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PATRAN®SLIDESHEETSANINEXPENSIVEWAYTOSTARTASAFE-PATIENT-HANDLINGPROGRAM

StefanieScott,CSPHASTEFANIESCOTT,CSPHA,ispresidentofJamarHealthProducts,makerofPATRAN®slidesheets

ABSTRACT

Budgetcrunchesandchangestotheleveloffinancialreimbursementformedicaltreatmentandstayshaveput

economicstrainsonhealthcarefacilities.Thestruggleoverfinancialprioritieshaskeptsomefacilities’leadersfrom

allocatingdollarsforsafe-patient-handlingequipmentandpractices.Yet,in-roadscanbemadeinreducingworkers’

compensationclaimsandothercostsrelatedtocaregiverinjurieswithonlyasmallinvestmentbyimplementingsimple

yetversatileslidesheets.Thesesheetsgreatlyreducefriction,allowingcaregiverstoslideapatientwithouttheneedfor

liftingorstrenuoustugging.Slidesheetscomeinavarietyofstylesandsizesand,whilenotappropriateinallsituations,

canbeusefulinnumerousfrequentlyencounteredscenarios–frommovingapatientwithintheirbedtotransferringa

fallenpatienttoamechanicalliftdevice.

KeyWords:slidesheets,safe-patienthandlingandmovement,equipment

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INTRODUCTION

Ashealthcareadministratorsfindoperatingbudgetsgettingtighter,someperceiveimplementationofasafe

patienthandlingandmovement(SPHM)programastoocostlytopursue.ButtheAmericanNursesAssociation

(ANA)andotherhealthcaregroupssaythat’safallacy.1,2

RepositioningandtransferringpatientsareamongthemostcommonSPHMtasksthatleadtocaregiverinjury.

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

Withnoinstallationoraccessoriesrequired,slidesheets(sometimesreferredtoasfriction-reducingdevices,

slips,glidesheets,orlateraltransferdevices)allowhealthcareorganizationstostartanSPHMprogramwith

littlefinancialinvestmentandquicklypreventsomeofthemostfrequentanddebilitatingmusculoskeletal

injuriesincurredbyhealthcareprofessionals.TheU.S.OccupationalSafetyandHealthAdministration(OSHA)

estimatesthatthedirectcostsofworkers’compensationclaimsandwagereplacementcombinedwith

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

perpatient-handlinginjury.3Withthereturnoninvestment4resultingfromreducedinjury-relatedcosts,a

casecanbemadetousethesavingstoeventuallyaddmoreextensiveequipmentandgrowtheSPHM

program.

HOWTHEYWORK

Slidesheetscomeinvarioussizesandstyles.Somearelargetubes,othersaresinglesheetsorapairofsheets.

Typically,theyaremadefromalow-frictionmaterialorfilledwithgel.5Whenplacedunderapatient,

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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,orpreservingapatient’sdignitybylettinghim

orheradjusttheseatingonacommode.

Slidesheetsvarywhenitcomestohowoftentheycanbeused.Somecanbelaundered,allowingusewith

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

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overagainwiththesamepatient,butaredisposedofwhenthatpatientleavesthefacility.Recyclableand

biodegradableoptionsareavailable.Athirdgroup,thetrulydisposableslidesheets,aremeanttobeused

oncewithasinglepatient,thendiscarded.

PATIENTSIZELIMITATIONS

Oneofthemostcommonlyaskedquestionsaboutslidesheetsiswhattheweightlimitis.Typically,

manufacturersdon’tputaweightlimitonslidesheets.Formosttasks,bedlinensareusedontopoftheslide

sheettoprovidestrengthandcomfort.Itismoreimportanttoconsiderthepatient’sbuildandwhetherthe

slidesheetislargeenoughtobeplacedunderthemainpointsofcontact:theshoulders,pelvis,and,when

possible,thefeet.5Itmaytakemorethanoneslidesheetplacedsidebysideorabariatric-sizedslidesheetto

getthepatient’sentirebodyfullyontoit.Inaddition,morecaregiversareneededtomovealargerpatient.

A900-pluspoundpatientwaslaterallytransferredataWisconsinnursinghomeusingPATRANslidesheets,

anda750-poundpatientwhofellinatightspaceandsoiledhimselfataWisconsinhospitalwasmovedwitha

PATRANtoaplacewhereliftequipmentcouldbeused.Inbothcasesittookanumberofcaregiversandmore

thanoneslidesheettomovethepatient,butnomanualliftingoccurred.Thesecasesdemonstratethatslide

sheetscanbeusedwithpatientsofanysize;however,manySPHMexpertssuggestusinghigher-tech,more

expensiveequipmentifavailablewhenheavierpatientsareinvolved.5

Insomefacilities,aslidesheetisassignedtoeverypatientuptoabout300pounds,andhigher-tech,higher-

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costSPHMequipmentisreservedforlargerpatients.Itisuptoahealthcarefacility’sleaderstosetguidelines

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

hospitalstaysandfewerreadmissionsandthuslowerafacility’scosts.2,13,14

AcutecarePTsspendmuchoftheirworkdayproblem-solving13howtogetapatientmoving.Accesstoamixof

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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

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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)–ameasureofhowdifficultitistomoveonesurfaceoveranother–is

oftenusedwhendescribingandcomparingslidesheets.However,theAmericanSocietyofTestingand

MaterialssaysthatCOFnumbersarenotnecessarilyreliablebecauseaslightchangeinvariables–fromthe

surfacesinvolvedtohowthepatientispositionedonaslidesheet–canchangeresults.18Ifthepatient’stotal

weightisnotontheslidesheet,itnullifiestheresults.Thethinplasticmaterialslidesheetsoftenaremadeof

isdifficulttotest,leadingtopotentialinaccuracies.AstudyconductedbyJamarHealthProductsInc.,makerof

PATRANslidesheets,takesalookathowsometypicalmedicalsurfacesimpacttheforcesrequiredtomovea

patient(Table2).Generally,forallslidesheets,movingapatientonasoftersurfacethatheorshecansink

intoisgoingtoprovemoredifficultthanmovingapatientonahardsurface.

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Themoreimportantfactortoconsiderwhenchoosingaslidesheetisthetaskthatneedstobe

accomplished.19Questionstoconsiderinclude:

• Isadisposablepreferredfortoiletingassistance?

• Isthematerialradio-lucentfortransfersandrepositioningonimagingequipment?

• Willtheslidesheetbeusedforpredominantlyfortransfers,requiringittomoveinjustonedirection,

orwillitbeusedforavarietyoftasksandneedtomoveinmultipledirections?

Slidesheetsshouldmeettheorganizationalgoals,aswellasthespatialconstraintsofafacilityandits

equipment,physicalneedsofthecaregiver,andphysicalandemotionalneedsofpatients.20,21

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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.Workers’CompensationBoardofBritishColumbia.Transferassistdevicesforthesaferhandlingofpatients–Aguideforselectionandsafeuse.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.

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7217 Hyacinth Court ô Greendale, WI 53129 ô Office (414) 529-5175 ô Fax (414) 529-3433 ô 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.SocietyofCriticalCareMedicine’sClinicalConnections,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.

19.CelonaJ.Elementsofasuccessfulsafepatienthandlingandmobilityprogram.InCurrentTopicsinSafePatientHandlingandMobility,asupplementtoAmericanNurseToday.2014.Availableathttp://www.americannursetoday.com/wp-content/uploads/2014/07/ant9-Patient-Handling-Supplement-821a_LOW.pdf.AccessedJuly13,2015.

20.KayG,BudruckP.Whatinfluencestheuseofliftandassistdevicesinhealthcare.TheErgonomicsReport,2011,reprintedwithpermissionontheErgoWebWebsite.Availableathttps://ergoweb.com/what-influences-the-use-of-lift-assist-devices-in-healthcare-2/.AccessedJuly13,2015.

21.NelsonA,BaptisteAS.Evidence-basedpracticesforsafepatienthandlingandmovement.OnlineJIssuesNurs.2004;9(3):4.

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Table1.OVERCOMINGBARRIERSTOSAFE-PATIENTHANDLINGPRACTICES

BarriertoSPHMEquipmentUse HowaSlideSheetCanHelp

Perceptionthatittakestoomuchtimetofindequipment/storageissues10,11

Typicallycompact,manyslidesheetscanbestoredclosetothepatient,suchasbetweenthemattressandfootboardofthebed,adispenserclosetopatientsorinanambulancesupplycabinet.

IttakestoolongtofindpeopletoassistinanSPHMactivity11

Oftennurseswillspendtimeroundingupagroupoffellowstaff,guessinghowmanypeopleitwilltaketosafelymoveapatient.Arecentstudy*usingthePATRANslidesheets,providesguidelinesforhowmuchforceittakestomovepatientsonseveraltypicalmedicalsurfacessoitcanbemoreaccuratelydeterminedhowmanypeopleitwouldtaketosafelytransferorboostapatient(Table2).Itmaytakefewercaregiversthanpreviouslythought.

Notenoughdevicesforthenumberofcaregiversand/orpatients10,11

Assigningaslidesheettoapatientuponadmissionandkeepingitnearthepatientastheymovethroughahealthcarefacilitycanhelpeliminatethatissue.

Notenoughspacetomaneuver10,11 Aslidesheetisflexibleandcanbefoldedandmaneuveredtofitinmostspaces.

SPHMequipmentiscomplicatedtouse Topreventinjuries,trainingisrequiredtouseslidesheets.However,theyarenotcomplicatedtouse.

SPHMequipmentisn’tproperlymaintained10,11 Slidesheetsarelow-tech.Therearenobatteriestochargeoraccessoriestofind.Ifaslidesheetisdirty,sendalaunderabletobecleanedorreplaceadisposable.

Patientaversiontoequipment11 Slidesheetsreduceskinshearandprovidephysicalandemotionalcomforttopatientsafraidofbeingmoved.

Lackoftrainingandunderstandingaboutproperequipmentuse11

Thesimpledesignhasledsomesupervisorstohandoffslidesheetsandexpecttheycanbeusedwithouttraining.RegardlessofthetypeofSPHMequipment,trainingandcontinuingremindersandencouragementareneededtochangehabits.

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Table2.FORCEREQUIREDTOMOVEPATIENTONDIFFERENTSURFACESUSINGPATRAN®SLIDESHEETSBYJAMARHEALTHPRODUCTS,INC.Dummyweight(lbs.) 171 223 300 350

Forceused(lbs) Min Max Min Max Min Max Min Max PATRANLocation

Hardtable

UnfoldingInsertion 13 18 25 31 Betweensheetandpad

Boost 23 26 29 36 36 43 46 58 OnpolycottonsheetTransfer 20 27 27 37 30 44 37 49 OnpolycottonsheetSegmentedtransfer 15 18 18 26 19 29 23 34 OnpolycottonsheetMassagetable

UnfoldingInsertion 12 17 18 24 UndersheetUnfoldingInsertion 14 19 23 28 BetweensheetandpadBoost 21 33 32 43 45 60 54.5 71 OnvinylcoverTransfer 20 34 30 42 43 61 57 74 OnvinylcoverSegmentedtransfer 14 25 18 28 25 39 32 53 OnvinylcoverTransferw/slideboard 24 31 29 43 48 60 52 73 Onslideboard350#ratedmattress

UnfoldingInsertion 18 19 22 27 Betweenmattressandsheet Boost 20 27 24 33 34 46 40 54 OnmattresscoverTransfer 18 25 24 39 34 56 50 75 OnmattresscoverSegmentedtransfer 10 21 19 28 20 43 32 51 OnmattresscoverUnfoldingInsertion 20 22 26 33 Betweenfittedsheet

anddrawsheet

Boost 24 36 31 46 43 63 57 74 OnfittedsheetTransfer 19 31 30 47 44 62 50 90 OnfittedsheetSegmentedtransfer 12 21 21 30 30 47 33 61 Onfittedsheet


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