Sliding Sheets? How to Use, How to Move my PAL with One Person

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Katalin

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Hello all, yet another of my basic questions, can't seem to get research online for this, or by searching on sliding sheet or slider sheet on this forum!

How do I use a sliding sheet? I've been currently going to the head of the bed, grasping the soaker pad while wrapping it close to her arms, then (mindful of my back! arched! blowing out before I hoik her), and in two quick moves, I've moved her UP the bed maybe 8" she needs to be comfortable. I've since learned moving a patient on a soaker pad is a big no-no. They're rough, and if a PSW did it, them might wind up just moving the pad, not the PAL, and tearing skin.

And on the topic of soaker pads, apparently, they're not good either?? They can interfere with efficacy of the Roho mattress, by building up too many layers between the bum and the Roho chambers? Although with a brief on, she's already got a heavy layer between her bum and the Roho. ARGH!!! I need more supervision, and the PSWs aren't going to teach me. Hope someone can school me on this!

Thanks again SO much!!

Kathy
 

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Hi Kathy,

Is your mom in a hospital bed? How is she being transferred into it? If she is placed just right in the middle of a hospital bed at the right angle, she should not need repositioning -- the frame should keep her in her vertical sweet spot. Does she still turn in bed on her own? How do you sit her up?

Why are you using a soaker pad -- how is she toileting? No, you do not want her in a brief on a soaker pad if you are banking on the ROHO for pressure relief. Is it the kind where the cells move on their own with power or when she moves?
 

Katalin

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Hi Laurie, thanks for getting back to me. She's in a hospital bed, and gets a once-a-day hoyer lift to a commode for morning toilet routine. Otherwise she's in briefs all day. She is placed at the correct spot, but as the day wears on, she slips maybe four inches or six, in spite of having legs slightly elevated. She doesn't just stay put. Maybe that's the PSWs at work when they change a brief. She can roll to the right and left enough to make the brief change and positioning of hoyer sling a bit easier.

We're using a soaker pad because we don't know any better. That's what she had at hospital, then for five months at the transitional attendant care facility. Now she's in a studio apartment in my building, on another floor. I thought, that's what you do. I also thought it's the safety measure so that if she leaks urine when the brief is changed, that it doesn't mess the bedsheets, it stay on top of the soaker pad. And I do find that the caregivers, in spite of my giving them tips on how to stop the urine from leaking (jam 3 or 4 kleenexes temporarily between her legs) when they roll her to change the brief, don't take those measures, and every few changes, the soaker pad needs to be replaced. So this is a case of the blind (me) leading the naked (the PSWs). Looking forward to the schooling you're going to give me Laurie.

The only reason I discovered that the soaker pads are wrong is because I was getting ready to buy more, to change once a day, and saw articles contrary to the practice on the internet coming up. And she has just a stationary Roho mattress, a section of Roho, underneath her butt area.

You may ask why she's in briefs. It started at the hospital, continued at the facility, and now we're at her home, maybe she could just be using the commode, but I truly worry the hoyering would wear her out, and I'm not sure I could meet her needs for that, and the PSWs might not be there at the right time. What other stupid, wrong things am I doing?? Argh! I have no training!
 
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If she is able, yes, I think most people would favor using the commode rather than wetting themselves. I would certainly ask her. There are other benefits such as avoiding skin injury, circulation, etc.

Her hospital bed has 4 buttons? Up/down, feet, head, tilt [well, the one the one that controls the head+trunk, not technically tilt]? What we did and I think many people do is create a landing pad by using all of those together before using the Hoyer, such that the center of gravity goes into the nook so even when you adjust head or feet after that, or even use tilt for a urinal (for guys), the butt stays where it should be. It's kind of like creating a C shape. Let me know if this is unclear...

My son just reminded me that fine-tuning the sling position while operating the Hoyer is part of the key. It's angle, not just position. It gets easier over time.
 
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Katalin

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Thanks, Laurie, was just talking to her about the commode thing. She thinks hoyering out of the bed 4 extra times is too hard on her. We can talk about that again tomorrow, but I don't think she'll budge on that. She kind of collapses (her trunk is weak) when sitting on the commode. She can't use a bedpan, because it's hard on her back. No tilt on the bed, I wish there was, it was so great at the hospital. I think I understand about the C shape. So really have a little nest for her to sit in. Yes, maybe I need to fine-tune the sling position, maybe have the legs on a longer loop. Will play around with that. I worry if she's in a more recumbent position on the Hoyer that her legs will get jumbled up in the main lifter post of the Hoyer. We transfer her off the bed as low as possible, and she winds up in pain when her feet get moved, to get her facing the right direction for the move. Hope that makes sense.

Still don't know how to safely hoik her *up* the bed after a few hours of slipping down a few inches. :(
 

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So if you are pulling her up with the slip sheet handles, if she has to have the briefs, I would try to only bring the pad in when it's needed, or vice versa -- cover her up on top of the pad. Have you tried a female urinal with her on her side?

She doesn't need to be recumbent in the Hoyer, it's all in how the bed is set up when you transfer her-- head up, feet up, you drop the head some as soon as the transfer is done.

I'm not clear on why/how her feet are pivoted, but with 2 people, you can use the slip sheet handles (one of you at each end) to pivot her 90 degrees and then bring the Hoyer in.
 

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Hi Laurie, no I don't have a slip sheet, or slide sheet...I was using the soaker pad to move her. So a few different things. We need to get rid of the soaker pad, so that the Roho has a chance to work its magic, as you suggest. Then I'll need to buy a slide sheet so I can boost her up the bed as I think she kind of collapses down which pulls her downward. Been looking on the internet, everyone says you need two people to use a slide sheet. I don't have two people. I have me, or she's looked after for a few hours by PSWs. Surely I don't need two people? That's what they said about the Hoyer lift too, must have two people, and that wasn't true.

When we use the hoyer, you go in from the side of the bed, not the foot of the bed. So after lifting her clear of the bed, you have to pivot her, so that she's now facing in a safe direction, in line with the hoyer lift, not at right angles to it.
 

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I just found this online. It describes the problem exactly as I have it.

 

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We used the SafetySure SlidEase slip sheet under the top sheet but we did not use a ROHO overlay. I don't see how you can use both since the slip sheet needs a smooth surface to glide on and if you put it under the overlay for smoother glide, the overlay weight would add to your mom's weight, unless you are much bigger/stronger. We had a foam overlay paired with a foam mattress.

However, the 90-degree pivot that we needed and that you need does require two people to hold the sheet handles and move (e.g. person at the head of the bed lifts the sheet and walks 90 degrees, as does the person at the foot of the bed), so if you can lift her upper body, you may be better off doing it against your body, sans sheet. There are videos (Stephen Hawking was pivoted that way). How are you doing the pivot now?

You can use the slip sheet on your own to reposition her if it's not enough weight and it will glide, and if you are not running into the headboard (which we didn't have). I watched all the draw sheet/ folding videos, too but since Larry could not be rolled, they didn't apply.
 

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Thanks Laurie, that makes sense, that the slide sheet would get snagged up a bit on the Roho bubbles. Thanks for sticking with me through this discussion.

The pivot part happens while she is suspended in the sling. Hoist comes in from the side of the bed, head of the hoist between hips and chest. Lower head of hoist, then loops attached to the arm hooks. Then lift till feet clear the mattress. Then rotate her so she's facing the front (the operating end) of the hoist. At this point, if she's suspended too high, the feet hit the main column of the hoyer. If she's lower in the air, then she's suspended farther away from the main column, and she is more able to be rotated while being suspended. I couldn't find any videos of the way Stephen Hawking was transferred. But it's just one person mostly at any time.

But I think you may be on to something about the slip sheet. Insert it as needed to position, then remove it. The soaker pad was working just fine, but it's just not a smart idea period, what with its roughness, and the problem with having too many layers of linens. I guess she's light enough for me to do that easily.

Perhaps someone else might wade through this thread, and if they've got a suggestion, I'd welcome it too.
 

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Oh, sorry, I was taking "pivot" later on as in the bed but you had mentioned it earlier in regard to the sling. Forget what I said about Hawking -- that was about getting her up in bed without a slip sheet, if you needed to turn her at the same time.

Never mind...

I do have to say, you shouldn't have to pull her up repeatedly in bed, still, even without tilt. Your thought of playing with the sling loops to maybe get a better angle(?) is a good one and also speaks to the height for the transfer. Are the PSWs screwing up her position somehow? You never want, for example, to move the head and feet at the same time, or to destabilize one without the other's being stable. How long is the bed? Generally, the most stable/comfortable position is a 10-20 degree angle for both the head and feet. The air cells could be overinflated, pushing her out of the zone, is another thought.

Nor should you have to choose between her legs hitting the lift and ability to position her in the lift. My husband was 6'1". Do you have a tall enough lift -- what model is it and how tall is she?

In re the pad, I don't see why you need it at all, if she is continent and you/they are ready with a cloth when changing her briefs. Maybe I'm missing something...
 

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Thanks, Laurie. The PSWs are doing their best, and know where they are to aim for. We're not pulling her a lot, maybe two times a day. But I still want to do it safely, and with one person. I think the answer has to be a sliding sheet, which we'll roll her onto when she needs a positioning, and then roll her off so she doesn't rest on it.

I think maybe we need to get her onto a different mattress, non-Roho. It's definitely not overinflated (having done that once, and see the results 12 hours later---Roho-shaped pressure points on her butt). I just want to know that no matter what, she's safe, and the d*mned Roho is inflated by touch. She can't clearly articulate if something feels good or not. And it feels like having my hand in a rubber forest in the dark when I slip in there to feel the inflation.

As for the lift, yes, maybe it is too small. We get this equipment from the ALS closet. It should have been specked by the original OT. I've got a new OT coming on Wednesday, and maybe she can clarify this. It's really confounding, as we've got her being transferred low to the floor, so the arm and hook is at a greater distance from the post and she's still bonking her feet. And she's only 5' 6".

As for the soaker pad...the problem is when they change her, she leaks when they roll her over, and it dribbles onto the mattress. I think there's maybe a few tablespoons of urine in the urethra that don't get properly passed because she's not in a totally upright position for a wee. It's enough to be a problem. Seems a miracle she doesn't have UTIs. Maybe we need to use a clean towel underneath each time to catch the drips. Or do people place the fresh brief underneath the brief the PALS is wearing, then remove the old brief? Then if there's a dribble it falls on the brief underneath?? Argh!

It just all feels so hard to figure this stuff out, and give my Mum dignity and cleanliness and comfort and safety. So many variables!!
 

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Don't let yourself think you aren't doing well enough Katalin. We always look for better solutions, but every PALS and situation is different and you work out what works for your situation.

A great thing about this place is you can get lots of different views of what worked, and then figure what suits your mum and your situation. So feel free to discard any ideas and run with any too. Then let us know later what worked for you (even if sometimes things only work for a while then progression changes it all again), so it helps others do the same :)

My Chris hated the ROHO in bed, but loved the smaller ones for chairs and PWC.
We had an alternating air mattress and it was very easily cleaned down.

We have VERY different slide sheets here in Australia, and wow but they work well. You do need to understand how to use them, but ours have no handles.

I bought mine from a place called slippery sally in Australia. (we aren't allowed to give links here, but you can google this) They are SO slippery that honestly it is unbelievable. We had a brilliant OT too who could demonstrate 50 things to do with a slide sheet and most of them I've now forgotten. I'm realising after seeing the slide sheets you are talking about that maybe over the past few years when I have said slide sheets are so awesome, that people had no idea what I meant. I didn't know they were so different there.

So far as the continence issue, I do think you are right, probably there is a little retained urine that leaks when mum is rolled, so finding a way to get the staff to ensure they have something to mop that up is important.

What lots of us CALS in Australia do also is use the hoist in place of a commode. We lift the PALS up from the bed, and just pop a bedpan underneath, let them do what they need, remove the pan, clean and position them back down in the bed. Lots of benefits to this including you would get her positioned again perfectly and not need to pull her up the bed.
 

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Tillie, I had suggested the sling over a commode as that's what we did, too, but Kathy had indicated her mom wasn't up for that many transfers. I do agree, Kathy, coping in bed takes trial and error, and definitely a good slip sheet so long as changing position is an option. But I would still try to get the bed right, before any transfer takes place. The thought occurs to me that if there are lift issues, etc. that maybe the reason she doesn't like transfers is that they are taking too long/as you say, hurting her in the process.

So hopefully the OT you have coming out can observe your procedure and make suggestions...
 
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No we just hoist gently up, pop a bedpan under, then lower again - very different to hoisting out and over a commode :) Sorry I mustn't have said that very clearly.
 
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