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Bradley SE, Chavez M, Barrett B, Lind J, Cowan L, Broderick V, Bulat T. Leaving Slings and Other Transfer Devices Under Patients: A Clinical Decision Support Quality Improvement Project. J Wound Ostomy Continence Nurs 2025; 52:14-22. [PMID: 39588638 DOI: 10.1097/won.0000000000001144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2024]
Abstract
PURPOSE 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. PARTICIPANTS AND SETTING Health care staff (n = 112) in patient safety and nursing at 77 unique VHA facilities responded to surveys between November and December 2019. Interviews (n = 24) were conducted using purposive sampling with VHA staff at facilities with highest and lowest PI rates (n = 9) between January and March 2021. APPROACH 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. OUTCOMES Leaving slings under patients was associated with higher proportion of patients developing PIs in intensive care units (ICUs, P = .042) and medical-surgical care units ( P = .025). In addition, use of sliding boards for seated transfer among short-stay residents in Community Living Centers was associated with higher PI occurrences ( P = .017). Qualitative interviews found perceptions and guidance about PI risk related to slings and other transfer devices varied among staff who consider many factors when determining risk. IMPLICATIONS FOR PRACTICE There are perceived benefits and risks of leaving slings and other transfer devices under patients and limited knowledge of PI occurrences associated with this practice. Clinical decision support can help staff determine safe sling use. More work is needed to test the safety of common sling and transfer device practices and define best practices for communicating PI risk related to sling and transfer device use across the care continuum.
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Affiliation(s)
- Sarah E Bradley
- Sarah E. Bradley, PhD, MPH, CPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, Michigan
- Margeaux Chavez, MA, MPH, CPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Blake Barrett, MSPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Health Care System, Aurora, Colorado
- Jason Lind, PhD, MPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida
- Linda Cowan, PhD, APRN, FNP-BC, CWS, James A. Haley Veterans Hospital and Clinics, Tampa, Florida
- Vianna Broderick, MD, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and University of South Florida, Tampa, Florida
- Tatjana Bulat, MD, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and University of South Florida, Tampa, Florida
| | - Margeaux Chavez
- Sarah E. Bradley, PhD, MPH, CPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, Michigan
- Margeaux Chavez, MA, MPH, CPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Blake Barrett, MSPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Health Care System, Aurora, Colorado
- Jason Lind, PhD, MPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida
- Linda Cowan, PhD, APRN, FNP-BC, CWS, James A. Haley Veterans Hospital and Clinics, Tampa, Florida
- Vianna Broderick, MD, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and University of South Florida, Tampa, Florida
- Tatjana Bulat, MD, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and University of South Florida, Tampa, Florida
| | - Blake Barrett
- Sarah E. Bradley, PhD, MPH, CPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, Michigan
- Margeaux Chavez, MA, MPH, CPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Blake Barrett, MSPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Health Care System, Aurora, Colorado
- Jason Lind, PhD, MPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida
- Linda Cowan, PhD, APRN, FNP-BC, CWS, James A. Haley Veterans Hospital and Clinics, Tampa, Florida
- Vianna Broderick, MD, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and University of South Florida, Tampa, Florida
- Tatjana Bulat, MD, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and University of South Florida, Tampa, Florida
| | - Jason Lind
- Sarah E. Bradley, PhD, MPH, CPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, Michigan
- Margeaux Chavez, MA, MPH, CPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Blake Barrett, MSPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Health Care System, Aurora, Colorado
- Jason Lind, PhD, MPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida
- Linda Cowan, PhD, APRN, FNP-BC, CWS, James A. Haley Veterans Hospital and Clinics, Tampa, Florida
- Vianna Broderick, MD, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and University of South Florida, Tampa, Florida
- Tatjana Bulat, MD, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and University of South Florida, Tampa, Florida
| | - Linda Cowan
- Sarah E. Bradley, PhD, MPH, CPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, Michigan
- Margeaux Chavez, MA, MPH, CPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Blake Barrett, MSPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Health Care System, Aurora, Colorado
- Jason Lind, PhD, MPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida
- Linda Cowan, PhD, APRN, FNP-BC, CWS, James A. Haley Veterans Hospital and Clinics, Tampa, Florida
- Vianna Broderick, MD, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and University of South Florida, Tampa, Florida
- Tatjana Bulat, MD, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and University of South Florida, Tampa, Florida
| | - Vianna Broderick
- Sarah E. Bradley, PhD, MPH, CPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, Michigan
- Margeaux Chavez, MA, MPH, CPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Blake Barrett, MSPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Health Care System, Aurora, Colorado
- Jason Lind, PhD, MPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida
- Linda Cowan, PhD, APRN, FNP-BC, CWS, James A. Haley Veterans Hospital and Clinics, Tampa, Florida
- Vianna Broderick, MD, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and University of South Florida, Tampa, Florida
- Tatjana Bulat, MD, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and University of South Florida, Tampa, Florida
| | - Tatjana Bulat
- Sarah E. Bradley, PhD, MPH, CPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, Michigan
- Margeaux Chavez, MA, MPH, CPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Blake Barrett, MSPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Health Care System, Aurora, Colorado
- Jason Lind, PhD, MPH, James A. Haley Veterans Hospital and Clinics, Tampa, Florida
- Linda Cowan, PhD, APRN, FNP-BC, CWS, James A. Haley Veterans Hospital and Clinics, Tampa, Florida
- Vianna Broderick, MD, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and University of South Florida, Tampa, Florida
- Tatjana Bulat, MD, James A. Haley Veterans Hospital and Clinics, Tampa, Florida, and University of South Florida, Tampa, Florida
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