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The right move: innovation improves care and dignity

A slide sheet created and developed by a moving and handling nurse is protecting patients and nursing staff. 
diane tile

A slide sheet created and developed by a moving and handling nurse is protecting patients and nursing staff.

As a moving and handling adviser and nurse, I'm committed to improving patient experience and safety during moving and handling tasks. To comply with the Manual Handling Operations Regulations, a nurse must minimise identified risks to patients, so I set out to simplify and improve slide sheet use for the benefit of patients and staff.

Whether in the patients home, care home or on the ward, moving and repositioning patients affects patients and staff. There are many slide sheets available, and 267 are on the NHS supply chain. Patient handlers in our trust told us that the type, number and size required, as well as the positioning

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A slide sheet created and developed by a moving and handling nurse is protecting patients and nursing staff. 

As a moving and handling adviser and nurse, I'm committed to improving patient experience and safety during moving and handling tasks. To comply with the Manual Handling Operations Regulations, a nurse must minimise identified risks to patients, so I set out to simplify and improve slide sheet use for the benefit of patients and staff.


No matter the environment, moving and repositioning patients can be difficult
for both patients and nurses. Picture: Diane Hindson

Whether in the patient’s home, care home or on the ward, moving and repositioning patients affects patients and staff. There are many slide sheets available, and 267 are on the NHS supply chain. Patient handlers in our trust told us that the type, number and size required, as well as the positioning and way they are used, can be confusing. 

To minimise friction and shearing, the slide sheet should be placed under all bony prominences of a dependant patient, and remain double throughout a repositioning task. For some tasks this may mean using multiple slide sheets, or involve changing the movement of tubular slide sheets.  

Because the options confuse staff, they either position the slide sheets incorrectly, putting themselves and the patient at risk, or they may not bother using a slide sheet at all, and drag the patient with bed sheets.

This was confirmed by a survey in the trust, which showed that staff frequently did not choose the appropriate slide sheet size and number, or position them correctly for specific patient repositioning tasks.


The variety of slide sheets available to staff means they are often 
used incorrectly. Picture: Diane Hindson

At first we reduced our ordering choice to three sizes of tubular slide sheet, but there was still confusion and user error. Staff often said they wished there was only one size and one placement for all repositioning tasks.

The problem had been on my mind, and for a long time I kept trying to find a one-size-fits-all solution. I cut up some slide sheets to try to work out how we could do it, at first without success, but with perseverance, the prototype emerged. And when it did, it seemed almost too simple to be true.

We know from research that there is a gap between training and practice reality, and that if a piece of equipment is difficult to use or difficult to access, people won’t bother to use it.

And so the Versal slide was born. The slide simplifies use, aids compliance and reduces user error. It reduces confusion because it replaces all of the other slide sheets with one – one slide sheet, one size and one placement – no matter what the repositioning task is.


After some trial and error, the Versal slide emerged. Picture: Diane Hindson

It is bed-sized, partially tubular to facilitate lateral transfer and turning, and has small splits in the seams of each corner to give freedom of movement to take patients up the bed.

Reducing the risk of getting it wrong has real benefits for patents – it reduces skin damage and delays, the patient is more comfortable and the process is dignified. It saves embarrassment because a bariatric patient does not need a different slide sheet. It is a much better moving and handling experience.
 
For staff there is no confusion in trying to decide which slide sheet to use depending on the task, or which one to order, which is in turn saving time to care.
 
Following successful trials, 5,000 Versal slide sheets were delivered to the trust in January, and it is now used throughout the trust’s five community and acute hospitals.


The Versal slide is now used across several hospitals. Picture: Diane Hindson

With just one slide sheet to master, we found training more efficient and focused, and there are link staff to offer support between wards. 
 
Furthermore, correct handling reduces the risk of musculoskeletal injuries to staff, injuries that can be debilitating and end many careers. It is estimated that 40% of staff sickness absence is due to injuries, at a cost of £400million to the NHS. The most common cause of sickness absence is due to moving and handling.
 
Around 3,600 nurses retire every year due to back injury. We need to retain our experienced staff, and we know staff well-being affects patient care. We are short of nurses and we need to look after them – especially as they are expected to work for longer these days. In addition, if sickness absence is lower, there is less need for agency staff, therefore saving money and retaining ward staff.

To meet high infection control standards, the Versal slide is patient specific and disposable. During an audit I was shocked to see how often slide sheets slipped out of boxes. We wanted to make sure this was minimised, and for this reason the sheets are individually packaged and have loops so that they can be hung by the bedside.


Studies show the Versal slide method requires less back strain. Picture: Diane Hindson

It is difficult to prove that a reduction in musculoskeletal injury is down to one incident, as it is often accumulative, but results from testing by the trust’s back care team and Professor Mike Fray at the University of Loughborough show that the forces required using the Versal slide rather than erroneous slide sheet methods are significantly reduced. Professor Fray described the Versal slide as an effective ergonomic solution to a problem.

In terms of tissue viability, it is difficult to know if a sore, such as a heel sore, is due to transfer or pressure. A pressure-mapping system Monitor Alert Protect (MAP), loaned to the back care department, identified increased pressures to the patient's skin during poor moving and handling practice.

The slide sheet has endorsements from patients, porters, nursing staff and consultants. Change is often not received well, and I was ready for the challenges, but staff came to us with a problem, and we listened and took action.

The Versal has now been used in the trust since February this year, and evaluations have just started. Early indications show that staff find the slide sheet much simpler and effective. 


The Versal slide has been a success so far, with endorsements all round. Picture: Diane Hindson

We have been approached by our community staff, too. They are interested, as the Versal is suitable for use on double beds. A company based in York bought the intellectual property rights from the trust and patented it, and it is now available on the NHS supply chain.
 
But the reward is knowing that it helps protect patient skin integrity, and ensures their comfort and dignity during repositioning, as well as looking after the musculoskeletal health of precious carers. One patient told me they had been in hospital year after year, and it was the most comfortable they had ever felt while being moved. It was like winning the lottery.

How I turned my idea into the Versal slide:

• Came up with the idea and put together prototype.

• Worked with the moving and handling team to test it.

• Sought peer feedback from moving and handling advisors, including from other trusts and National Back Exchange members.

• Sought feedback from trust patient handlers.

• Submitted the idea to RTC North (NHS Innovations).

• Worked with the trust’s business development team, including those responsible for procurement.

• Presented the idea to a moving and handling equipment manufacturer.

• Formulated survey questionnaires.

• Carried out audits, re: ‘traditional’ slide sheets.

• Organised new slide trials on wards and evaluated.

• Was part of the project team implementing the product throughout the trust.


Diane Hindson is a back care adviser at County Durham and Darlington NHS Foundation Trust. She was highly commended in the Liverpool Victoria-sponsored Innovations in your specialty category of the Nurse Awards 2016

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