An interesting enquiry came into our postbag last month, from a volunteer Nursing Home visitor who was concerned to see that residents in the dementia unit she visited seemed to be sitting on hoist slings draped over their chairs for long periods of time, and wondered whether this was acceptable. I responded that some slings were intended to remain under the user for periods of time, and that for some patients, the pain and distress of transfers was such that remaining on the sling rather than being lifted off it might be the lesser evil. I suggested that she find out from the home management what the rationale behind the decision was, so that she could be sure that the best interests of the residents was being put first, and I also offered to forward her enquiry to industry experts who could give her a more detailed response.
To be honest, I was not expecting to hear more on the subject, but then this was my first communication with Jill Leslie, who has turned out to be not only deeply concerned about the well-being of a group of people who are often not able to protect their own interests effectively, but also an uncommonly energetic investigator!
It transpired that residents were sitting on their slings since the occasion of a fatal hoisting accident, when one of them had fallen while being transferred, and subsequently died.
Social Services, together with the relevant sling supplier and manufacturer, and the community OT decided that rather than risk a further such incident, it would be safer to leave the slings in situ, for residents who required regular hoisting.
Jill's investigation into care industry/expert attitudes to this is published in the hoisting section on Independent Living, and makes interesting reading: Sling High – Sling Low
The clearest message to emerge is that there is no consensus on this subject. Some people would have a “zero tolerance" approach to leaving slings in place, while others point to technical developments in fabric to protect from pressure damage, allied with the distress occasioned by frequent transfers.
Everybody, of course, is in agreement that the interests of the patient must be paramount, but how to ensure this? In this particular Home, poor staff training and language difficulties were some of the factors, apparently, which made it safer to leave residents sitting on slings, rather than moving them. So perhaps more professional standards and greater value given to the work of carers would be a good place to start. But I fear that at a time when local authority budgets are under more pressure than ever, and even the biggest, most efficiently run care home operations find it hard to operate profitably, the idea of developing a cadre of well-trained, highly valued, professional staff will find few takers.
Meanwhile, the most vulnerable in society pay the price.
What you think? Several organisations contributed their opinions to Jill's report, and you can add your comments here, whether you are a supplier; working as a carer; someone who needs assistance to transfer from one place to another; or indeed a friend or relative of someone in this situation.
26 November 2010
Sling Safety – Whose Interests First?
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I have only used hoists to transfer from wheelchair to couch for radiotherapy. Normally I transfer with the help of a carer.
ReplyDeleteMy perspective on this issue is as much from a dignity and psychological perspective as from a physical and safety aspect.
It seems wrong that a disabled person should be, in effect, restrained and constrained in such circumstances. It feels and looks undignified and serves to negatively accentuate the perception of the disability.
As you state this is a training issue and irrespective of budget cuts standards of those employed as carers should not be affected. It should be built into the overall process. If this does not happen then budgets cuts will be used as an ongoing reason or excuse for taking inappropriate action because it falls into the too difficut basket.
Maybe a somewhat naive statement but I am assuming that if the transferring individual does not fall out of the sling first time round then that's OK and they can stay in it.
The main thing that needs to be appreciated is that the well being of the patient is paramount.
As an additional comment to the Report, may I add that one resident with very severe dementia, became extremely distressed when carer's tried to put her sling on. (Again: this could have been a training issue) Leaving it in place on her chair certainly minimised this aspect for her and she was much more compliant and calm when being hoisted. I agree with John (above) about dignity and the psychological aspects - having said that, those to whom I spoke apppeared to be very accepting of this new arrangement and said they found them comfortable. I have no idea as to whether these residents were actually asked if they minded sitting on their slings, or if they were told that this is what has to happen now! (I'll ask next time I visit!) I rather suspect it may be the ,latter!
ReplyDeleteWhen my late wife was in the last stage of Alzheimer's I fought a losing battle in the use of hoists. (1) they are badly designed and need someone like Dyson to look at them. The staff were afraid of them and some were not adept at using them, Surely, with people im mocrosoft and silicone valley, daily producting technical innovations - the internation organisations can get together and think of new ways to move mentally and physically disabled people, geralddavies22@aol.com
ReplyDeleteA very interesting read and I'm sure a situation that isn't that unusual - lack of staff training, panic within a care home following a potential litigation situation, lack of appropriate equipment and human rights issues are obviously all raised but without knowing some key points it's very difficult to pass judgement.......was this decision taken following a full risk assessment - if so what were the findings and recommendations? Are the slings all day slings - if so this isn't that terrible an idea as long as the protocol is agreed with residents and staff and suitable training / checks put in place, does each resident have their own slings and equipment, do the residents have skin conditions / specific conditions or needs that would make this practice unsafe (skin conditions, potential for pressure sores, continence issues, etc)?
ReplyDeleteMy Best Beloved has recently had a tracked hoist installed in her bedroom to facilitate transfers from wheelchair to bed or shower chair.
ReplyDeleteThis was supplied under a Disabled Facilities Grant. The OT came, several days after the hoist was installed and gave me a demonstration of how to fit the sling and hook it to the hoist. That was it, no suggestions as to how to remove clothes for toileting; we are just left to get on with it.
Is there a booklet available to give further instructions as to how one should perform different tasks with the minimum of risk and discomfort to both the cared for and the carer?
Hoisting someone with a full bladder is prone to accidents of a trouser nature, so one learns the hard way. With certain illnesses and disabilities, bladders don’t work to the clock or on demand, making life difficult for both of us.
Maybe out there somewhere, there is an OT who could produce some guidance notes on different subjects, such as manual handling and mechanical handling, to be made available through the Independent Living site and slinks placed on sites such as the Princess Royal Trust for Carers and similar.
There seem to be a number of justifiable comments from a range of people on the benefits and disadvantages of leaving slings in place, particularly with patient profiles concerned.
ReplyDeleteI have two points to make:
1. How does leaving the sling in place actually prevent a future case of of someone falling through? It is a mute point.
The patient will be continually shifting in their seat/sling to the point where it can ride up and out of position. So the carers are not safeguarding another accident at all.
thickOnce we conclude this, then the decision to remove or leave in slings is based purely on how stressful it is for the patient to remove it (with the caveat that the sling should suit the purpose of being left in-situ).
2. Mr Anonymous does have a point about Mr Dyson, however there is nothing simpler than using a hoist when adequate training and refresher training is given. There are a number of ways to slide a sling into position without distressing the client, as well as simple and cheap tools to help the carer to fit it.
See the following link for slide boards used for fitting slings which cost under £30.
http://www.romedic.com/en/Products/SystemRoMedic/Transfer/Sliding-aids/EasyGlide-Oval/
My thought would be that having the sling “on” should guarantee that the correct sling for the client would be used, i.e. weight limits etc. (providing it was the correct sling in the first place!)
ReplyDeleteAnother thought would be the safety of the staff putting on a sling on a patient who had for example uncontrolled muscle spasms which could result in injury to staff, or patient.
There is also the question of where the hoist is
Are they sat in a lounge and transferred on a mobile then to a Ceiling track hoist or does the ceiling track hoist do the lounge and the nearest toileting facility??
I think this one has no correct answer, only a correct statement
“This should not be done for the ease of the staff as this could destroy the dignity of the client”
At the moment I only use a sling to pick my mother up from the floor but have often wondered about the time when she needs it for transfers to bed/commode etc. Knowing the effort needed to put one on, I would have thought it best to leave it in place, undone, until it is needed again. The down side of this would be in hot weather, when the nylon fabric could lead to increased sweating which in turn could worsen pressure sores or create heat rashes.
ReplyDeleteI have also wondered about how one would go about preparing someone in a sling for the commode, even with the correct sling, pants have to be lowered and skirts raised. If there is an easy way, no one has advised me of it up to now!
I could do with lessons from Anonymous on picking up from the floor. I have always had to call the paramedics.
ReplyDeleteYes, I too wonder how one would cope with a full sling.
Dad uses a stand-aid hoist and I can change & wash him like this. For a carer working alone a full hoist is no bloody good. I will maintain to his death that he can weight-bear, otherwise we are stuffed.
In answer to the question: I leave his belt on if he is sitting because on my own it is so difficult to sit him forward and upright and at the same time put belt round him.
That would be the least of my worries in a Nursing Home.
It seems to me there has been a "knee-jerk" reaction regarding the fatal incident and that the assessing of individual service users' needs has been shelved in favour of a blanket safety/safeguarding intervention;i.e being seen to do the right thing.Whilst not wishing to discriminate against people for whom english is not their first language,one has to wonder at the recruitment process of the establishment, and the thoroughness (or not) of their staff induction/supervision.Continence issues have been mentioned in some of the comments and I think there are definite Infection Prevention and Control/hygiene issues around material of sling and length of time residents are left in them.Obviously residents having their own sling is a very possitive thing,but this may be negated by the hygiene issues mentiioned above.
ReplyDeleteI do not think it is particularly dignified to be left in a sling,and there are obvious "choice" issues as regards the client group mentioned; the Mental Capacity Act and "best interests/least restrictive" measures spring to mind.
Over the past six months or so I have had the opportunity on many occasions to see carers at work on the nursing floor of a very well appointed care home, but willing and well-intentioned as the majority of the care staff seem to be, they often appear to be as headless chickens, mainly due to lack of adequate supervision.
ReplyDeleteThe manager, of Phillipine origin, was scarcely able to converse in intelligible english and certainly lacked management skills in her dealings with client's relatives.
However, when acting as a nurse, and filling in due to lack of nursing staff, she displayed quite remarkable skills and attitude.
My view is that the requirement for a manager of a care home to be a qualified nurse is misguided and there are very many managerial administrators both in local government and elsewhere whose skills would be very usefully employed in this role. Appoinment of a senior nurse with broad administrative skills as Deputy Manager would then provide a formidable management team
The shearing forces associated with inserting a sling under a sitting person can be reduced by trained use of a slide sheet.
ReplyDeleteSlings reduce the efficacy of pressure cushions.
Where appropriate I consider a special sling for clients who are 'sitting' on a sling all day.
How long is 'all day'?
It highlights the need for more training for carers in all settings and a promotion of their role in managing elderly/vulnerable people.
I now have vicarious experience: my daughter is a carer in a care agency and she struggles to make any sense of it at the sharp end. Generally her clients determine what/how manual handling is done. She then feels vulnerable because appropriate equipment is not accepted into the client's home for safe manual handling of all concerned.
There are in-chair glove slings available which are designed to be left in the chair under an individual so they are minimal risk re pressure issues, but their primary use would be where it is very distressing for the service user to have a sling put on and taken off several times a day due to severe disability or deformity, not just for staff ease of use.
ReplyDeleteIt's quite saddening to hear of such a story in today's world especially if residents' safety and comfort are being jeopardised due to carer convenience. It is unjustifiable for residents needs and dignity to be overlooked when there are a number of solutions available. At Mangar, we are proud of our product designs that put the resident at the heart of the solutions to lifting products. In the Camel and Elk we have two lifting products that are comfortable, dignified and offer a safe lift for both the resident and the carer.
ReplyDeleteThere are alternatives to hoists, and whilst we accept that care homes have a choice of the equipment that they purchase - they should not be putting residents safety at risks for perceived cost benefits, especially when the alternatives to hoists are not necessarily more expensive.
A particular issue is the fitting of slings where the client is sitting in moulded seating. The sling needs to be easy to fit, conform well and actively wick moisture away from the skin as moulded seating tends to cause heat build up. Add to this the thought that many clients who need such seating have neurological conditions which can lead to higher core tempearatures and sweating.
ReplyDeleteAll day slings are widely used in care homes in Holland. The skill once yo have found a sling made of the correct fabric is to roll the thigh supports out from under the thighs and ease the back of the sling up so that it is clear of teh sacrum. To refit, reverse the proicess. I stress, you do need the correct type of sling to do this so that there is no shearing. Also clip slings are more convenient as you do not have to work out where to tuck in those loops!
I have muscular dystrophy and and confined to a wheelchair. I spend 12 hours of my 24 in bed and 12 hours in my wheel chair.
ReplyDeleteI have carers twice a day -- 8 AM in the morning to get to me up, wash and
dressed and 8 p.m. to put to me to bed.
I have sit in a sling for the whole of that 12 hours because my husband, who is my main carer,
and still be able to take me to the bathroom and also transfer me from the wheelchair to my armchair.
I have to use an ' ordinary' slaying made of nylon and edged with fairly rough binding.
I had no choice as the only things that are made from soft material are the 'stay in' slings which are made for people who do not use the toilet. I am permanently uncomfortable and have to be massaged with Cavalon to try to prevent bed sores.
The issue is not just about comfort, but the risk of pressure sores, and it is not good practice to leave someone with a sling in place unless it is an "all day" sling. I suspect staff training is the issue in most cases, as it is possible to place and remove slings fairly easily and without distress with the right techniques-using a slide sheet if necessary.
ReplyDeleteI don't work in care homes so I don't know how frequent this practice is. In our team we would always remove slings unless another transfer is imminent.
Firstly my background:- Electronics Engineer by profession and fell into the Care Industry by being made redundant & started working for Social Services here in Somerset in 1991 & have been specialising in moving & handling ever since, in particular prescribing slings. I have also done prescription wheelchair & seating courses, mainly in order to fully understand the requirements of seating a user correctly and I was a regional for Silvalea for 6 years. Also being married to a clinical wheelchair & seating specialist who ensures that I do get it right.
ReplyDeleteI do not know any of the background to the incident but it sounds as if a wrong size sling was used or wrongly applied. The practice of leaving slings made of poly in place is still fairly widespread and due to a combination of factors, i.e. easier for staff, no assessment for each user and funding of individual slings!
If a poly sling is left behind or generally underneath the user, this can and does cause pressure hot spots and subsequent tissue viability problems which are very expensive to cure. If a sling is correctly positioned, your ITs (Ischial Tuberosities) should be free of the sling thus when you are lowered onto your seat there should be no sling material underneath your bottom or thighs.
There are of course, conflicting views to this but my wife says that extra material can & does destroy all her efforts in getting somebody sat correctly. However when putting a user into a comfort chair things get more difficult due to the nature of the design of the chair. Larger people present a greater challenge as do amputees.
With regards to material, parachute silk is still asked for. Silk was the original material Silvalea used mainly for its tensile strength, but it does cause slipping and heat problems. I have specified Superfine or Superfine Pluss for several years now. These material have excellent properties for leaving a sling in place mainly being mesh have 2 way stretch & have “Coolmax” in them. Coolmax does help to wick away body heat especially those who have poor temperature control. However if they are in a foam based seating system it helps but the nature of the system will stoke that person up.
With slings I tend to use the analogy of ladies buying clothes: who is this medium model!! I think you know where I’m going with that, everybody is different and has varying needs.
With the home concerned then they could be using a combination of sling designs, maybe dress/toileting slings for those who are able to take that amount of strain on their body, a Low Convenience sling, a half way design between a dress sling and a full sling, then the all day sling for those whose disability dictates the need for a very supportive design. However I have to say that the dress sling is much abused by care staff as it is easy to use but the user can end up like a trussed up chicken!! One of my pet hates, especially with Ladies with MS.
We've been hoisting our son for about 20 years and as far as I'm aware, apart from a brief introduction, have had little or no formal training in the use of slings and hoists. Having said that, we have spoken at length to the manufacturers etc. many times and I think we've got to be experts by practice. It still worries me that paid carers get trained, informal unpaid carers, who do most lifting rarely get any training at all.
ReplyDeleteafter few years of having a sling, the information provided here in this article help me a lot and give me more idea about safety use of sling..
ReplyDeletethank you
I work in a rehab unit, we have a client at the moment who has pressure sores on her sacrum, the lady does not like to have bed rest to ease pressure, she is totally non weight bearing and requires hoist for all transfers with a hammock sling due to spinal problems. Recently community O/T's informed us that we should not leave her hoist sling under her as it could cause her pressure sores to deteriate. She is a large lady and this makes it extremely difficult to apply the sling when she is sitting in her wheel chair. My argument is, how can pulling and dragging a hoist sling around someone which causes a lot of friction to her sores, be less likely to cause sores than leaving the sling in situ
ReplyDeletemy carer takes me off the bed with a sling and puts me in the shower chair. i have my shower and then pushed to the sling which puts me in my chair and the sling is taken out. night time I am taken out of my chair and put on to my bed and i have never had a sore. This has been going on for 10 years now. i cannot imagine how uncomfortable it must be to sit on a sling all day as it must be very rough and cause sores.
ReplyDeleteThere are slings available which are designed to be left in place, they are generally made from Para silk. The lifting straps can be tucked in the side of the chair to maintain dignity. The problem of removing or leaving in place is not generally due to the shearing of skin, but the type of sling not designed to be left in place will 'ruck' up and cause localised pressure on the skin, resulting in pressure sores.
ReplyDeleteWith the correct type of sling the patient would not be aware that the sling is in place, also Para silk is breathable so does not cause the sweating problems associated with nylon / polyester.
Our conpany do not allow new carers to use slings and hoists until they have attended a full day (patient handling)training course and are competent.