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.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe purpose of this quality improvement project was to develop guidance for safe patient handling and mobility efforts to prevent pressure injuries within the Veterans Health Administration when slings and other transfer devices are left under patients.Leaving patient transfer slings or devices (like hoer lift slings or lateral transfer sheets )underneath a patient posses risks primarily by contributing to friction, shear and pressure injuries .However the approach depends directly on the specific device type ,manufacturer guidelines and a clinical risk assessment .Leaving devices unattended under patients increases the risk of pressure injuries .The wrinkled fabric or the device itself alters how body weight is distributed ,disrupting the microclimate of the skin (temperature and moisture)and creating stress concentrations .
What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteLeaving slings and other transfer devices under patients involves a critical trade off between caregiver safety and patient skin integrity .While it eliminates physically strenuous manual lifting keeping devices in situ can significantly elevate interface pressures ,reduce the efficacy of therapeutic support mattresses and increase the risk of Pressure Injuries
Advantages
Caregiver Efficiency and Safety allows for rapid mechanical transfers without the physical strain and risk of back injuries associated with constantly repositioning and rolling patients to place slings
Patient Comfort minimizes the need for frequent turning or sliding which can be painful for patients with severe pain, fractures or extreme sensitivities .
Specialized Design Certain all day or in situ slings are designed with breathable low friction materials meant to stay under a patient for extended periods without excessive bunching
Disadvantages
Pressure Injury Risks where slings can create high interface pressures ,particularly along seams and edges ,which obstruction blood flow
Mattress interference shows leaving a sling (especially non mesh or padded types )underneath a patient interferes with the function of pressure relieving air mattresses or therapeutic support surfaces
Friction and shear which shows wrinkles bunching ,or moisture trapped beneath the device can increase friction against the skin, leading to rapid skin breakdown .
Discuss the research question or main problem discussed in the study?
ReplyDeleteSkin tears are a prevalent but often under recognized type of injury in clinical settings ,particularly affecting vulnerable patients in intensive care and surgical environment.The Descriptive study was conducted between December 2024 and April 2025with 81 Intensive care and 76 operating room nurses at a training and research hospital .The Study Data were collected face o face using a descriptive characteristics form ,the Skin Tear Knowledge Assessment Instrument (OASES). The data were analyzed using SPSS software .Descriptive statistics ,including frequency ,percentage ,mean and standard deviation, were calculated .Additionally ,independent samples t tests, one way ANOVA and regression analysis were performed .Skin Tears are traumatic common wounds often under recognized by healthcare professionals .For high acuity patients in Intensive Care Units (ICU) and Operating Rooms (OR),recognizing the causes ,classifications and proper management of skin tears is essential to preventing chronic complications and prolonged hospital stays .
1. Discuss the research questions or main problem discussed in the study.
ReplyDeleteHospitalized patients who endure pressure injuries (PIs) can experience more pain, slower recovery and therefore longer hospitalizations, as well as increased risk of sepsis and mortality. PIs are preventable one of the benchmarks of quality of care for nursing, and thus an important goal of patient safety for the Veterans Health Administration (VHA). More specifically, slings and transfer devices left for a prolonged period of time underneath patients may be a cause of hospital-acquired PI and are utilized by VHA hospitals, however there are no specific best practice protocols to govern their use. For this study, a quality improvement project is performed to try to develop specific guidance regarding proper use of these devices for the prevention of skin breakdown.
2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
One limitation of the study is that the PI outcomes were aggregated and not separated to differentiate which part of the body had the injury or which patient had it, making it more difficult to determine which PIs were more prevalent and which device caused more injury. Another issue is that qualitative data was collected in only 9 VHA facilities of many, limiting the ability of the study to be generalized to the larger patient population. In addition, facility-level rather than unit-level outcomes were used, and therefore more detailed data of PI outcomes was sacrificed in favor or more normal distributions which would better highlight significant effects. One last thing to consider is that survey respondents and interviewees were unable to come to a consensus on how long slings and other transfer devices could safely be left under patients to prevent pressure injuries.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe main purpose of this quality improvement project was to develop guidance for safe patient handling and mobility efforts to prevent pressure injuries within the Veterans Health Administration when slings and other transfer devices are left under patients. Pressure injuries among hospitalized patients have clinical and emotional impacts including increased pain, slower recovery, prolonged hospitalization, and increased risk for sepsis and patient mortality. Pressure injuries are considered preventable adverse events, and their prevention is an indicator of quality of care.
Discuss the sample size used in the study.
The sample size used in this study included 112 health care staff members in patient safety. The members were across 77 unique VHA facilities that responded to surveys between November and December 2019. 24 interviews were conducted using purposive sampling with VHA staff at facilities with highest and lowest PI rates between January and March 2021.
1. What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteThe article recommends using clinical judgment instead of a universal policy when deciding whether to leave slings and other transfer devices under patients. One advantage of this recommendation is that it allows healthcare providers to consider each patient's individual needs, including skin condition, mobility, comfort, and overall safety. It may also reduce pain from repeated sling removal, improve staff safety during patient transfers, and make repositioning patients more efficient. However, a disadvantage is that relying on individual judgment can lead to inconsistent practices between healthcare providers and facilities. In addition, because there is limited evidence on best practices, leaving slings under patients without proper precautions may increase the risk of pressure injuries, skin breakdown, moisture buildup, and pressure caused by wrinkles or seams in the sling.
2. Describe the method used by the author of the study.
The authors used a mixed-methods quality improvement approach to examine the safety of leaving slings and transfer devices under patients. They collected data through cross-sectional online surveys completed by healthcare staff from Veterans Health Administration facilities, conducted semi-structured interviews with staff from facilities that had both high and low rates of pressure injuries, and reviewed electronic health record data from several Veterans Health Administration databases. The survey and interview data were analyzed to understand current practices and staff opinions, while statistical analyses were used to determine whether leaving slings under patients was associated with higher rates of pressure injuries.
Describe the method used by the author of the study.
ReplyDeleteA mixed methods rapid assessment approach was used for this study by using quality improvement project activities from October 2019 to September 2021. The quality improvement activities focused one several key objectives including: data collection about common practices at VHA facilities related to leaving slings under patients, examine reported patient transfer practices, and evaluate current practices against best available evidence about the use of slings preventing PIs. The data techniques used to evaluate these objectives were cross sectional surveys, electronic health record reviews and qualitative interviews with active participants within the study.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
The main limitation of the research article was examining sling and transfer device outcomes at the facility level rather than unit level. Not all results were evaluated at the same level and therefore can result in different results produced. The results also did not specify body site location for observed pressure injuries. This prohibited further analysis and understanding of location of pressure related injuries. All results were also only concluded at VHA facilities, rather than comparing outcomes amongst different healthcare organizations.
by Cindy Wein RN
ReplyDeleteDescribe the method used by the author of the study.
This article uses a couple of different methods. Predominantly it is a quality improvement project within the Veterans Health Administration as a patient safety initiative for the prevention of pressure injuries in patients with a transfer device equipment that is left under them throughout their hospitalization. The researchers used three methods for this study including surveys, reviews of medical records and interviews.
How does this research article compare to our practice, policy and/or procedure?
On my unit we recently concluded a trial of a new transfer device that is also left under the patients. The device was intended to assist with turning and therefore increase skin safety and prevent pressure ulcers while assisting staff with transfers and mobility in bed. This device was rolled out to the staff based on specific criteria that was in the chart and gathered upon assessment. Like all studies and trials, there are always advantages and disadvantages and more importantly limitations to the study. Without going into details about my unit’s trial and the outcome, there is always a concern that the transfer device can cause pressure ulcers unintentionally in patients.
1. Describe the method used by the author of the study
ReplyDeleteThe quality improvement project used a mixed‑methods approach, combining surveys, interviews, and existing data to understand sling‑removal practices across the VHA. The first survey had 93 staff members from 66 facilities with a follow‑up survey including 112 staff members from 77 facilities. They interviewed 27 staff members, mostly nurses and therapists, from 9 facilities chosen deliberately as they had either very high or very low pressure injury rates which helped the researchers compare different practices. The study also looked at facility level data from 132 VHA facilities to see how reported sling practices were related to actual patient outcomes.
2. what are the advantages and disadvantages to the proposed recommendations in the article?
A major advantage of using the recommended decision support tool is that it allows for a more individualized approach to patient care by considering medical histories, skin condition, and mobility. For patients who are bariatric or clinically unstable, leaving a sling in place can minimize the pain and discomfort of frequent turning while also reducing the risk of skin shearing. This practice also promotes nurse safety and efficiency because it makes it easier for staff to use handling equipment for regular repositioning.
But a significant disadvantage is the increased risk of pressure injuries, since the study showed a higher rate in both ICU and medsurg units where slings were left under patients. Relying on subjective clinical reasoning without a formal policy or protocol could lead to inconsistent practices where staff might prioritize their own convenience. There are also technical disadvantages because leaving devices under a patient can trap moisture and create high skin pressures at seams or wrinkles, which can even interfere with the performance of therapeutic air mattresses. Successful implementation of these recommendations would also require additional training and a significant focus on communication to ensure that skin risk is monitored across the care continuum.
1. What are the advantages and disadvantages of the proposed recommendations in the article?
ReplyDeleteThe recommendations encourage individualized clinical decision-making, improve patient and staff safety, and promote better communication to help prevent pressure injuries. However, they rely heavily on staff judgment, which may lead to inconsistent practices, and there is still limited research proving the safest way or length of time to leave slings under patients.
2. Discuss the research question or main problem discussed in the study.
The main problem was the lack of clear evidence and consistent guidelines about whether it is safe to leave slings and other transfer devices under patients without increasing the risk of pressure injuries. The study sought to examine current practices, staff perceptions, and the relationship between sling use and pressure injury rates to develop guidance for safer patient handling.
1. What are the advantages and disadvantages of the proposed recommendations in the article?
DeleteThe recommendations encourage individualized clinical decision-making, improve patient and staff safety, and promote better communication to help prevent pressure injuries. However, they rely heavily on staff judgment, which may lead to inconsistent practices, and there is still limited research proving the safest way or length of time to leave slings under patients. The recommendations also support a patient-centered approach by considering each patient’s mobility, skin condition, and overall health status. As additional research becomes available, these recommendations can be refined to provide more standardized and evidence-based guidance for clinical practice.
2. Discuss the research question or main problem discussed in the study.
The main problem was the lack of clear evidence and consistent guidelines about whether it is safe to leave slings and other transfer devices under patients without increasing the risk of pressure injuries. The study sought to examine current practices, staff perceptions, and the relationship between sling use and pressure injury rates to develop guidance for safer patient handling. The researchers recognized that differences in clinical practice may contribute to inconsistent patient outcomes and uncertainty among healthcare providers. Their goal was to identify best practices that balance patient comfort, safety, and the prevention of pressure injuries while supporting safe patient handling.
1. Describe the method used by the autor for the study.
ReplyDeleteA mixed-methods fast assessment methodology was employed in this quality improvement (QI) project. Information gathered between October 2019 and September 2021. The project aimed to evaluate current practices for leaving patient transfer slings under patients, look into the connection between transfer procedures and inpatient pressure injury rates, and compare current practices with the best available data in order to develop evidence-based recommendations for reducing pressure injuries and skin damage. Both quantitative and qualitative data were obtained through the use of cross-sectional surveys, electronic health record (EHR) reviews, and qualitative interviews. When the James A. Haley Veterans' Hospital Research and Development Committee determined that the trial constituted a quality improvement effort, it was exempt from Institutional Approval Board (IRB) approval.
2. Discuss the research question or main problem discussed in the study?
Preventing hospital-acquired pressure injuries (PIs) linked to the use of patient transfer slings and safe patient handling equipment was the primary issue addressed in this quality improvement effort. There was no data on the safety of leaving transfer slings under patients in between transfers, despite the fact that pressure injuries are regarded as avoidable adverse events and a crucial measure of healthcare quality. The study aimed to identify current procedures in Veterans Health Administration (VHA) hospitals, investigate the connection between the usage of sling and the risk of pressure injuries, and create evidence-based recommendations to lessen skin injuries and enhance patient safety. In the end, the initiative sought to support the VHA's objective of eradicating avoidable hospital-acquired pressure injuries while addressing the absence of defined best practices for sling use.
Ronit Malamud
Discuss the sample size used in the study.
ReplyDeleteThis study focused on making guidance for preventing pressure injuries in patients with patient transfer slings left under them. This study surveyed 112 healthcare staff across 77 VHA hospitals. They then interviewed 24 staff at VHA facilities with the highest and lowest rates of pressure injuries.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
Limitations of this study include variations of unit based practices which may have lead to differences in outcomes. Another limitation noted was the lack of specification of body location for pressure injuries that were observed. Finally, data was only collected from 9 facilities, greatly limiting the findings across facilities.
Discuss the sample size used in the study.
ReplyDeleteThe study included 112 healthcare staff from 77 VHA facilities who completed the follow-up survey. In addition, 27 staff members from 9 VHA facilities participated in interviews. The participants included nurses, therapists, nursing assistants, and safe patient-handling staff. Although the study included many facilities and healthcare roles, the small interview sample may limit the generalizability of the findings.
Describe the method used by the author of the study
The authors used a mixed-methods quality improvement approach that included surveys, interviews, and electronic health record data. Surveys assessed staff practices and opinions about leaving slings and transfer devices under patients. Interviews explored staff perceptions of pressure injury risks and safe patient-handling practices, while pressure injury rates were reviewed from VHA databases. The findings from these methods were combined to develop guidance for safer use of slings and transfer devices.
1. Leaving Slings and Other Transfer Devices Under Patients
ReplyDeleteHow does this research article compare to our practice, policy and/or procedure?
This article is directly relevant to bedside pressure-injury prevention. The authors found that leaving slings under patients was associated with a higher proportion of pressure injuries in ICU and medical-surgical settings. This supports a cautious approach to leaving transfer equipment beneath a patient and fits with the Providence Skin Integrity policy's overall purpose of identifying, preventing, and caring for patients at risk for altered skin integrity (Bradley et al., 2025; Providence, 2026a).
What are the advantages and disadvantages to the proposed recommendations in the article?
Advantages. A major advantage is that the recommendations can strengthen nursing assessment around transfer equipment. Staff can consider whether a sling truly needs to remain in place, reassess the skin and pressure points, and communicate the reason for continued use during handoff. The study also supports clinical decision support rather than a one-size-fits-all rule, which is practical because patient mobility, acuity, and transfer needs vary (Bradley et al., 2025).
Disadvantages. Implementation could create workflow challenges. Removing and replacing slings may require additional staff and may increase handling of patients who are difficult or unsafe to reposition. The study also does not establish that every sling or transfer device must always be removed, so an overly rigid policy could create unintended safety concerns.
Describe the method used by the author(s) of the study.
This was a quality-improvement project using mixed methods. The investigators used online cross-sectional surveys, staff interviews, and secondary VHA inpatient pressure-injury data to examine staff practices and associations between transfer-device practices and pressure injuries (Bradley et al., 2025).
Discuss the research question or main problem discussed in the study.
The main problem was the lack of clear evidence and consistent guidance about whether leaving slings and other transfer devices under patients contributes to pressure-injury risk and how staff should make safe decisions about these devices.
Discuss the sample size used in the study.
The survey sample included 112 healthcare staff members from 77 VHA facilities. In addition, 24 staff members from nine facilities with relatively high or low pressure-injury rates participated in interviews (Bradley et al., 2025).
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
Important limitations include reliance on staff-reported practices, the observational nature of the associations, and variation in equipment and patient circumstances across facilities. Because the project was conducted within the VHA, the findings may not transfer perfectly to every hospital. The results show associations rather than proving that leaving a sling directly caused a pressure injury.
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ReplyDelete
ReplyDelete1.) How does this research article compare to our practice, policy and/ or procedure?
The entire purpose of this quality improvement project was to develop guidance or safe patient handling and pressure injury prevention, particularly when slings and other transfer devices are left under patients. This is the core of what we do in our practice as far as pressure injury prevention. For example, We have a policy not to use more than one bed bad under a patient because of the increased risk it has in developing pressure injuries to our bed rest patients. This correlates with the outcomes of this particular article because it was found that leaving slings or other transfer devices under patients leads to a higher proportion of patients developing pressure injuries. Here at St. Joseph we currently do have certain transfer devices that are ok to leave under our patients, the "air tap" device for ICU and the "tortoise repositioning device" for our tele units. These are considered transfer devices that actually help prevent pressure injuries.
2.) Describe the method used by the author of this study.
Quality improvement project activities were conducted from October 2019 to September 2021 using a mixed-methods rapid assessment approach. Data collection techniques were cross-sectional surveys, electronic health record review, and qualitative interviews. The method used in this study has to do with feedback on practices and perceptions related to leaving slings and other transfer devices. This feedback was evaluated using online cross-sectional surveys and interviews with Veterans Health Administration staff. Survey invitations were sent in accordance with the Dillman method for internet surveys, which emphasizes strategies to improve response rates. Also, this study used secondary data for VHA inpatient rates of pressure injuries. These were used to examine associations with staff-reported sling and other transfer device practices.
1. What are the advantages and disadvantages of the proposed recommendations in the article?
ReplyDeleteOne advantage of the recommendations is that they can help nurses make safer decisions when using slings and other transfer devices. Instead of applying one strict rule to every patient, the article recommends assessing each patient individually, including their skin condition, mobility, comfort, medical history, and the type of sling being used. This could help reduce pressure injuries while still allowing staff to safely reposition and transfer patients. Another advantage is that better communication and documentation about skin risks can help keep everyone on the healthcare team aware of the patient’s needs.
One disadvantage is that these recommendations depend a lot on the nurse’s or healthcare worker’s clinical judgment. Different staff members may have different opinions about when it is safe to leave a sling under a patient. It may also require more frequent skin assessments, documentation, communication, and staff education. Since the study found that there is still not enough evidence to create one universal guideline, more research is needed to determine the safest practices.
2. Discuss the sample size used in the study.
The study collected information from healthcare staff working at different Veterans Health Administration facilities. The initial survey included 93 staff members from 66 facilities, while the follow-up survey included 112 staff members from 77 facilities. The researchers also conducted interviews with 27 staff members from 9 VHA facilities. The participants included nurses, safe patient handling staff, nursing assistants, wound care nurses, and physical and occupational therapists. Having participants from different healthcare roles and facilities provided different perspectives on the use of slings and transfer devices. However, the interview portion involved only a small number of VHA facilities, which may limit how well the findings apply to other hospitals and healthcare settings.
Q: What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteA: There are differences in the perceived benefits and risks of leaving slings and other transfer devices under patients and limited knowledge of PI occurrences associated with doing so. This is because staff on different units take many different factors into account when weighing risks and benefits. Improved patient safety, consistent and standardized care and reduced risk of injury to staff might be considered advantages on any unit. But the need for adequate staffing (or the consistent lack there-of on select units), availability of equipment, lack of physical space to deploy new larger equipment in older smaller rooms, the need for additional training and continuing education of super-users and staff, and workflow disruptions may all outweigh perceived benefits, depending on the frequency of need for these types of transfers and the focus of each unit.
Q: Discuss the sample size used in the study
A: Health care staff in patient safety and nursing at 77 different VHA facilities responded to surveys between November and December 2019. Interviews were conducted using purposive sampling with VHA staff at facilities with highest and lowest PI rates between January and March 2021. Feedback on practices and perceptions related to leaving slings and other transfer devices were evaluated using online cross-sectional surveys and interviews with VHA staff. Secondary data for VHA inpatient rates of PIs were used to examine associations with staff-reported sling and other transfer device practices.
Q. Describe the method used by the author of the study.
ReplyDeleteA. In this study, authors used mixed methods rapid assessment approach. First, they collected data using cross-sectional surveys, electronic health record review, and qualitative interviews. Two surveys are used to for staff on sling and transfer device use. Nursing Staff were interviewed with 12 questions. Review of medical records of patients with pressure injuries. Second, they evaluate the information collected and Lastly, from this conclusions, Authors used this in development of safety guidance in using slings to prevent pressure injuries and skin injury risk.
Q. Discuss the research question or main problem discussed in the
study?
A.The purpose of this quality improvement project was to develop guidance for safe patient handling and mobility efforts to prevent pressure injuries (PIs) within the Veterans Health Administration (VHA) when slings and other transfer devices are left under patients.
Preventing pressure injuries is very important in any use of transfer devices. Even short term use can lead to longer complications.
This study is conducted to assist nurses and health care staff in decision making in leaving the sling or other transfer device under the patient.
After this study, authors were able to develop the decision support to tool guide.
Leaving Slings and other Devices under Patients: A Clinical Decision Support Quality Improvement Project
ReplyDelete1. Discuss the research question or main problem discussed in the study.
This article discusses whether leaving slings or other transfer devices poses a threat to the development of hospital acquired pressure injuries to patients. There was noted determining influencing factors associated with such device use, such as the material of the sling / transfer device or the length of time it was under the patient. It is important to outweigh the benefits versus risks of using such transfer devices as the article stated and to explore the basis of whether or not staff has proper understanding of when to use slings or transfer devices, while minimizing the risks of pressure injury development.
2. What are the advantages and disadvantages to the proposed recommendations in the article?
Advantages to the implementation of slings and transfer devices left under patients is that it allows caregivers to efficiently, safely, and more easily transfer patients with minimal or reduced risk of injury or strain to the caregiver. Nurses / caregivers are more prone to use such devices if they are readily available for use immediately under the patient versus having to set it up under the patient upon each use. Disadvantages to leaving slings or transfer devices under patients include possible pressure injuries if the device is not positioned correctly, creating wrinkles or imprints on skin leading to pressure injuries. Also, depending on the material of the transfer device, it can possibly harbor moisture which can increase the risk of skin breakdown.
1) How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteDirect patient caregivers in our hospital are required to attend safe patient handling classes and we have in-services on our transfer devices, and also consider manufacturer guidelines. For example, green slide sheets and lift slings needs to be removed after use. There are other devices can be left under patients such as hovermatt, tortoise, and airtap (used ICU). Overall, nurses have to assess each patient’s individual needs, mobility and risks for pressure injury. Nurses should ensure that appropriate device is used and removed, patients are being repositioned. Skin should be regularly assessed for moisture or incontinence that may increase the risk of skin breakdown.
2)Discuss the research question or main problem discussed in then study?
The main problem discussed in this article is that slings and other transfer devices may be left under patients, which can increase the risk of pressure injuries. This article discusses gaps in the proper use and management of slings and transfer devices and the risk of pressure injuries when these devices are left underneath patients across Veteran Health Administration (VHA) facilities. The quality improvement researchers conducted mixed method approach to collect data, using VHA’s pressure injury rates with staff-reported practices, and survey about their practices on devices and perceptions about leaving devices and pressure injuries. The data collection was to establish guidance for best practices on transfer devices and pressure injury prevention.
1. Discuss the research question or main problem discussed in the study?
ReplyDeleteAs hospital-acquired pressure injuries are considered avoidable adverse events, and the cost of which is over $10 billion in the United States each year, the Veterans Health Administration considers this a completely avoidable occurrence. In this Quality Improvement Project article, the research question asked, how often and under what circumstances do transfer devices left under patients cause hospital-acquired pressure injuries on hospital units and in Community Living Centers. While it is understood that leaving slings and other transfer devices under patients can lead to pressure injuries, the issue is what is the best practice to prevent these from occurring.
2. Describe the method used by the author of the study
The authors surveyed 112 health care staff at 77 Veteran Health Administration facilities about the use of overhead and other transfer devices, whether these devices were left under patients, and if so, what kind of device and for how long. After an interview guide was designed based on the interview collected from the survey, 24 health care staff were asked: 1) how were these devices used in the interviewee’s facility and 2) what were the interviewee’s perception of how these devices affected skin health. Lastly, electronic health records were reviewed for pressure injury outcome data.
1: Discuss the sample size used in the study.
ReplyDeleteA: The study included 93 respondents from 66 Veterans Health Administration (VHA) facilities in the initial survey and 112 respondents from 77 facilities in the follow- up survey. Researchers also conducted 24 individual interviews and one group interview, involving 27 healthcare staff members from nine VHA facilities. The participants included nurses, physical and occupational therapists, and safe patient handling personnel, allowing researchers to gather perspectives from different healthcare roles. This sample provided information about sling use and pressure injury prevention across multiple facilities.
2: Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
A: One limitation was the small qualitative sample, which included only nine VHA facilities, making it difficult to generalize the findings to other healthcare settings. Additionally, sling practices were evaluated at the facility level rather than the individual unit level, which may not accurately reflect actual patient care practices. The researchers also lacked patient- specific pressure injury information, preventing them from determining whether particular slings directly contributed to injuries. Finally, the study relied partly on staff- reported practices and perceptions, which could introduce reporting bias, and the statistical analyses were exploratory rather than sufficient to establish causation.
Valarie Renaux ICU
ReplyDelete1) How does this research article compare to our practice, policy and/or procedure?
We have many devices we are trained to use when moving patients. This is for both our protection and protection of the patients. We annually go to safe patient handling and are signed off to use the equipment. Moreover, equipment or supplies that are incorporated into the units are also in-serviced from the reps companies. A recent example of this would be the new boot protectors. We also do a shift assessment on safe patient handling, and generally patients who were previously bed bound or show to have some physical limitations will get orders for physical therapy. Physical therapists will then guide both the patients/family members and staff the safest ways of mobility. For equipment or devices used on patients we the nurses take responsibility checking the skin around that device and are required to offload and change sites when applicable.
2. What are the advantages and disadvantages to the proposed recommendations in the article?
Advantages in patients laying on top of the transfer devices, certainly makes it more convenient to transfer patients. Avoiding extra unnecessary turns enables comfort for the patient and minimizes injury to the caregiver. Compliance will be better achieved when the downtime of retrieving the device, prepping the patient to turn and position onto the device, as well as removing the device are avoided. An example of this we see in the hospital is the use of the air taps in ICU and the tortious used on the floors. Disadvantages are nurses can become complacent and have too much confidence in the equipment and may not diligently assess skin as well as they should. Additionally, devices/equipment have more opportunity to get soiled and then would most likely be thrown out.
David Kahn 5 south
ReplyDelete1. Research question or main problem discussed in the study:
The main issue this study looks at is whether leaving slings or other transfer devices under patients actually increases the risk of pressure injuries. A lot of staff across the VA system use slings differently, and there isn’t a clear, universal rule about when it’s safe to leave them in place. So the study is looking at how common this practice is, how staff feel about it, and whether it’s linked to higher pressure‑injury rates in different units like ICU or Medsurg. Overall, they’re trying to understand the real risks and benefits so staff can make better decisions instead of guessing or relying on inconsistent habits. However, this article is more of a survey of staff and does not have evidence based research to reach a definitive conclusion.
2. Advantages and disadvantages of the proposed recommendations:
The recommendations in the article focus on using clinical judgment instead of strict “always leave it” or “never leave it” rules. One advantage is that this approach makes sense because patients are all different, some have fragile skin, some need frequent transfers, and some are safer when the sling stays under them. Another plus is that leaving certain slings under patients can save time, reduce staff injuries, and help reposition patients more often, which can actually prevent pressure injuries in some cases.
The disadvantages that the study shows are that leaving slings under patients can be linked to higher pressure‑injury rates in ICU and Medsurg units if precautions aren’t followed. It also means staff have to be extra careful about things like wrinkles, straps, moisture, and skin checks, which adds more work. And because there’s no universal rule, different staff might make different decisions, which can lead to confusion or inconsistent care. So the recommendations are helpful, but they also require good communication and solid training to actually work well. It seems to conclude that the individual facility needs to create their own policy with specific guidelines but it does not go far enouigh to show specific evidence based findings or recomendations, it was more about the staff feelings on the pros and cons.
The study discussed about whether leaving leaving slings and other transfer devices left under patient can cause increase the incidence of pressure injuries in patients. The study was done across VA facilities and data were obtained from different units. Different factors were taken into considerations when obtaining evidence. Considerations were made in regards to patient's background, and medical histories to assess for risks of developing injuries. Materials of the slings or transfer devices were also considered because certain materials allow the skin to breathe and certain placements of attachments affect the risk assessment for pressure injuries. Additionally, the staff's role plays an important part in the skin assessment risks. At the conclusion of the study it was determined that there is no sufficient evidence that leaving slings and transfer devices can be directly attributed to the increase in pressure injuries. It outweighs the benefits of patient's decreased discomfort and staff's safety. There are also a few limitations in the study e.g length of time the slings were left under the patient and staff's perception of risks and education.
ReplyDeleteComparing the study to the practices and policy of my place of work, we use slings and transfer devices quite often. The use of them is highly recommended for reasons of patient and staff safety. Almost all slings or transfer devices are removed after use, except for the hover mat. The staff were educated during safe patient handling classes that were conducted in our facility that the materials of the hover mat is safe to be in contact with the patient's skin and can be left under the patient for relatively extended time. Having to use slings and transfer devices greatly decrease staff injury, and decrease patient's discomfort during patient care, and having it already under the patient promotes efficiency and less time for patient's to endure any discomfort. Staff education is scheduled and provided in the proper use of the device and frequent patient skin assessment.
ReplyDeleteValerie Dressman
ReplyDelete1. How does this research article compare to our practice, policy and/or procedure?
This article includes a study on the prevalence of pressure injuries from transfer slings and devices when left under patients. This is relevant study to our practice when used, and can put our patients at possible risk. As far as our policy, we remove slings after transferring patients with lift devices. A lift device/sling should never be left under a patient at our hospital, so our patients should not have the risk associated with their pressure injuries. This could have been implemented from previous issues with pressure injuries including slings/devices, but this practice has been in place before my time at Providence.
2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
The main issue this article investigates is if transfer devices and slings put patients at higher risk for pressure injuries. However, the article highlights a limitation that the study did not look at pressure injuries specific to body sites that could be associated with the transfer devices. This is crucial when trying to prove that a sling caused a pressure injury. The article also states that the pressure injury data was taken from a unit or facility level, which would exclude other risk factors for pressure injuries, specific to certain patients or units.
Discuss the research question or main problem discussed in the study:
ReplyDeleteThe study is about pressure injuries related to patient lifting and transferring devices including slings but not limited to other devices that are left under patients when repositioning or transfers. The researchers studied practices within VHA facilities to determine how slings and transfer devices are being used under patients that may increase the potential risk of pressure injuries. The study also identifies problems in current practices and helps develop protocols for safer use of patient handling equipment's.
Discuss the limitations:
The study had some limitations. The researchers evaluated transfer -device practices mostly at the facility level rather than individual units or patients; therefore, difference in actual unit practices may not have observed. The pressure injury data also did not identify specific body location or transfer device that was used; therefore, making it difficult to determine actual direct relationship between a particular sling or device and a pressure injury. In addition, only a subset of VHA facilities participated, and qualitative data came from only nine facilities which limits how the findings can be utilized.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThis quality improvement initiative addressed the prevalence of hospital-acquired pressure injuries (PIs) associated with patient transfer slings within the Veterans Health Administration (VHA). Despite PIs being recognized as avoidable adverse events, there was a critical lack of data regarding the safety of leaving slings under patients between transfers. By analyzing current VHA practices and examining the correlation between prolonged sling use and skin breakdown, this study developed evidence-based recommendations to standardize sling protocols. The primary goal was to enhance patient safety and support the VHA’s commitment to eradicating preventable hospital-acquired pressure injuries.
How does this research article compare to our practice, policy and/or procedure?
All direct patient care staff are required to complete mandatory safe patient handling training and remain current on all in-service protocols regarding transfer devices. Personnel must strictly adhere to manufacturer guidelines; for instance, slide sheets and lift slings must be removed immediately after use, whereas specialized systems such as HoverMatts, Tortoise surfaces, and AirTap systems may remain positioned under the patient. It is the responsibility of the bedside nurse to assess each patient’s mobility requirements and pressure injury risk to ensure the selection and appropriate utilization of the correct device. Furthermore, nurses are accountable for maintaining a consistent repositioning schedule and performing regular skin assessments to monitor for signs of moisture or incontinence that may contribute to skin breakdown.
1. Discuss the research question or main problem discussed in the study?
ReplyDeleteThe main problem being discussed in this article is leaving medical devices such as slings or repositioning devices. They question whether or not it is appropriate to leave such devices under a patient following a risks and benefits chart. This pictorial chart allows staff to potentially make the right decision based on patient’s risk to developing pressure injuries.
2. How does this research article compare to our practice, policy and/or procedure?
In our policy procedure; we are not supposed to leave and device under a patient; unless it’s a device designed specifically to prevent developing a pressure injury. These devices include a waffle cushion, and for patients that are total care and limited in mobility we use a tortoise. The tortoise is designed to help offload patient pressure points and has straps on the side to help reposition the patient. It also has a design where you tuck edges to prevent patient from sliding off the device.
How does his research article compare to our practice, policy and/or procedure?
ReplyDeleteWe have a very similar practice with this VA facilities' one regarding the safety of leaving slings and transfer devices under patients except for AirTap in ICU. I believe we have the policy and have been educated we shouldn't leave slings and transfer devices under Patient any time unless obtaining a MD order. For example, Hover mat, which was often used especially for obese patient before AirTap was introduced . I saw a few obese patients who kept Hover mat under the patients due to hemodynamic instability or increased bleeding risk in the past. The research article showed potential variable practices of leaving sling due to lack of consensus in the staff members. In our hospital, I believe, we follow our policy just because it's our hospital's policy and we do not leaving sling under a patient although we may have various opinions on it; we've been told we'll be covered as long as we follow our policies in case of legal action.
What are the advantages and disadvantages to proposed recommendations in the article?
When we feel policy and or procedure is too rigid, it would be very natural outcome with low compliance of the policy and or procedure, which may result in various practice compromising standard of care. The VA facilities can enforce their policy and/or procedure by authoritarian approach like our hospital does, instead they researched the staff members' opinions and developed a guidance. The biggest advantage is to create a decision support tool that can guide the staff best practices on using a transfer equipment. Since this decision tool was developed from participant insights as well as the experts and evidence in the medical literature, the staff members' compliance of this tool would be higher I believe; the staff must feel like being listened and their opinions are valued. The second biggest advantage is that the document also includes the efficient communication, which derived from their findings that staff at facilities with the lowest rates of PI uses both verbally and in written form on communicating patients skin injury risk.
As for disadvantages, There is a concerning. Their decision support tool might enhance variable practice among the bedside nurses, which may contribute to compromise standard care. As the article mentions under Limitations, their finding of observed pressure injuries failed to specify body site location, which prevents further analysis of relationship between specific sling/transfer device type and pressure injury body site location. I am very curious if an incidence of pressure injuries will be improved after implementation of the decision support tool to guide or not. If improved, the tool is very helpful to guide the nurses to best practice.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThis study was to develop best practice information to guide safe patient handling, specifically in regard to leaving slings and transfer devices under patients. They found that there is a higher risk of patients developing pressure injuries when slings have been left underneath patients. Although it does not seem like we have a specific policy against leaving slings under patients, most nurses at our facility will not leave slings under patients. This seems to be more so related to a unit culture where lifts are not often used for patient mobility and less so related to reducing pressure injuries. However, having best practice guidelines established can help our hospital continue to develop our safe patient handling practices.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
This study chose to examine the effects of sling use at a facility-wide level, instead of a unit level which could provide more valuable information regarding unit-specific differences. This study also failed to specify which specific body locations were observed for pressure injuries which limits researchers’ ability to connect specific sling types with pressure injuries locations. Additionally, researchers only minimally looked at role type despite data showing that role type can influence staff perceptions and how they make decisions regarding sling-use.