Safe Sling Selection

1
Safe Sling Selection Use

• Acknowledgement Michelle McCleerey, RN, MEd, MA,
  PhD - Hill-Rom

2
Safe Sling Selection Use

• Sling Selection
• Sling Insertion/Placement
• Sling Attachment
• Sling Removal

3
Sling Selection

• Choosing the Appropriate Sling
• Patient handling task
• Patient characteristics
• Lifting device
• Use Patient Handling Care Plan (Algorithms)
• A-11 Sling Selection Chart

4
Sling Selection

• Basic Sling Categories
• Seated
• Supine
• Standing
• Ambulation
• Position Support

5
Seated Slings

• Patient Handling Task Patient Characteristics
• Vertical Transfers Tolerance for sitting
  position
• Toileting
• Bathing Adequate hip knee
• Move Up in Bed flexion
• Reposition in Chair
• Make Occupied Bed Consider wounds
• Fall Rescue

6
Supine Slings

• Patient Handling Task Patient Characteristics
• Lateral Transfer No tolerance for sitting
• Bathing position
• Move Up in Bed
• Turning in Bed Patient must remain flat
  Make Occupied Bed
• Fall Rescue Restricted hip/knee flexion
• Post-Mortum Care
• Contraindicated if respiratory
  compromise
• Consider wounds

7
Standing Slings

• Patient Handling Task Patient Characteristics
• Vertical Transfer Upper body
• Toileting strength
• Sit-to-Stand Training
• Reposition in Chair Ability to grasp with one
• Dressing hand
• Peri Care
• Partial weight bearing
• Cooperative/ability to follow
  directions
• Consider wounds

8
Ambulation/Walking Slings

• Patient Handling Task Patient
  Characteristics
• Ambulation Support/Training Partial weight
  bearing
• Cooperative/ability to follow
  directions
• Physician/therapist direction

9
Limb/Position Support Slings

• Patient Handling Tasks Patient
  Characteristics
• Turn Assist If sustained holding of
  extremity,
• Dressing consider
• Surgical Procedures Joints
• Bathing/Hygiene Neurovascular supply
• Wound Care/Dressing Wounds
• Comfort

10
Sling Selection

• Considerations
• Compatibility with lift
• Spreader bar design
• Manufacturer directions
• Weight capacity
• 57 of nurses unaware
• (Moody et al. 1996)
• Appropriate sling size
• Varies across manufacturers
• Body weight distribution

11
Sling Selection

• Considerations (continued)
• Sling design (McGuire et al. 1996, Edlund et al.
  1996, 1993)
• Determinant of comfort/safety/dignity
• Head and neck support
• Leg support
• Leg Abduction
• Task Dependent

12
Sling Selection

• Considerations (continued)
• Sling Condition
• Medical Conditions
• Skin Integrity
• Wounds
• Knee/hip flexion
• Amputee
• Obesity
• More

13
Sling Selection

• Considerations (continued)
• Assess for pressure points/comfort
• (McGuire et al. 1996)
• Seated
• Upper/lower back
• Buttocks
• Thighs
• Lower legs
• Standing
• Under arm
• Upper/lower back

14
Sling Insertion/Placement

• Method Considerations
• Position of Patient
• Patient medical condition/s
• Patient ability to help
• Safety Considerations
• Patient comfort
• Sheer forces
• Caregiver safety

15
Sling Insertion/Placement

• Considerations
• Different for sling types
• Multiple Techniques
• Side to side, Head to toe, use of FRD, etc.
• Lying in bed, seated
• Lack of Education/Training (Moody et al. 1996)
• 22 None
• 61 OTJ training by colleague

16
Sling Attachment

• Obstacles/Considerations
• Inconsistency across manufacturers
• Multiple methods of attachment
• Loops
• Hooks
• Clips
• Magnitude of swing
• Difficult to Attach
• 57 Preclude use (Moody et al. 1996)

17
Sling Attachment

• Obstacles/Considerations continued
• Variance of spreader bar types
• Length, height, suspension points

18
Sling Attachment

• Improper Sling Attachment (Edlund et al. 1996)
• Excess backward inclination
• Insufficient backward inclination
• Large flexion angle
• Large sling opening
• Proper Sling Attachment (Edlund et al. 1996)
• Thigh position 7 forward/upward
  of horizontal plane
• Trunk/thigh angle gt 83
• Backrest inclination 20 - 25

19
Sling Removal

• Method Considerations
• Position of Patient
• Patient medical condition
• Patient ability
• Safety Considerations
• Patient comfort
• Sheer forces
• Caregiver safety
• Leaving Sling Under Patient

20
Barriers to Consistent Safe Sling Use

• Knowledge Gaps
• Awareness of sling types and designs
• Technical knowledge regarding facility slings
• Sizes, types, weight limits, corresponding lifts
• Proper sling selection guidelines
• Importance of sling safety
• Sling application process
• Safe sling use protocol and policy

21
Barriers to Consistent Safe Sling Use

• Skill Needs
• Sling inspection
• Sling insertion and placement
• Sling attachment
• Assessing patient comfort
• Maintaining patient dignity
• Sling removal

22
Organizational/System Deficits

• On unit level, availability of
• Adequate of slings
• Required sling types
• Required sizes
• Infection Control
• Standard Operating Procedure
• Sharing slings
• Laundering
• Maintenance and tracking
• Provision of training time

23
Recommendations

• Access to manufacturing product information at
  the unit level
• Diverse sling offerings at unit level
• Disposable/Single-patient assigned
• Variety of types and sizes
• Well-marked, standardized markings and weight
  limits on slings

24
Recommendations

• Involvement of point-of-care staff
  with facility sling purchase
• Systematic laundering process to prevent sling
  loss
• Use of labeling to promote correct sling
  attachment
• Development of guidelines/protocol for
  sling use

25
Recommendations

• Annual skills check off/competency evaluation

26
Recommendations

• Systematic solicitation of patient
  feedback/involvement
• Periodic, formal training targeting sling use for
  all levels of staff
• Inclusion of wound care nurse on patient
  handling/ergonomics/safety committee
• Further research regarding sling use and other
  issues affecting consistent use of patient
  handling equipment