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