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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.

    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.

    SPHMequipmentisntproperlymaintained10,11 Slidesheetsarelow-tech.Therearenobatteriestochargeoraccessoriestofind.Ifaslidesheetisdirty,sendalaunderabletobecleanedorreplaceadisposable.

    Patientaversiontoequipment11 Slidesheetsreduceskinshearandprovidephysicalandemotionalcomforttopatientsafraidofbeingmoved.

    Lackoftrainingandunderstandingaboutproperequipmentuse11

    Thesimpledesignhasledsomesupervisorstohandoffslidesheetsandexpecttheycanbeusedwithouttraining.RegardlessofthetypeofSPHMequipment,trainingandcontinuingremindersandencouragementareneededtochangehabits.

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

    Table2.FORCEREQUIREDTOMOVEPATIENTONDIFFERENTSURFACESUSINGPATRANSLIDESHEETSBYJAMARHEALTHPRODUCTS,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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