Article: Leaving Slings and Other Transfer Devices Under Patients: A Clinical Decision Support Quality Improvement Project
Year Published: January 2025
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What are the advantages to the proposed recommendations in the article?
ReplyDelete- Healthcare staff considers multiple factors when making decision whether to leave the slings or transfer devices under the patient. Considerations include patient’s characteristics such as medical history, current condition, skin integrity and mobility level and patient’s preference. Also in consideration is the material characteristics such as breathabililty, thickness and manufacturer’s guidelines. These findings show that there is no universal guidance for and against leaving sling and transfer device under the patient. Different opinions regarding the risk versus the benefit led to the recommendation of the importance of further research and quality improvement. Another recommendation is further research to determine how staff understanding and opinions related to leaving sling and transfer devices under patient might differ by discipline or role type and how that affect patients pressure injury rates. Greater understandings and communication of the risk for pressure injury by leaving slings and transfer devices under under patient could lead to better clinical practice and decrease in hospital acquired pressure injury.
Discuss the limitations of the article.
-Findings of sling and transfer device practices were evaluated at facility level rather than unit level. Variations in actual unit practice may have led to different observations. The lack of information for specific patients and specific body location did not provide analysis for specific sling or transfer device and pressure injury body site location.
Method: The purpose of this quality improvement project was to develop guidance for safe patient handling and mobility efforts to prevent pressure injuries with the Veterans Health Administration when slings and other transfer devices are left under patients. To accomplish this, activities were conducted between Oct 2019-Sept 2021 using a mixed methods rapid assessment approach. Objectives were to 1) collect data about common practices at VHA facilities related to leaving slings under patients, 2) examine reported patient transfer practices and associations with rates of inpatient pressure injuries, and 3) evaluate current practices against best available evidence to develop guidance about safely using slings to reduce PI and skin injury risk. Data collection techniques were cross-sectional surveys, EHR review and qualitative interviews. The goals of the qualitative interview guide were to identify 1) how slings are used in the interviewees facility and 2) perceptions of safe sling and transfer device use and how these practices influence skin health and PI risk. These interviews were co-facilitated virtually by 2 trained qualitative evaluators and lasted for up to 1 hour with audio and video recordings with interviewee consent.
ReplyDeleteLimitations: While selection of unit-specific outcomes allowed for a more precise examination of PI outcomes, patient transfer practices were evaluated at the facility level. Variations in actual unit practice may have led to slight differences in observed associations. Most unit-level PI outcomes were non-normally distributed, which limited the ability to observe significant effects. Pressure Injury outcomes were aggregated at either unit or facility level and did not specify body site location for observed PIs, which prohibited any analyses for specific sling/ transfer device type and pressure injury body location. Within the scope of this project, qualitative data were minimally analyzed by role type, however date suggests that role type ,ay influence staff perceptions of the risks and benefits, and decision—making processes associated with leaving slings and other transfer devices under patients.
what are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteSome advantages of the proposed recommendation include improved patient safety, more consistent and standardized transfer practices, reduced risk of staff injury, and better clinical decision-making through guided use of appropriate transfer devices. However, disadvantages include reliance on adequate staffing and availability of equipment, the need for additional training, potential workflow disruptions, and difficulty consistently following recommendations in busy or understaffed clinical settings.
Discuss the sample size used in the study.
The study used a relatively small, unit-based sample typical of a quality improvement project, which limits how generalizable the findings are to other settings or larger populations. While the sample size was sufficient to evaluate changes within the specific unit and demonstrate improvements in practice, it may not fully represent diverse patient populations or different hospital environments, and results should be interpreted with this limitation in mind.
How does this research article compare to our practice, policy, and procedure? On my floor slings and other transfer devices like slide sheets are never left under the patient. As soon as a patient is transferred or repositioned the sling or transfer device is promptly removed. I prefer this method because it only takes a few moments to position the sling or slide sheets and then there is no worry of complication or pressure injury in between uses. In the research article it seems that a lot of subjective reasoning is used instead of a concrete flow sheet or algorithm and I don’t believe this is the best evidence based practice.
ReplyDeleteWhat are the advantages and disadvantages to the proposed recommendations in the article? In this article it seems that a lot of the decision making is left to the caregivers subjective reasoning without hard guidelines. I believe this is a disadvantage as it could lead to a caregiver prioritizing their own convenience over optimal patient outcomes. I feel that preventing a pressure injury saves a lot more time in the long run than a few moments of properly placing a sling. The advantage however is that for some patients excessive movement to place and remove a sling could present a danger if they were clinically unstable it might be best to limit unnecessary position changes.
ReplyDeleteMarch article: Leaving Slings and Other Transfer Devices Under Patients: A Clinical Decision Support Quality Improvement Project
ReplyDeleteQuestion # 1: Discuss the research question or main problem discussed in the study?
The article's evidence suggested that sling and transfer device use is a cause of hospital-acquired pressure injuries, and therefore skin protection must be considered when using these devices. The Veterans Health Administration facilities utilize fabric slings with safe patient handling and mobility equipment for patient transfers. Knowledge or best practice regarding the safety of leaving slings under patients' skin has not been established. To address this evidence gap, the Veterans Integrated Services Network (VISN) Patient Safety Center of Inquiry (PSCI) conducted a quality improvement project to develop guidance regarding leaving slings and other transfer devices under patients and
potential for skin or pressure injury risk. The purpose of this report is to describe current use of slings and transfer devices at VHA facilities and introduce a guidance document that may be used to facilitate best practices in use of transfer equipment
Question #2: Describe the method used by the author of the study
Quality improvement project activities were conducted from October 2019 to September 2021 using a mixed-methods rapid assessment approach. The objectives were to collect data about common practices at VHA facilities related to leaving slings under patients, examine reported patient transfer practices and associations with rates of inpatient pressure
injuries, and evaluate current practices against best available evidence to develop guidance about safely using slings to reduce pressure injury and skin injury risk. The data collection techniques were cross-sectional surveys, electronic health record review, and qualitative interviews. This project was determined to be quality improvement (QI) by the James A. Haley Veterans’ Hospital Research and Development Committee and therefore exempt from additional Institutional Review Board.
The feedback on practices and perceptions related to leaving slings and other transfer devices was evaluated using online cross-sectional surveys and interviews with VHA staff. Secondary data for VHA inpatient rates of pressure injury were used to examine associations with staff-reported sling and other transfer device practices.
Bethany Sobesto
ReplyDeleteDiscuss the research question or main problem discussed in the study?
The question in this study was whether or not slings and transfer devices should he removed from beneath patients after use and within what time frame these items should be removed. This quality improvement project was done in order to decrease pressure ulcers and skin injuries from the devices mentioned. Surveys and interviews were done with staff in order to find out their opinions on the matter, to find out their current practices, and to compare their practices to evidence based practice on this safety issue.
what are the advantages and disadvantages to the proposed recommendations in the article?
The advantages of leaving the sling or other transfer device beneath a patient are time efficiency and less annoyance for the patient. Leaving the device under them saves the staff time because they do not have to turn the patient to properly position the sling or device each time. It there was an emergency were the patient needed to be returned from the chair to their bed urgently, then it would save time not if the device was already under the patient. Also, sometimes the patient does not want the hassle of having to be turned each time they need to be transferred. If the device is already under them, then it saves the patient from the hassle of having to be turned to put the device under them again. The disadvantages of leaving the sling or device under the patient are the possibility of acquiring a pressure ulcer or another skin injury. Plastic or other material on the devices could cause these.