Quality improvement initiatives are essential to meeting key national benchmarks when delivering care, and prevention of skin breakdown and pressure injuries is often one of the priority QI measures addressed. Failing to adequately address the risk of pressure injury has significant impact on patient safety ratings, quality outcomes, and creates serious financial implications due to the cost of treating hospital-acquired skin breakdown.

Because of this, hospitals and health systems put a great deal of focus on the selection of appropriate patient support surfaces to reduce pressure, shear, friction, and moisture for patients at high risk of skin breakdown.

However, despite these efforts, one source of pressure injuries and skin breakdown is often overlooked: stretcher mattresses. For true continuity of care for skin integrity throughout a hospital stay, every surface a patient may spend time on requires consideration. An organization’s choice of stretcher mattresses can have significant impact on pressure injury incidence, facility risk, and patient satisfaction. Therefore, it is critical to choose stretcher mattresses that help prevent both pressure and shearing.

A Hidden Challenge: Time Spent on Stretchers

It’s well understood by wound care specialists that pressure injuries can develop in as little as two hours. Older adults, those who are critically ill, incontinent, immobile, or have poor nutritional status are all at increased risk, and these people are the ones who require hospital care the most. While resting on a poorly designed surface, occlusion of blood flow to tissues and cell death begins quickly due to uneven distribution of pressure.

With as many as every 10th hospital patient having a pressure injury, the urgency of this threat starts as soon as a patient comes through the hospital doors. In many cases, that entry point is the emergency department (ED), where the primary hospital “bed” is in fact a stretcher.

In this context, the length of time a patient spends on a stretcher can be significant. Recently, the American College of Emergency Physicians (ACEP) highlighted a particular issue which they deem a “public health emergency”: ED boarding.

ED boarding is the practice of holding patients in the ED while they wait for an inpatient bed — many times in the ED hallways and crowded overflow or observation areas. In an ACEP poll, 44% of people reported that either they or a loved one had faced extended wait times in the ED, many as long as 13 hours. Sometimes, at the most extreme, these waits can stretch into days or even weeks.

A Hidden Challenge Time Spent on Stretchers

When a patient finally reaches that inpatient bed, the availability of an appropriate mattress usually reflects decisions made at an organizational level by a committee with representation from various areas of the organization, including clinical, risk management, infection control, procurement, environmental services, and bio-med.

But in the ED, stretcher mattresses may not have been afforded the same level of careful consideration. And by the time a patient reaches a proper support surface, it can be too late.

Additional time spent waiting on stretchers may also loom, even after admission to an inpatient bed. With healthcare staffing shortages creating delays in care, patients may find themselves resting on stretchers for an extended time in many scenarios:

The Hidden Danger of Transferring

It’s clear that stretchers should not be viewed as a short-term patient support solution that does not have potential to lead to pressure injuries. But what about patients that are only on a stretcher for a very brief time? These patients are quickly transferred to more supportive surfaces, which may create a false sense of security — but the reality is that a poorly designed stretcher mattress also increases the risk of pressure injury during transfers. These transfers can cause another problem: shearing.

Shearing is tissue damage caused by opposing forces of movement separating skin and deep tissue from each other. This can happen as patients shift or move on a poorly designed stretcher mattress, with increased risk during activities such as sliding across a stretcher during a transfer. This deep damage can develop into a more serious pressure injury, especially if the patient then experiences continued exposure to poorly distributed pressure on a poorly designed surface.

Each time a patient is moved from a stretcher to a bed and vice versa, the stretcher mattress is half of the equation in safely transferring the patient without shearing. If the bed has a properly designed mattress but the stretcher does not, patients are needlessly placed at risk.

How to Choose the Right Stretcher Mattress

Obviously, a standard stretcher mattress is not enough to reduce the risk of skin breakdown. The SPAN UltraMax™ stretcher surface, from Savaria Patient Care, addresses the risk of both pressure and shearing, helping to eliminate these dangers for patients who are placed on stretchers for any length of time and creating exceptional continuity of care for skin integrity across all support surfaces in a facility.

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Features to Reduce Pressure

The UltraMax™ addresses pressure with Ultra High Performance Foam, a specialty foam product precision engineered to offer differing densities of support across the surface of the stretcher. This results in a level of restful comfort typically possible only on full-sized hospital bed surfaces. With a “three-dimensional zoning” design and 55% higher support factor in the seat section than traditional stretcher mattresses, it provides premium pressure redistribution.

Features to Reduce Shearing

Targeted design features inside and out of the UltraMax™ address shearing. This helps improve protection in two ways:

These features combine to provide additional support where it matters most: under bony prominences like the heels, sacrum, and scapula, and by preventing problems like “bottoming out” that can happen during transfers with standard stretchers, causing shear injury.

Additionally, the UltraMax™:

Exceptional Continuity of Care with the Right Stretcher Mattress

Stretcher mattresses are the first line of defense when it comes to protecting skin integrity in the hospital. Just like a high-quality bed mattress can guard against pressure and shear injuries, a high-quality stretcher mattress that helps eliminate these threats is essential.

By ensuring careful selection of a durable, innovative stretcher mattress like the SPAN GeoMattress® UltraMax, your quality initiatives, patient outcomes, and improved patient safety ratings are supported throughout the entirety of a patient’s hospital stay.

To learn more, get in touch with our experts today. We can help you ensure continuity of care across the spectrum of patient support surfaces.

Unlocking Superior Care: 10 Reasons to Choose PressureGuard Support Surfaces

If you are considering buying vs. renting therapeutic support surfaces for your residents, what you buy has critical implications. From the largest corporate groups to the smallest independents, clinicians and administrators recognize the unique benefits that SPAN PressureGuard air therapy support surfaces deliver:

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Before you choose a support surface, consider these 10 Reasons why so many choose PressureGuard

Reason 1. PressureGuard – Built to own, not to rent.

Does your rented mattress come rolled up in a bag? It’s designed for easy storage and delivery. That’s a benefit to the rental company, not to your patients. Truth is, it is impossible to build these roll-up mattresses with all the key features found in PressureGuard products. Roll-ups are designed to maximize income for the rental company, not outcomes for your residents.

Reason 2. Documented, Time-Tested Results. 

It’s important to practice evidence-based care, and PressureGuard products provide that evidence in two ways.  First, they’re backed by proof of their effectiveness published in clinical articles, scientific posters and white paper documenting their superiority compared to traditional designs. Second, this outstanding performance has made PressureGuard products a go-to in a variety of patient care settings for more than three decades—particularly as North America’s #1 seller in long-term care. 

Reason 3. Prevent Falls and Entrapment.

Liability due to patient injury or death from falls or entrapment in the bedframe/mattress combination is a constant worry in long term care. The unique features of the PressureGuard Safety Edge limits a facility’s exposure to these events.

Reason 4. Patient Stability in Rolling and Edge-Sitting.

Our patented PressureGuard design combines a multi-cylinder air system surrounded by an engineered foam outer shell. This design builds in a level of stability that simply cannot be achieved by typical, roll-up rental air mattresses. In fact, it is documented to be up to 40% more stable in edge-sitting. And unlike other mattress designs whose unstable edges cause them to lose up to 50% of the width of the mattress in safe area of use, PressureGuard gives stability across the entire surface.

Clinical Training Surfaces

Reason 5. Clinical Support.

With certified wound care specialist consultants on staff, Savaria Patient Care continues to provide evidence base for your product decision, a phone consultant for product decisions and patient-specific questions, and backing for questions from surveyors. Our Survey Survival Guide provides information often requested by surveyors about support surfaces, information that is available to you at your fingertips. One less worry on Survey-Week.

Reason 6. Hassle-Free Use and Maintenance.

Your staff should be taking care of residents, not equipment. PressureGuard products are designed to deliver maximum performance with minimal intervention. Our control units are simple to set up and operate (no programming patient weight or special settings) and the surfaces are designed to be easily wiped clean, just as you would clean any standard mattress in your facility.

Reason 7. Low-Air-Loss That Actually Does What Low-Air-Loss is Supposed to Do.

Our PressureGuard Easy Air microclimate management surface controls skin maceration—that is, removes more excess perspiration from the skin—than any other system on the market. Period. What’s more, our design accomplishes this without all the usual compromises associated with tradition microclimate /”low-air-loss” products. For starters, it won’t go flat in a power outage. And it won’t “swallow up” your resident, nor make them too hot or too cold.

Reason 8. Bariatric Models.

Outstanding PressureGuard air therapy surfaces are available in bariatric sizes to support the needs of users up to 1,000 lbs.  See the line-up.

Reason 9. Exclusive Anti-Shearing Geo-Matt Top Surface.

We build the proven Geo-Matt anti-shearing geometry into the top surface of every PressureGuard mattress. Without even turning on the power your patient is already lying on a surface that has proven itself for decades to be an effective at addressing pressure redistribution, and for decreasing the effects of shearing and heat/moisture buildup.

Reason 10. Risk-Free 30-Day In-House Trial.

Contact us to arrange a free, no obligation 30-day in-house trial. Your local sales rep will be happy to assist you. Yes, it is really risk-free. Really.

BONUS Reason 11. Performance Over Time – Ours, and Our Products’.

What you buy is important, and so is from whom you buy it. SPAN has been designing and manufacturing innovative pressure management solutions since 1975. Our 200,000 square foot plant in Greenville, SC is ISO 13485:2016 certified and boasts fully staffed Quality Assurance and Research and Design Departments. We have built a reputation for market-leading design innovation, outstanding product quality, and industry-best warranty protection.

Now that we’ve covered the sling basics on how to select, inspect and apply slings, let’s take a closer look at the various sling styles.

As you may recall from the 5 Steps to Choosing the Right Sling for Patient Transfers, slings can be grouped into a few basic categories. There are slings for seated transfers, toileting, positioning, sit-to-stand, and walking.

Today’s blog will focus on the band sling, a small, versatile sling that is often under-utilized or overlooked.  It’s designed to assist caregivers with tasks that involve lifting, supporting, and positioning of limbs.

Here are the 6 Ways the Band Sling can be used to help caregivers perform care tasks:

So why is the Band Sling not often used? Is it the lack of awareness that this type of solution exists? Is it the uncertainty of how to use this sling style?

Or is it because we believe limbs are easy to lift and hold?  After all, how heavy can a limb be

Well, let’s consider, in 2018, Stats Canada reported that 26.8% percent of adult Canadians were considered obese and 36.3% were overweight, increasing the risk of various medical conditions such as cardiovascular disease, diabetes, osteoarthritis and more.  The trend in healthcare has seen the steady rise of heavier patients with complex care needs, couple this with aging caregivers and overall caregiving has become harder.

A quick Google search indicated that the average male weighs about 187 lbs. and the average female weighs roughly 155 lbs. So, how heavy are the limbs our caregivers are lifting?

Well, to roughly estimate the weight of limbs, the VA Safe Patient Handling app Safe Patient Handling | VA Mobile suggests using 16% of the individual’s body weight to calculate the lower extremity and 5% to calculate the upper extremity.  Keep in mind that medical devices, casts, splints, or various medical conditions, for example lymphedema will increase the weight of the limb.

Given these guidelines, the lower extremity weight for the average male would be about 30 lbs. and almost 25lbs for the average female.

It seems like a weight anyone can lift, but can you lift a 25 or 30 lbs. limb frequently, while maintaining an awkward position, or bending and reaching over the bed with injury?

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The 2007 article titled “When is it safe to manually lift a patient” by Thomas R Waters, recommended 35 lbs. as the maximum weight limit for manual lifting with the caveat that the lift needed to be performed under ideal conditions. In situations where the caregiver needed to lift with extended arms, off the floor, or from a seated or kneeling position the 35 lb. weight limit would need to be decreased. When a task required the caregiver to lift greater than 35 lbs. the recommendation was made to use safe patient handling solutions. For limbs that require lifting and weighed greater than 35 lbs. a band sling could be the solution.

Limb lifting in healthcare oftentimes requires the arms to be extended while providing care or being in awkward positions, which sets both the caregiver and patient up for a potential injury.  Given that these situations are not ideal, how much weight can be manually lifted if we cannot or do not want to use a band sling?

A paper from 2009 titled “Recommended Weight Limits for Lifting and Holding Limbs in the Orthopedic Practice Setting” provided insight into this question. The authors of the paper developed an easy-to-use limb lifting tool for orthopedic clinicians in the form of a chart. This visual aid provides body mass ranges, limb weight estimates, maximum limb lift weights and maximum limb hold times. This tool could also prove to be helpful in other settings where caregivers need to lift and hold limbs for various caregiving tasks.

The guideline suggests that a maximum weight for a one-handed limb lift should not exceed 11.1 lbs.  and a 2 handed lift should not exceed 22.2lbs. If we consider the average male and female lower limb weights given these guidelines, manually lifting these limbs should not be performed without either additional help or with the use of a safe patient handling solution like a band sling.

The tool also provides recommendations regarding weight limits when holding the limb up for 1, 2 and 3 minutes at a time.

Now given what we know, if we can potentially reduce the risk of caregiver injury from lifting limbs manually and at the same time provide a safe, comfortable, supportive, and dignified limb lift for the patient, the Band Sling is worth a try.

If you are interested in learning more about our Band Sling or to demo it, feel free to connect with us at Handicare.

At Handicare we strive to make everyday life easier.

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Webinar

The Band Sling, Small But Mighty – A Discussion On Its Many Uses

What tools do you use to activate individuals? Many times, we rush to complete a transfer and don’t think of how they can assist. During this session we will look at the many ways a band/limb sling can be utilized through the continuum of care.

Wednesday, September 14, 2022 @ 2:00pm EST

 View Past Webinar

What tools do you use to activate individuals? Many times, we rush to complete a transfer and don’t think of how they can assist. During this session we will look at the many ways a band/limb sling can be utilized through the continuum of care.

Let’s recap, picking up from the last blog post, you may recall we touched upon the pre-use sling inspection, the safety check performed by the caregiver prior to the sling application for the lift and transfer.

The Inspection Process Should Ensure

The sling is clean for a dignified lift and transfer

The sling is clean for the individual’s comfort

The sling is clean to reduce the risk of an infection

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Important Info on Launderable Slings

Launderable slings should only be used by a single patient or resident and washed when soiled. With regards to using slings between patients or residents, caregivers should ensure slings are clean and should also be aware of and follow their organizational infection control policies procedures and protocols related to sling use and care. If using disposable slings, caregivers should be aware that these slings cannot be laundered and need to be removed from circulation when they become soiled, damaged, or no longer required by the individual.

Prior to sling application, the caregiver needs to check the sling to ensure it is the correct sling style, and size for the patient or resident. The caregiver also needs to ensure the individual does not exceed the sling’s safe working load (SWL).

During the pre use sling inspection process the sling also needs to be inspected to ensure it is in good working order.

Why? It’s important for caregivers to be aware that there are numerous factors that will impact the integrity of the sling. Given that slings will deteriorate over time and with use, misuse, and/or from the washing and drying process the sling will need to be inspected to ensure it is safe to use.

Taking the time to perform the visual sling check prior to each use is important and can potentially prevent painful and costly injuries.

Slings that do not pass the pre use sling inspection should be removed from circulation as per the organizations policies, procedures, and protocols.

Slings that need to be removed from circulation include

Worn out with holes, rips, tears, loose stitching, or frays

Are discoloured

Damage to Velcro, loops, clips, or buckles

Missing pieces such as straps

Have knotted loops or straps

Questionable in the eyes of the caregiver

Our Sling Audit Process

Another sling inspection process that you may or may not be familiar with is the Sling Audit, which differs from the pre-use sling inspection.  The pre-use sling inspection is performed prior to each sling use at the point of care and the sling audit, is a standardized and documented sling inspection process, the frequency of which may be defined by your organization.

Handicare recommends that sling audits be conducted once every year.

This formalized process which captures information such as sling manufacturer, sling style, size, serial number, and documents damage to the components of the sling for example has many benefits.

Here are 4 Reasons Why Sling Audits Are Critical in Safe Patient Care

It’s evident that both the visual pre-use sling inspection and the standardized and documented sling audit are important safety strategies. Ensuring slings are available, are appropriate for the patient or resident’s needs, are used correctly, and are clean and in good working order will benefit the patient, resident, caregiver, and organization.

And I think you may agree with the words of Benjamin Franklin, “An ounce of prevention is worth a pound of cure”.

If you are interested in learning more about sling inspections and audits, please feel free to connect with us at Handicare.

In our last blog post we walked you through the basic steps involved in the sling selection process. To recap, the selection of a sling as with all safe patient handling and mobility solutions requires a through clinical assessment, risk assessment, and sound clinical judgement. This month we will guide you through the steps and tips and tricks for the application of a Universal Sling in a chair.

The application of the Universal Sling can be broken down into 5 Basic Steps beginning and ending with safety checks.

Step One : Perform the Sling Pre-User Inspection

The process of applying a Universal Sling in a chair involves performing the pre-use sling inspection to ensure the sling is in good working order. The sling is checked to ensure there are no visible signs of damage; no holes, rips, tears, frays, discoloration, and the stitching should be intact. The pre use sling inspection also includes a visual inspection of the sling label to ensure that it is legible and not compromised.  The sling label provides identifying information such as the serial number, the sling style, size, safe working load (SWL), and laundry instructions necessary for safe use.

If the sling does not pass inspection, follow your site or facilities policies, procedures & protocols with regards to removing the sling from circulation.

Step Two : Apply the Sling Body Behind the User’s Back

There are two basic scenarios with the application of the sling body in a seated position.

The first scenario involves the user who can lean forward independently or with caregiver assistance.

With individuals who can lean forward in the chair, place the sling body behind their back with the label facing out. The midline of the sling should be aligned with the spine and the centre arch is aligned with the coccyx.

In the second scenario with individuals who are unable to lean forward due to medical conditions, pain, stiffness, tone, decreased ROM and so on, an alternative solution will be required. The large EasyGlide Ovals, Slider Sheets, or the Comfort Care Sling may be options.

Step Three : Apply the Leg Bands under the User’s Thighs

Next the leg bands of the sling are applied under the individual’s thighs. Some individuals may be able to assist with leg band application by creating space under their thighs; by going up on their toes or using their upper body strength to lift the thigh up. If the individual requires assistance to create space under their thighs the FootStool placed under the feet may be an option -remember to remove it post leg band application to prevent slips, trips, or falls.

For individuals who are unable to assist, the small EasyGlide Ovals may be an option. Another leg band application method can be viewed in this video featuring the Universal PolySlip Sling utilizing the low friction, SlipFit material to facilitate the application.

Next, based on your clinical assessment, risk assessment, and your clinical judgement you may choose to criss-cross the leg bands, which is the most used application, or apply the leg bands in a closed or open position.

Step Four : Apply the Sling Straps/Loops to the Lift Carry Bar

With the sling in place, the lift’s carry bar is lowered, and the sling’s straps are applied via the loops for this loop style sling. The various loops within the straps allow caregivers to position the individual in a seated to a more reclined position for the lift and transfer.

For a more upright seated position the shortest loop at the shoulder straps and the longest loop at the leg straps are applied to the carry bar, for a more reclined position the longest loops at the shoulder straps and the shortest loop at the leg straps are applied to the carry bar.

Step Five : Perform the Safety Checks Post Application

Once the sling has been attached to the carry bar the safety checks are performed to ensure the sling is a good fit for the individual.  The individual is raised off the chair surface until the straps are tensioned and then checked to ensure they are securely in place. Next the individual is lifted off the surface and checked to ensure they are not migrating through the commode opening. Also ensure the individual is comfortable, well supported, safe, and secure in the sling before proceeding with the lift and transfer.

Conclusion

There you have it, the 5 Steps to Applying a Universal Sling with Safety Checks.

For more information on Universal Sling application consult the user manual and video located on our website or reach out to our Clinical Academy Team.

Sometimes, finding the right sling can feel overwhelming with all the different styles, sizes, and fabrics to choose from. With a fresh start to the year, we thought it would be ideal to revisit the fundamentals for selecting a sling. We hope this simplifies the sling selection process for you to make everyday life easier.

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There are 5 Basic Steps that we found useful when selecting a sling.

Step One : Clinical Assessment

Step One in the sling selection process is to conduct a thorough clinical assessment of the individual’s abilities. Identifying the individual’s mobility level, whether they are independent with transfers, require supervision or assistance (minimum, moderate or maximum) is one factor in the selection process which helps narrow down sling style options.  Keep in mind that choosing a sling based solely on 1 factor may not ensure the correct sling has been selected.

To ensure the individual is prescribed the correct sling, consideration must also be given to other factors such as medical conditions, medications, pain, behavior, cognition, communication, weight bearing status, height, weight, body shape, skin integrity, range of motion (ROM), strength, endurance, tone, medical devices, and so forth.

Step Two : Needs Assessment

Step Two of the sling selection process involves identifying the individual’s needs – the tasks requiring caregiver assistance – transferring from bed to wheelchair, repositioning in bed, lifting a limb for hygiene care, transferring onto a toilet or commode, and so on. Identifying the various task(s) requiring caregiver assistance during the assessment process will help to further narrow down the sling style options.

Consideration for sling selection must also include factors related to the caregiver’s abilities, the environmental conditions, equipment accessibility, and other factors that you may identify during the assessment process.

Ultimately, selecting a sling, as with all safe patient handling and mobility solutions, requires a through clinical assessment, risk assessment and sound clinical judgement. The sling should balance the individual’s need for support and comfort without compromising the individual’s abilities or the caregiver’s safety.

Step Three : Sling Style Selection

To select the sling style, Step Three in the sling selection process, we’ve created an easy-to use Situations Table which can be found in our Handicare Sling Brochure.  Simply, select the task(s) across the top of the table and then choose one of the corresponding slings in the column.

Please see our Sling Brochure for full charts and fabric descriptions for sling selection.

As there is no “one-size-fits-all”, we’ve designed a variety of slings to meet the needs of individuals!

In brief, sling styles can be grouped into Five Styles as seen in the image below.

Please see our Sling Brochure for full charts and fabric descriptions for sling selection.

To help those who may be unfamiliar with the Seated Transfer Slings, we’ll quickly go through some of their key differences to assist you with your selection process.

In a nutshell:

Feel free to connect with us or your Handicare Account Manager if you require an in-depth look at our sling styles.

Step Four : Sling Size Selection

Now, when selecting a sling size, Step Four of the sling selection process, it’s important that you find a sling that is the right fit for the individual’s height, weight, and body shape. Located in the Handicare Sling Brochure is an easy to use, “Sling Size Guide” that will help with our sling sizing.

Please see our Sling Brochure for full charts and fabric descriptions for sling selection.

Step Five : Fabric Selection

Once the sling style and size have been selected, choose a sling fabric, Step Five in the process. In short, mesh slings are durable and breathable. Quilted mesh slings provide increased comfort under the thighs. Mesh/Poly slings have non-absorbent padding on the leg sections and may be used for bathing or swimming pools. Slings with padded polyester leg bands are designed for increased leg comfort. Poly/Slip slings are constructed with a low friction material on the outer leg sections for easier leg band application and removal. Spacer slings may be suitable for individuals with skin integrity issues with its multi-directional stretch, breathability, and ability to wick away moisture. Disposable slings, designed for single patient use, are strong, breathable, and liquid repellent.

Please see our Sling Brochure for full charts and fabric descriptions for sling selection.

Conclusion

There you have it – the 5 Steps to Choosing the Right Sling for Patient Transfers.

Now, where do we go from here you ask?

If you have selected a sling then it’s time to perform a trial sling fitting – this is where you apply the selected sling to the individual – to check and ensure the sling provides a safe, supportive, and comfortable fit before proceeding with the lift and transfer.

If you have not found a sling that meets the needs and abilities of the individual and the situation, then connect with us at Handicare to assist you!

We hope you found this blog post on sling selection helpful.