Category Archives: Patient & Staff Safety

PATRAN® Slide Sheets, an Inexpensive and Efficient Way to Safely Move Patients

By Stefanie Scott

Repositioning and transferring patients are among the most common tasks that lead to healthcare worker injuries, the U.S. Occupational Safety and Health Administration reports. A low-tech, low-cost slide sheet can assist in most of these patient-handling tasks, reducing the risk of injury to caregivers while increasing patient comfort.

With no installation or accessories required, PATRAN® slide sheets (sometimes referred to as friction-reducing devices, slips, glide sheets or lateral transfer devices) allow healthcare organizations to start a safe patient handling and mobility program with little financial investment and quickly prevent some of the most frequent and debilitating musculoskeletal injuries incurred by healthcare professionals.

Slide sheets are designed to slide, not lift a patient, so there is no weight limit to who can be moved with a PATRAN slide sheet. However, larger patients may require using a larger size or multiple slide sheets so the entire body fits.

PATRAN single-patient, multiple-use slide sheets can be used in just about every area of a hospital or health care setting. With the full-body size, log-rolling a patient is not required to insert the PATRAN under a patient, which can prevent pain, dislocation or further injury in orthopedic patients. From pre-hospital emergency response to radiology, surgery and orthopedic medical floors, slide sheets have a number of patient handling and mobility uses.

The following are just a few reasons why PATRAN slide sheets are the industry leader:

PATRAN slide sheets can be used 30+ times with the same patient before they lose their slip, which is generally more than sufficient for an acute care patient.

PATRAN moves in all directions, so one tube-shaped sheet can be used 20+ ways, including lateral transfer, repositioning/boosting in bed, getting slings on patients and even putting on compression hose.

PATRAN is inexpensive, especially based on its size. The original PATRAN at 72×36 fits most patients’ entire body. Smaller slide sheets, many at a higher price point, require additional caregivers to hold the head and feet of the patient or the body parts hanging off the slide sheet increase the friction and skin shear.

PATRAN helps prevent cross-infection. Patients get their PATRAN upon entering a healthcare facility and it stays with them throughout their stay. Then it’s disposed of upon discharge. It can be used in just about every area of a hospital. PATRAN is radio-translucent, is latex-free and contains an anti-stat.

PATRAN comes in more styles than any other single-patient-use (sometimes called disposable) slide sheet brand. In addition to the original PATRAN, smaller and larger (bariatric), as well as individually wrapped versions are available.

PATRAN doesn’t require log-rolling to get it under a patient. The size, flexibility and slipperiness give caregivers options about how to insert it and methods of use that allow them to take the patient’s medical condition into consideration.

Click on PATRAN SLIDE SHEET to see the PATRAN listing on OrthopaedicLIST.com.

Stefanie Scott is President of Jamar Health Products, Inc., manufacturer of PATRAN® slide sheets. She is a Certified Safe Patient Handling Associate through the Association of Safe Patient Handling Professionals.

Accepting the Risks in Medical Education and Medical Practice

by Douglas Dirschl, MD

In a March 17, 2009 article in the New York Times, Dr. Richard Friedman, a professor of psychiatry at Weill Cornell Medical College, discusses the nearly universal preference patients have for a seasoned physicians over residents or physicians just out of training.  The strong perception is that physicians learn from experience, implying that the “practice” of medicine is just that – a process of continual learning and improvement.

How does one learn in medicine? Clearly, one large component has been intensive exposure to medical practice within the supervision of residency training programs.  Dr. Friedman points out to us, however, that there may be an inherent conflict at the heart of medical training: “what may be best for making a skilled, independent-thinking doctor may not always be best for patient comfort or safety”. We want our young physicians to be competent, knowledgeable, and confident, yet we also have a responsibility (and increasing scrutiny from regulatory and legal agencies) in protecting patients from the medical errors that could result from a physician’s inexperience.

All residents, at some point, leave the relative security of training and go out on their own. Some experts are now questioning whether medical training programs are striking the right balance between education and training and patient safety to produce physicians who can function optimally. Dr. Friedman argues that restrictions imposed by resident duty hour limitations, decreasing amounts of resident autonomy due to concerns of patient safety, and regulatory groups mandating that some medical complications should never occur, have combined to create a generation of young physicians who lack confidence in their ability to make judgments about patient care. In the pursuit of patient safety, we now deliberately prevent residents from acting independently on their own judgment in situations where a patient poses a theoretical risk.

It is said that 90% of orthopaedic residents currently go on to do fellowship training after residency. Is this because orthopaedics has become so highly complex that 5 years is not sufficient time to master it all, is it that residents completing programs today have less self confidence in their own abilities than the generation of physicians before them, or is it that society expectations have increased and it now expects ‘perfection’ of every physician, no matter how experienced. The answer is probably “yes, yes, and yes”.

To date, there are no reliable national data that regulatory changes in resident work hours, patient safety initiatives, or ‘never events’ (for example, CMS has determined that no patient should have a DVT after an orthopaedic procedure, and won’t pay for it if a patient does), have had a significant impact on preventable medical error or patient mortality rates. There is a cost to the development of professional identity of young doctors, arguing that it is hard to feel confident and independent unless you are given ample opportunity to stand on your own — and risk making a mistake.

There is no doubt that all physicians in training – and those in practice as well – pose an inherent risk to patients.  We should do everything we can to minimize this risk but recognize that doing so will probably impair physicians’ self-confidence.  We may end up with a generation of physicians who, by virtue of the environment in which they have trained, are more hesitant, more uncertain, and less self-confident that the American public might like.

Click here to read the full text of Dr. Friedman’s article.

Dr. Douglas R. Dirschl is Frank C. Wilson Distinguished Professor and Chair of Orthopaedics at UNC School of Medicine. He also serves on the Own the BoneSteering Committee and chairs the Critical Issues Committee for the American Orthopaedic Association.

Patient Warming: The Inside Story

by Scott D. Augustine MD, Augustine Temperature Management

October 15, 2015

 Almost 30 years ago, I invented a forced-air warming system for surgical patients and introduced it to the medical world.  Now, I am proclaiming that forced-air warming, in certain circumstances, is a danger to patients.  Given the irony, I thought some people might be interested in the full story.

 I was a new anesthesia resident at the Naval Hospital in San Diego when I first encountered perioperative hypothermia. Nearly all patients were clinically hypothermic on admission to the recovery room in 1981, and no one thought twice about it.  Despite using all available patient warming equipment (i.e. water mattresses, airway heaters, and fluid warmers) hypothermia was ubiquitous and considered an accepted part of surgery.

I started asking postoperative patients and found that “freezing to death” was the most memorable aspect of surgery.  My interest was piqued.

What was clear from the literature is that under anesthesia, general or conduction anesthesia, we all become poikilothermic.  Just like the reptiles, we gain or lose heat depending on the environmental temperature.  The challenge was obvious: how to produce a warm environment around a patient without requiring the whole room to be warm, as was the common practice in pediatric surgery.

During my spare time as a resident, I started working on an inflatable air blanket that would wrap around the patient and circulate warm air. The first prototypes were very crude and made of plastic sheets that were heat-sealed together using a clothes iron. The first blower was a hairdryer. It took a lot of prototyping and refining, but by 1988 forced-air warming (FAW) was launched in recovery rooms across America.

It was a good product that solved a need.  The “need” morphed from simply providing thermal comfort to avoiding the many recently documented negative physiological effects of hypothermia.  Hundreds of published studies demonstrated that mild hypothermia had an adverse effect on nearly everything that we studied: increased soft tissue wound infections, increased bleeding, increased adverse cardiac events, increased mortality, and increased hospital stays among other things.

FAW changed surgical practice and measurably improved the outcomes of hundreds of millions of surgical patients over the past 25 years.

I left Augustine Medical (renamed Arizant) at the end of 2002. Arizant was subsequently sold to a private equity firm and later to 3M.  After sitting out my two-year non-compete, I formed a product development company with no intention of getting back into patient warming. We were working on reliably producing a bubble of HEPA-clean air over a pillow for allergy and asthma reduction when we stumbled on the FAW waste heat rising phenomena.

Forced-air systems produce 1000 watts of heat at 40 ft/m3. Convective heat transfer is not particularly efficient, so only about 50 watts of the heated air gets transferred to the patient. We learned that there is a significant unintended consequence of that waste heat. The remaining 950 watts of waste hot air vents near the floor, heats the contaminated air resident near the floor, and then rises alongside the table into the sterile surgical field carrying contaminants with it.

For 18 months we studied the rising waste heat from every angle.  Bottom line–the waste heat rises 100% of the time, which is not surprising since it is a basic principle of physics.

Even though I had been gone from the Company for six years, I was feeling terribly responsible for the unintended consequences of my invention.  Digging into the research, we found that while soft tissue infections require contamination of over 1 million bacteria, the biofilm that can form on implanted material allows a single airborne bacterium to cause a devastating periprosthetic joint infection.  Clearly implant patients, especially orthopedic implant patients, were the “at-risk” group.

The fact that a problem turned up with forced air warming after 20 years on the market is certainly not unheard of in the medical device or pharmaceutical industries.  For example, Cox-2 NSAIDs—after many years on the market–now carry a “black box” warning to not use if you have coronary artery disease.  They are still very good drugs, just don’t use them if you’ve got heart problems.  Similarly, I believe that forced-air warming should have a “black box” warning: “do not use in implant surgery, especially orthopedic implant surgery.”

I became a doctor to help patients, not hurt them. I have the same motivation as an inventor, so I invented a safe alternative to FAW:  air-free HotDog® patient warming. It’s the only warming system that can warm from above and below the patient simultaneously, which is far more effective than either above or below individually. HotDog® uses conductive fabric to deliver safe, even warmth—no blowing air or water—resulting is a uniquely versatile, more effective warming solution.

Over the next short while, six independent studies were published corroborating our research showing that the rising waste forced air heat contaminates the sterile surgical field with contaminants from the floor.  One study by Legg et al showed 2000 times more contaminating particles in the air above the surgical site with FAW than with HotDog® warming.  McGovern et al published their study showing that their deep joint infection rates dropped 74% (1437 patients, 2.5 years, p=0.028) when they discontinued FAW in orthopedics. They switched to HotDog® for safely maintaining normothermia.

I let the manufacturer know about the problem with FAW, urging them to take action, offering business collaborations.   Their response was massively negative. The more research that was published showing contamination and infection risk, the more adamant their denials.  They have no credible research to refute the published waste heat studies—zero studies. With no research to promote, they instead decided to start a personal smear campaign against me and the HotDog® product, as if that could possibly solve their problem.

A company can obfuscate, confuse and mislead for awhile, but eventually their customers and plaintiffs lawyers catch on.  About two years ago, a law firm out of Houston filed two product liability lawsuits against that FAW manufacturer alleging that their clients’ devastating knee infections were caused by the waste heat from FAW. By August 2015, a Google search of “FAW infections” revealed over 100 law firms advertising for injured joint implant patients.  Many of these firms are also advertising on TV.  These mass tort lawyers are well funded and seem to be very well organized.  They have already filed for Multidistrict Litigation (MDL) certification in Federal Court. It is reasonable to assume that there could be tens of thousands of plaintiffs.

We at ATM are just 3rd party bystanders watching the litigation show.  While I feel terrible that my invention is causing catastrophic infections, I also feel that I’ve done everything that I could reasonably do to warn both the FAW manufacturer and the medical community.  FAW remains a useful tool, just not in ultra-clean surgeries like orthopedics. That is where air-free warming is the safer alternative.

Dr. Augustine is a retired Anesthesiologist and inventor of the HotDog® Warming System.