Leaving Slings and Other Transfer Devices Under Patients: A Clinical Decision Support Quality Improvement Project.

IF 1.7 3区医学 Q2 NURSING Journal of Wound Ostomy and Continence Nursing Pub Date : 2024-11-26 DOI:10.1097/WON.0000000000001144

Sarah E Bradley, Margeaux Chavez, Blake Barrett, Jason Lind, Linda Cowan, Vianna Broderick, Tatjana Bulat

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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 pratice: There are perceived benefits and risks of leaving slings and other transfer devices under patients and limited knowledge of PI occurrences associated with this preactice. 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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将吊带和其他转移设备留在患者身下：临床决策支持质量改进项目。

目的：本质量改进项目旨在为退伍军人健康管理局（VHA）内的安全患者搬运和移动工作制定指南，以防止吊带和其他转移设备留在患者身下时造成压力损伤（PIs）：退伍军人健康管理局（VHA）77 个设施中负责患者安全和护理的医护人员（n = 112）在 2019 年 11 月至 12 月期间对调查做出了回应。2021 年 1 月至 3 月期间，采用目的性抽样对 PI 率最高和最低的设施（n = 9）的 VHA 工作人员进行了访谈（n = 24）：方法：通过在线横断面调查和对 VHA 员工的访谈，对有关离开吊衣和其他转运装置的实践和看法的反馈进行评估。使用有关 VHA 住院病人 PI 发生率的二手数据来检查与工作人员报告的吊衣和其他转运装置做法之间的关联：在重症监护病房（ICU，P = 0.042）和内外科护理病房（P = 0.025）中，将吊衣留在病人身下与发生 PI 的病人比例较高有关。此外，社区生活中心的短期住院患者使用滑板进行坐位转移与较高的 PI 发生率有关（P = .017）。定性访谈发现，工作人员在确定风险时会考虑很多因素，因此他们对与吊衣和其他转移设备相关的 PI 风险的认识和指导也不尽相同：对实践的启示：将吊衣和其他移位装置留在患者身下既有好处也有风险，但对与这种做法相关的 PI 发生率了解有限。临床决策支持可以帮助工作人员确定吊衣的安全使用。还需要做更多的工作来测试常见吊衣和转运装置做法的安全性，并确定在整个护理过程中传达与吊衣和转运装置使用相关的 PI 风险的最佳做法。

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来源期刊

Journal of Wound Ostomy and Continence Nursing 医学-护理

CiteScore

3.10

自引率

34.60%

发文量

186

审稿时长

6-12 weeks

期刊介绍： The Journal of Wound, Ostomy and Continence Nursing (JWOCN), the official journal of the Wound, Ostomy and Continence Nurses Society™ (WOCN®), is the premier publication for wound, ostomy and continence practice and research. The Journal’s mission is to publish current best evidence and original research to guide the delivery of expert health care. The WOCN Society is a professional nursing society which supports its members by promoting educational, clinical and research opportunities to advance the practice and guide the delivery of expert health care to individuals with wounds, ostomies and continence care needs.