9.Availableathttp://www.sccm.org/Communications/Critical-Connections/Archives/Pages/Importance-Early-Rehabilitation-Mobility-ICU.aspx.AccessedJuly13,2015.

    15.FragalaG,FragalaM.Sustainingmobilitythroughenhancedbedegress.AnnalsofLong-TermCare.2014;22(6).Epub.Availableatwww.annalsoflongtermcare.com/print/2194.AccessedJuly13,2015.

    16.DarraghAR,CampoM,KingP.Work-relatedactivitiesassociatedwithinjuryinoccupationalandphysicaltherapists.Work(Reading,Mass).2012;42(3):10.3233/WOR-2012-1430.

    17.Wound,Ostomy,andContinenceNursesSociety(WOCN).Guidelineforpreventionandmanagementofpressureulcers.MountLaurel(NJ):Wound,Ostomy,andContinenceNursesSociety(WOCN);2010.

    18.AmericanSocietyofTestingandMaterials.StandardD1894-11,Standardtestmethodforstaticandkineticcoefficientsoffrictionofplasticfilmandsheeting.BookofStandards.Volume8.01.

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