A patient mobility assessmentdetermines your new patientneeds a dependent sling.

But when you finish your admis-sion intake and reach the sling in-ventory storage site, you find noslings are available. Or perhapsyou see a sling hanging on a hookand wonder if it’s clean or dirty. If you’ve had an experience

like this, you’re probably eagerfor your workplace to adopt asafe patient handling and mobility(SPHM) program that addressesslings, among other things. Butbefore adopting such a program,a healthcare facility must performa unit assessment to evaluate:• medical conditions and mo bilityneeds of its patient population

• maximum number of bariatricpatients on the unit at a giventime, and how often the unitreaches this number

• tasks performed on the unit• unit staffing• storage constraints.Other parts of an SPHM pro-

gram related to sling use includeinfection control and selection ofthe sling fabric.

Launderable vs.disposable The SPHM committee, whichoversees all aspects of the SPHMprogram, must decide if the facil-ity should use launderable andreusable slings, disposableslings, or both types. Input from

the laundry department is criti-cal. Each type of sling has bene-fits and drawbacks. (See Com-paring launderable and dis-posable slings.) If the committeechooses launderable slings, the next decision is whether tolaunder them in-house or out-

source laundering to a laundrycompany.

In-house laundering Advantages of in-house launder-ing include:• negligible number of missingor lost slings because all slings

www.AmericanNurseToday.com September 2014 Current Topics in Safe Patient Handling and Mobility 23

Developing a slingmanagement systemLearn about key decisions for this segment of an SPHM program. By Jan DuBose, RN, CSPHP

Comparing launderable and disposable slings Despite their laundering costs, launderable slings are more cost-effective than disposableslings because they’re reusable. Also, more launderable sling types are available, givinghealthcare facilities more solutions for patient transfer and lifting needs. However, theseslings raise concerns about infection control and sling sharing.

Disposable slings, on the other hand, are easier to store. With no laundering process, thesafe patient handling and mobility (SPHM) program is simpler, no slings are lost to launder-ing, and infection control is easier. On the flip side, the ever-increasing cost of replacingslings can be a financial drain even on a successful, sustainable SPHM program. Also, dispos-able sling styles are limited, which can reduce the potential success of the program by failingto address all the manual tasks required.

stay in the facility• shorter turnaround time due tobetter control of the process

• reduced sling purchase costdue to reduced inventory

• better oversight for maintainingsling standards.

Disadvantages include:• the need for a dedicated staffmember to oversee and man-age the process

• the need for space to house awasher, dryer, drying cabinet,folding surface, and storagecarts

• a properly vented environmentto avoid dampness and mold

• possible injuries to laundrystaff due to the added work-load. (See Case study: On-sitelaundry with centralized distri-bution.)

Outsourced laundering Advantages of outsourced laun-

dering include a reduced impacton laundry staff and transfer of re-sponsibility for a smooth, success-ful process off-campus. Disadvan-tages are possible loss of slings,sling damage from industrial laun-dering methods, long turnaroundtime, and costs (determined bythe pound or item).

Fabric maintenance Whichever laundering process ischosen, fabric maintenanceguidelines must be followed.Meeting infection-prevention stan-dards is paramount. For exam-ple, a protocol for disposing ofor treating soiled or infectedslings must be established, alongwith protocols for single patientuse of slings. Fabric integritymust be maintained to extendsling life; preserving sling qualityfor prolonged fabric reliabilityand sling longevity promotes pa-tient safety and cost-effectiveness.

If the facility has chosen to out-source its sling laundering, itmust establish a good workingrelationship with the laundrycompany, with clear and regularcommunication.

Inventory purchase andstocking of supplies A sling management process in-cludes estimating the number andsizes of slings a unit uses, pur-chasing inventory, and stockingsupplies in an organized, effec-tive way. Several factors can af-fect inventory. For instance, as theSPHM program grows, the facilitywill need more slings and acces-sories, and purchasing may beslow to catch up. The laundryservice, whether in-house or out-sourced, also may be unable tokeep up with demand. And de-spite seemingly reasonable initialexpectations, turnaround timemight become impractical as theSPHM program evolves. Also, thenumber or sizes of slings a unituses may have been estimated im-properly initially. Healthcare facilities have two

options for establishing and keep-ing a satisfactory sling inventory—periodic automatic replenishment(PAR) or centralized distribution.

PAR system To maintain a PAR level, thefacility must keep enough slingson hand so it doesn’t run outwhile waiting for resupply. Spaceconstraints may limit the PARlevel. PAR requires not just astorage area but also adedicated staff member, alongwith unit staff, transport staff, andlaundry staff for backup. What’smore, if specialized slings arestored on specific units, they’renot easily available on other

Case study: On-site laundry with centralizeddistribution By Deanna Watkins, MSN, RN, CSPHP

One hospital chose to build an 800-square-foot on-site laundry facility to reduce overallproduct processing costs, reduce the required product inventory, and decrease the risk ofproduct loss. The laundry facility also represented an investment in the hospital's infra-structure. Achieving return on investment was estimated to take less than 18 months.

The hospital purchased four times the estimated inventory of slings and accessories,compared to six times the inventory that offsite laundering would require. Keeping prod-ucts on-site keeps losses low and allows barcoding of all items for product managementand tracking. Also, the on-site facility custom-launders linens with the potential for futuresavings.

The hospital has a centralized process managed by the linen service of the environ-mental services department. This allows better inventory tracking and accountability. Eachunit and department has an established inventory or periodic automatic replenishment(PAR) level of lift products. PAR levels were determined by reviewing patient demograph-ics for each unit; the most difficult tasks reported by the staff; admission, discharge, andtransfer data; average patient weight; and location from where most patients are admit-ted (such as direct admit vs. postoperative).

All products are barcoded and labeled with organization identification, not unit or de-partment identification. That way, slings can be transferred with the patient as he or sheflows throughout the care continuum. This is accomplished by the linen service using alaundry cart exchange process. Carts are exchanged daily depending on product use. Spe-cialty slings and accessories (such as amputee slings) also can be acquired through thecentralized system by calling the main phone number for linen distribution.

Deanna Watkins is a nursing administrative specialist at Mayo Clinic Hospital in Phoenix, Arizona.

units. On the other hand, using aPAR system means slings will bereadily available on all shifts,which leads to better compliancewith the SPHM program.

Centralized distributionWith this system, access to slingsmay not be available when need-ed, especially on evenings,nights, weekends, and holidays.A staff member must be put incharge of maintaining central stor-age for efficient distribution, anda process for obtaining slingsmust be established. For instance,is a runner needed? If so, whosupplies the runner? Nonetheless, a well-organized

centralized distribution processcan be highly effective if commu-nication is clear and consistent.Also, lack of unit storage forslings isn’t a concern.

Sling tracking Sling tracking promotes return ofslings to the proper unit. Trackingcan be handled in several ways:• Slings can be labeled with anindelible marker, barcoded, orembroidered. A simple mark-ing system can yield valuablebenefits.

• Vendors may have sling track-ing systems your facility canuse.

Support for the SPHMprogram A well-developed sling manage-ment system supports a facility’sSPHM program. The SPHM mustelicit input from units that will usethe system and from the laundrydepartment or outsourced laun-dry company to ensure all par-ties’ needs are met. It mustchoose sling styles and fabric

and put in place procedures forsling purchase, inventory mainte-nance, care, laundering, track-ing, and replacement. Once theseissues have been addressed, thefacility is ready to embark on anSPHM program that can improvepatient care and help preventstaff injuries. 8

Selected referencesThe Facility Guidelines Institute. 2010 HealthGuidelines Revision Committee Specialty Sub-committee on Patient Movement. Patient han-dling and movement assessments: A white pa-per. April 2010. https://www.dli.mn.gov/wsc/PDF/FGI_PHAMAwhitepaper_042710.pdf. Ac-cessed June 24, 2014.

Occupational Safety and Health Administration.Lift program policy and guide: Introduction to the lift program. https://www.osha.gov/CWSA-attachment/beverlyliftprogramguide.pdf.Accessed July 3, 2014.

Jan DuBose is director of Safe Patient HandlingPrograms and Services at Hill-Rom.

www.AmericanNurseToday.com September 2014 Current Topics in Safe Patient Handling and Mobility 25

way to becoming firmly rootedand incorporated into caregivers’daily practice. Although the prac-tice change is becoming the newnorm, coaching and mentoringare needed to help maintain mo-mentum. Stories learned along thejourney should be used to inspireboth novice and expert clinicians. Objective evaluation of the im-

provement process should contin-ue, focusing on outcome measuresand identifying improvement op-portunities to promote refinement.Team members are now doingthings they never thought werepossible—and previously believedto be unsafe. Recently, I learned ofa ventilator patient at St. Luke’sMedical Center, Boise/Meridian(Idaho) who was receiving contin-uous renal replacement therapy(CRRT). Staff safely mobilized the

patient to the chair using the hos-pital’s mobility protocol. In manyICUs, such a patient would bebedbound. But at St. Luke’s, earlymobility is now routine practiceeven for these patients. Conversa-tion about mobility occurs in dailyrounds and often is a major focusof daily patient goals. In fact, staff members are likely

to comment that they no longer askthe question “Can we mobilize thispatient?” Instead, they ask, “Isthere a reason why we can’t mobi-lize the patient?” Key lessonslearned to promote and maintainthis cultural transformation includethe importance of testing new prac-tices on a small scale, getting regu-lar feedback of performance andoutcome data, providing sufficienteducation, and increasing care-givers’ will to mobilize patients byseeing the work in action.

Deliberate focus, fullengagement Incorporating new evidence intodaily practice isn’t enough to sus-tain a culture change to empha-size early mobility and SPHM.Such a change comes only with adeliberate focus on three key ques-tions: What are we are doing?Why are we doing it? What’s myrole? Full engagement and culturaltransformation can occur onlywhen all team members can re-spond to these questions with fullunderstanding. 8

Visit www.AmericanNurseToday.com/Archives/aspx for a multidisciplinary progressive mobilitycontinuum tool and a list of selected references.

Kathleen M. Vollman is a clinical nurse specialist,educator, and consultant with Advancing Nurs-ing, LLC in Northville, Michigan. Rick Bassett is acardiovascular clinical nurse specialist in adultcritical care at St. Luke’s Medical Center,Boise/Meridian, Idaho.

(continued from page 10)