Slippery Sally

From Di Brown, RN, PhD. Volunteer, Australian Volunteers International. Bali, Sept 30^th 2010

Rumah Sakit Umum Pusat (Sanglah General Hospital), located in Denpasar, Bali is the largest hospital in eastern Indonesia and is the major referral centre for the populations of eastern Indonesia and East Timor as well as being the main government hospital in Bali.  RSUP has 754 beds and employs 2,115 staff, of whom approximately 984 are nurses. The hospital offers a range of acute care services consistent with the range of services that would be expected of a major tertiary hospital in Australia.  However, the quality of the care is variable and not of the standard that would be expected of an equivalent Government hospital in a Western country.

After the Bali bombings in 2002 and 2005, the Australian Government invested significant funds and resources trying to help raise the standards of care within the hospital.  In recent years a number of Australian nurses have been funded by AusAID to work in the new units and to train the local staff. In 2008, AusAID decided not to continue funding any further Australian nurses, so in 2009 support was gained through Australian Volunteers International (AVI) to assist the rest of hospital.  A position of Nurse Educator was created for two years commencing September 2009, this is the role I am currently working in.  I am an Australian Registered Nurse employed through Australian Volunteers International. My job is to work with nurses in the hospital to identify areas for improvement, then to develop appropriate educational programs and clinical practices to assist in improving the quality of care.  I spent my first few weeks doing an evaluation of clinical care and am now implementing a number of improvement projects.

This project was aimed at improving the safety of staff and patients through the introduction of SlipperySally Sheets for moving patients.

Within Indonesia there is very low awareness of the risks associated with manual handling and also no systematic way of measuring the adverse consequences to both nurses and patients of poor manual handling practices.  Nevertheless it is clear from current practices that both nurses and patients are regularly being placed at risk of injury through the manual handling practices currently in place. Nurses had received very little training previously about how to lift and move patients safely and over 40% of nursing staff complained of intermittent low back pain. We decided that we needed to introduce an integrated educational program to assist nurses to better manage moving patients in bed and also how to take care of their backs at work. We then approached Rotary in Nuhlunbuy in the Northern Territory to ask them if they would be willing to donate some Slippery Sally sheets to the hospital.

In April of 2010 the Rotary Club of Nhulunbuy in the Northern Territory generously purchased 400 meters of Slippery Sally sheets to be donated to Sanglah hospital. There was a lot excitement about this purchase and we waited keenly for the delivery of the sheets. Unfortunately none of us had understood the regulations involved in importing the sheets to Indonesia. Suffice to say we ended up involving people at many levels of the Government to no avail. In the end Tim Harkness of Haines Medical Australia came to our rescue and we were able to finally get the sheets into the country (some 5 months after the initial donation!).

Initially we had planned to introduce the sheets into the poor people’s division of the hospital, but thanks to receiving 400 metres of the sheets we have been able to share them across all wards and divisions of the hospital. For many nurses this is the first training that they have received in manual handling, so we have introduced an integrated approach which gives them education about how to care for their back as well as how to lift correctly and to use the sheets. We have had a lot of fun doing this as the attached photos show.

In preparation for the introduction of the sheets we carried out some research into nurses’ levels of fatigue at the end of a shift and have found, since the introduction of the sheets the nurses level of fatigue has fallen by 33%. In Australia we take many of these tools that assist us in our work for granted, but in somewhere like Indonesia where they have never had anything like this, these sheets have literally changed the lives of both nurses and their patients. The use of the sheets has been adopted with great enthusiasm and little difficulty. So from the nurses and patients at Sanglah Hospital we’d like to say a big thank you to both Rotary Nhulunbuy and Haines Medical for persisting when things got tough!