Moving and Handling (MH1)

Transcription

1 MH1 Moving and Handling Policy Moving and Handling (MH1) 1 of 69

2 MH1 Moving and Handling Policy Document Information This is a controlled document. It should not be altered in any way without the express permission of the author or their representative. On receipt of a new version, please destroy all previous versions. Date of Issue: Feb 2015 Next Review Date: Feb 2017 Version: V1 Last Review Date: Not Applicable Author: Moving and Handling Team Director(s) Responsible: Estates and Facilities Management Approval /Consultation Route: Approved By: Health and Safety Committee Date Approved: Health and Safety Committee Feb 2015 Amendment History Version Status Date Reason for Change Authorised 2 of 69

3 MH1 Moving and Handling Policy Contents 1 Policy Statement 4 2 Introduction 4 3 Equality Impact Assessment 5 4. Roles and Responsibilities 5 5 Principles of moving and handling 8 6 Risk Assessment Process 9 7 Manual Handling equipment 10 8 Moving and Handling training 10 9 Provisions of training for trainers Communication and Implementation of policy Monitoring, Review and Evaluation of this policy References Appendix 1 -Moving & Handling Team Structure Appendix 2 - Risk Assessment Process Appendix 3 -Guidelines for lifting inert loads Appendix 4- Risk Assessment form Inanimate loads Appendix 5 - Risk Assessment form Pushing/Pulling Appendix 6 - SS10A Handling Assessment Community Appendix 7 - Handling Assessment child/young patient Appendix 8 - Patient Handling Falls & Bed rail assessment - acute Appendix 9 - Guide to Therapeutic handling in therapy treatment Appendix 10-Hoist & Sling provision Appendix 11 - Procedure for post fall of patient - acute Appendix 11- Post fall flow chart -in patient community Appendix 12 - Reba Assessment tool Appendix 12A- RULA assessment tool Appendix 13 - Practical Training Record- Induction Appendix 14 - Practical Training Record- Refresher Appendix 15 - Training Non Attendance letter Appendix 16 - Training Persistent Non Attendance Letter Appendix 17 - Non Attendance Process 69 If you require a copy of this policy in an alternative format (for example large print, easy read) or would like any assistance in relation to the content of this policy, please contact the Equality and Diversity team on of 69

4 MH1 Moving and Handling Policy 1. Policy Statement 1.1 The aim of this policy is to contribute to providing an effective service by reducing injuries and ill health; improving patient care and patient experience, and where possible reducing unnecessary loss and liabilities. The objectives of the policy are: Reduce the number of injuries year on year resulting from moving and handling activities to staff within the organisation; Minimise the risks to staff and patients when loads including patients/service users are moved by bodily force; Create a safer working environment for all staff, and anybody else, who may be affected or involved with moving and handling activities; Clarify the procedure of performing a moving and handling risk assessment in order to deal with hazardous moving and handling operations; Ensure that managers assess and control risks arising from moving and handling activities within their department/unit and are responsible for them; Ensure that handling equipment is used when reasonably practicable to do so; Provide information training and instruction to employees to ensure safe working; Ensure the effectiveness of moving and handling training. To monitor quality assurance, the implementation and delivery of this policy. 2 Introduction 2.1 South Devon Healthcare NHS Foundation Trust & Torbay and Southern Devon Health and Care NHS Trust (hereafter known as the Trusts) are committed to protecting staff and providing the highest standards of quality of care to our patients. 2.2 Moving and handling is a key part of the working day for most employees; from moving of equipment, laundry, catering, supplies or waste to assisting patients/clients in moving. 2.3 Moving and Handling means any transporting or supporting of a load (including lifting, putting down, pushing, pulling, carrying or moving) by hand or bodily force (such as the shoulder). The force applied is human, not mechanical. Clearly in a healthcare environment, it is useful to distinguish between patient and non-patient handling. 2.4 Poor moving and handling practice can lead to: back pain and musculoskeletal disorders, which can lead to inability to work moving and handling accidents which can injure both the person being moved and the employee discomfort and a lack of dignity for the person being moved 2.5 This policy details the robust and effective arrangements that the Trusts have in place to support staff in moving and manual handling. 2.6 This policy applies to all staff in the Trusts, including permanent, temporary, bank workers and contractors. 4 of 69

5 MH1 Moving and Handling Policy 3 Equality Impact Assessment 3.1 The Trusts are committed to preventing discrimination, valuing diversity and achieving equality of opportunity. No employee will receive less favourable treatment on the grounds of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex or sexual orientation, or on the grounds of trade union membership. 4 Roles and Responsibilities 4.1 The Chief Executive is accountable for the health and safety of staff within their organisations. 4.2 The Trust Boards are responsible for ensuring the effective implementation, communication and delivery of the Moving and Handling Policy. 4.3 The Health and Safety Committee are accountable to the Chief Executive of the trusts. 4.4 The Moving and Handling Team are accountable to the Health and Safety Committee. The diagram in Appendix 1 details the structure of the moving and handling team. 4.5 The Trusts recognise that the objectives set out above cannot be achieved without the full co-operation of all staff. 4.6 All Managers are responsible for ensuring that: This policy is is implemented at a local level and communicated to and read by all staff; All staff comply with this policy; All staff receive Moving and Handling training, in accordance with the training needs analysis. This includes taking appropriate action when a member of staff fails to complete their mandatory training; Moving and Handling tasks are eliminated where possible, and where they cannot be eliminated that a suitable risk assessment is performed and recorded; The risks associated with moving and handling operations are reduced to the lowest level practicable, and that where appropriate, risks are recorded on the risk register. Any risks that cannot be managed locally are escalated in accordance with the Risk Management Policy; Adequate arrangements and equipment are in place following all moving and handling risk assessments; Employees adhere to safe systems of work and are adequately trained to correctly use any equipment provided; All moving and handling incidents are reported following the Trusts incident reporting procedure and are investigated appropriately; Occupational Health are contacted if an employee is injured as a result of moving and handling, and liaison with the employee to ensure that any rehabilitation plan to assist the individual in a return to normal working duties is achieved; Managers need to be aware of the moving and handling practices within their areas and highlight if staff are posing any risk to themselves or patients. They follow the New and Expectant Mothers Risk Assessment Procedure. 5 of 69

6 MH1 Moving and Handling Policy 4.7 Moving and Manual Handling Advisors are qualified staff who are specialists in moving and handling. All advisors have regular training and have undergone the required train the trainer through the University of Plymouth, or an equivalent qualification, as well as experience of front line working. In addition to this all advisors are members of the National Back Exchange, and share working practices across Devon and Nationally with other advisors. Advisors have responsibility for; Providing training on moving and handling techniques to staff, with the assistance of Moving and Handling Key Trainers where appropriate; Providing training and advice to Moving and Handling Key Trainers as well as ongoing annual assessment of their competence; Providing specialist advice to managers regarding moving and handling; Providing training and advice to Moving and Handling Trained Risk Assessors in the assessment and control of moving and handling risks; Liaising with the Health and Safety Manager to ensure that serious moving and handling incidents and RIDDORS are investigated, and that appropriate follow up action is taken; Monitoring the effectiveness of this policy through reviewing incidents reported, equipment provision and training provision. Attending the Health and Safety Committee groups, and providing a quarterly report on moving and manual handling. All of the advisors are based at Horizons Centre on the Torbay Hospital site, but are willing to travel across the Trusts to advise on Moving and Handling issues. 4.8 Accredited Trainers are qualified staff in front line positions who are responsible for: Delivering training to staff Supervising moving and handling practice in the workplace Perform moving and handling risk assessments when required. Complete an annual training update. Monitoring compliance to policy and risk assessment process. Reporting any concerns to the moving and handling advisors. Please contact the Moving and Handling Team for the names of a Trainer or Risk Assessor in your area. 4.9 In the Acute Trust Manual Handling Ward Coaches are appointed for each area. These coaches have an additional interest in moving and handling and receive additional training in Patient Handling activities. They do not have an accredited training certificate. Their duties include iintroducing new staff to: Departments general Moving and Handling tasks Ward MH File, guidance notes and risk assessments Instruction and guidance on specific equipment usedreporting system and policy access online Contact / Icare 6 of 69

7 MH1 Moving and Handling Policy They also assist the manager; With workplace assessments ( hazardous manual handling activities) Monitor practice to reduce risk of injury Monitor completion of moving & handling documentation (traffic light form etc.) Monitor team competency; refer to training or competency sheet Coaches will act as a link person between the workplace and moving & handling advisors. They are committed to: Attend meetings as planned (twice Yearly) to keep in the loop. Feed into and feedback to quarterly newsletters. Disseminate information to colleagues. Share good practice In Community, Risk Assessors are based in community hospitals and the wider community teams. They are responsible for: Performing patient and non-patient manual handling risk assessments in their area; Performing complex service users/ patient handling risk assessments; Keeping records of risk assessments and escalating any issues; Ensuring any action plans are followed up; The person responsible for the risk assessment is responsible for monitoring of the action plan immediately after the risk assessment has been set up. Thereafter this should be audited periodically. Encouraging good practice in moving and handling of loads; Assist Trainers to deliver practical training sessions as required; Attend an annual Risk Assessor update To gain further advice and assistance with complex needs contact the moving and handling team at the Horizons Centre The Human Resources directorate are responsible for: Ensuring all new staff attend induction sessions according to the Training Needs Analysis (either patient or non-patient moving and handling); Maintaining a database to evidence which staff have received induction and mandatory training; Informing managers of staff who are due or overdue mandatory training; Reporting attendance at training sessions on a monthly basis to the Moving and Manual Handling Advisor Occupational Health will: Accept management referrals for employees suffering adverse health effects because of moving and handling and provide advice and support, where appropriate, and as necessary; 4.13 The following organisations are commissioned to provide services in Patients/Clients own homes following assessment by an authorised prescriber; Community Equipment Services PLUSS in Exeter serves the Torbay and Southern Devon Health & Care Trust. NRS in Torbay serves the Torbay area. 7 of 69

8 MH1 Moving and Handling Policy PLUSS/NRS maintain a database of all moving and handling equipment in the Trust and arranges for the inspection and maintenance of the equipment in accordance with the Lifting Operations and Lifting Equipment Regulations The following individuals/ groups/ organisations are responsible for making sure that they comply with these regulations: Medical Electronics- Acute Hospital maintenance Individual (Privately owned)- These individuals are responsible for their own maintenance. Residential and Nursing Homes- All Homes are responsible for their own maintenance All Staff must: Read, understand and follow this policy, and should raise any queries with their line manager; Make full and proper use of any system of work put in place following risk assessment to reduce the risk of injury during moving and handling; Ensure they attend moving and handling training and updates and that they undertake moving and handling tasks in accordance with the training provided; Ensure that they have received adequate training before undertaking new moving and handling tasks or using new handling aids, etc; Inspect any lifting equipment before it is used and report any defects via the Trust s incident reporting procedure. Defective items must be withdrawn from service until their safety can be guaranteed; Report every injury or near miss from moving and handling via the Trust s incident reporting procedure. 5 Principles of Moving and Manual Handling 5.1 This policy is based on the Moving and Handling Operations Regulations 1992 (amended 2002), which impose the following duties on the Trust: To avoid so far as is reasonably practicable the need for employees to carry out those moving and handling operations which involve a risk of injury; Where moving and handling cannot be eliminated, to make and keep up to date a suitable and sufficient risk assessment of moving and handling tasks, considering the factors and questions specified in the Schedule to the Regulations. To take appropriate steps to reduce the risk of injury to employees arising from moving and handling operations to the lowest level reasonably practicable. To take appropriate steps to provide employees who are carrying our moving and handling operations with general indications and, where reasonably practicable to do so, precise information on the wright of each load at the heaviest side of any load whose centre of gravity is not centrally positioned. 5.2 These duties must be carried out as far as is reasonably practicable. This involves balancing risk with cost and practicality. 6 Risk Assessment Process 6.1 The Management of Health & Safety at Work Regulations 1999 require suitable and sufficient risk assessments to be undertaken. Where this general risk assessment identifies a risk of injury from any hazardous manual handling that cannot be avoided, 8 of 69

9 MH1 Moving and Handling Policy a risk assessment must be carried out (See Appendix 2). The risk is then reduced as far as is reasonably practicable. 6.2 All loads should be continually re-assessed to ensure that the risk continues to be eliminated/ reduced. 6.3 If the identified risk control measures cannot be fully implemented, which may include lack of appropriate equipment, then the risk must be recorded in the zone/ department risk register and escalated to the directorate and/ or the Health and Safety Manager. 6.4 Inanimate Manual Handling Assessment For inanimate Manual Handling of loads please see the guidelines set out in Appendix 3 and complete the Manual Handling of Loads Checklist, Appendix 4. Appendix 5 is a specific Pulling and Pushing checklist. 6.5 Client Handling Assessments - A Handling Assessment and Summary Plan (Appendix 6,7 or 8) must be completed for every client who requires manual handling assistance from Trust staff. The assessment must be kept in the clients notes and reviewed regularly. Immediately prior to each handling task staff must assess the risk and where necessary change the care plan accordingly. It is our responsibility to handover this risk assessment and moving and handling advice to the appropriate organisation or care agency on discharge 6.6 Therapeutic Handling - For additional Information on Therapeutic Handling please refer to Appendix Bariatric Care The Trusts are committed to treating people with a BMI of 35 and above plus associated co morbidities, safely and with dignity whilst ensuring the health and safety of staff involved in their care. For further information and Bariatric equipment provision please refer to the Management of Bariatric Procedure (This is available on Trust intranet) 6.8 Children and Young People See Appendix Unplanned Events In the event of employees encountering a collapsed or fallen client a clinical assessment should be undertaken and the appropriate action taken. See appendix The Falling Patient - At all times DO NOT RESIST or STOP a Patient from falling if you are at risk of injuring yourself. Allow the patient to go to the floor as safely as possible for both parties. See Appendix 11 7 Manual Handling Equipment 7.1 In hospitals Manual handling equipment will be provided in each working area relevant to the identified handling task and based on completed risk assessments. If the equipment identified is not available, this should be reported to the Line Manager for action. 7.2 Where lifting equipment is provided, managers must ensure compliance with the Lifting Operations and Lifting Equipment Regulations of 69

10 MH1 Moving and Handling Policy 7.3 Any moving and handling equipment that is found to be defective must be labelled as unsafe and reported in accordance with the Trusts procedures 7.4 In patients own homes staff visiting (OT, Physio or Nursing staff) should offer advice and risk assessment. 8 Moving and Manual Handling Training 8.1 To ensure compliance with the Moving and Handling Regulations, the Trust endorses a cascade training system for the provision of information, instruction and practical training. Training sessions will include: Back Care Legislative information Basic equipment available within the Trust Principles of good handling Practical training in moving and handling activities required by the individual. Training needs to be undertaken on induction for all staff and yearly for all staff who are required to move patients as part of their role. For non-patient handlers, moving and handling training is required two yearly. Please see Core Training Policy (T1) for methods of delivery. All Occupational Therapists and Physiotherapists and (with exception of Musculoskeletal MSK physios) are required to undertake an initial 2 day risk assessor course and annually update. 8.2 Trainers are not experts, but individuals who have undergone additional training and are able to pass on necessary skills. 8.3 Persons other than the Moving and Handling Trainer or designated qualified persons will not deliver training. Risk assessors will demonstrate methods and techniques for individual patients. 8.4 All staff who attend a Manual Handling course will be inputted onto their individual Electronic Staff Record. (ESR) The manual handling team will also have a record of attendees for to enable them to monitor compliance Training needs analysis of mandatory and other training is undertaken annually by line managers. Line managers will receive staff attendance reports and it is their responsibility to ensure that their staff are adequately trained. 8.6 Manual handling training attendance reports are provided to the moving and handling team who will report on attendance of the training to the Health and Safety Committee on a quarterly basis. 8.7 See Appendix 15 for the letter of non-attendance that will be sent to delegates who do not attend a training session. The letter will highlight the next available training dates and who to contact. 8.8 See Appendix 16 for persistent non attendee s a letter will be sent to the individual at their home address and their line manager will receive the letter as an attachment internally. 10 of 69

11 MH1 Moving and Handling Policy 8.9 See Appendix 17 for the Non Attendee process 9. Provision of training for Advisors/Trainers 9.1 The Trusts will send nominated persons on an initial 5 day training course. During this course students will be instructed in: Relevant Legislation Moving and handling risk assessment Basic ergonomics Normal body movement Moving loads Moving and handling people Teamwork Teaching skills Record keeping Managing change Basic anatomy and physiology of the spine Following successful completion of this course the trainer will be competent in moving and handling risk assessment, and will be responsible for the delivery of moving and handling training within the trusts. 9.2 All Trust moving and handling trainers are required to attend an annual update to maintain their training role. Attendance is required to ensure they remain on the moving and handling trainer register. 9.3 Appendices 12 and 12 A REBA and RULA templates are useful for trainers to assist in the risk assessment process. 9.4 Templates to record and evidence training induction Appendix 13 and Refresher training Appendix Communication and Implementation of policy 10.1 All staff must read and understand the Moving and Handling Policy The policy will be published on icare and Contact as well as the external Website. The publication of this document will be highlighted on the news section on icare, in the staff bulleting and via management meetings It is the responsibility of the Health and Safety Manager to ensure this policy is published in the final version with a completed ratification document. It is also the responsibility of the Health and Safety Manager to ensure that the publication of this document is communicated to all line managers It is the responsibility of each line manager to ensure that their staff read and understand the information contained within this policy. 11 of 69

12 MH1 Moving and Handling Policy 11 Monitoring, Review and Evaluation of this policy 11.1 The Moving and Handling team will provide a quarterly report on moving and handling issues and attendance of courses to the Health and Safety Committee Mandatory training attendance will be monitored and managed in accordance with the Core Training Policy (T1) 11.3 The Health and Safety Team will provide quarterly staff incident reports encompassing moving and handling issues to all directorates for discussion and monitoring This policy and associated documents will be reviewed on an annual basis (or sooner in the event of major organisational change), by the Moving and handling team, to ensure that it is relevant and effective The Induction and Mandatory Training Lead will monitor compliance with the policy by reviewing individual ward/units compliance figures and meeting with workplace leads Statistical information regarding attendances at mandatory training will be produced by workforce and sent to managers on a quarterly basis. This information will be monitored by Workstream Feedback from all staff regarding this policy is encouraged and should be sent to the Moving and handling team. 12 Key references Health & Safety Executive - Health and Safety in Human Health and Social Care in Great Britain, 2013 NHS UK British Association/ College of Occupational Therapists Chartered Society of Physiotherapy The Royal College of Midwives The Royal College of Nursing Royal College of Radiologists HSE Guidance on Regulations Moving and Handling Operations Regulations 1192 (as amended 2004) The Guide to the Handling of people 6 th edition - Backcare Rapid Entire Body Assessment (REBA), Sue Hignett and Lynn McAtamney 2000 A Rapid Upper Limb Assessment Tool (RULA), Nigel Corlett and Lynn McAtamney 1993 Moving and Handling of Plus Size People- an illustrated guide. National Back Exchange 2013 Manual Handling of Children. National Back Exchange of 69

13 MH1 Moving and Handling Policy Appendix 1 Moving and Handling Team Structure INDUCTION AND MANDATORY TRAINING LEAD ACUTE 2 MOVING AND HANDLING ADVISORS 1 MOVING AND HANDLING TRAINER ALL ACCREDITED TRAINERS ACUTE WARD BASED COACHES COMMUNITY 2 LEARNING AND DEVELOPMENT ADVISORS ALL ACCREDITED TRAINERS COMMUNITY RISK ASSESSORS BASED WITHIN ZONES AND TEAMS 13 of 69

14 MH1 Moving and Handling Policy Appendix 2 - Risk Assessment Process Where a moving and handling operation is seen as a significant risk, and cannot be avoided, an assessment will be made having regard to the following factors i) The task iii) The working environment ii) The load iv) The individual capability How to follow the Moving and Handling Operations Regulations 1992: Do the Regulations apply i.e. does the work involve a moving and handling operation? No Yes Is there a risk of injury? No Yes /possibly Is it reasonably practicable No to avoid moving the load? Yes No Is it reasonably practicable to automate or mechanise the operation? No Carry out assessment Yes Yes/Possibly Determine measures to reduce risk of injury to the lowest level reasonably practicable Does some risk of manual handling injury remain? Implement the measures Is risk of injury sufficiently reduced? Yes No Written record End of initial exercise Review if conditions change 14 of 69

15 MH1 Moving and Handling Policy Appendix 3 - Guidelines for the Lifting of Inert Loads Think before handling/lifting. Plan the lift / handling activity. Where is the load going to be placed? Use appropriate handling aids where possible. Will help be needed with the load? Remove obstructions, such as discarded wrapping materials. For long lifts, such as from floor to shoulder height, consider resting the load mid-way on a table or bench to change grip. Keep the load close to the waist. Keep the load close to the waist for as long as possible while lifting. The distance of the load from the spine at waist height is an important factor in the overall load on the spine and back muscles. Keep the heaviest side of the load next to the body. If a close approach to the load is not possible, try to slide it towards the body before attempting to lift it. Adopt a stable position. The feet should be shoulder width apart with one leg slightly forward to maintain balance (alongside the load if it is on the ground). Be prepared to move your feet during the lift to maintain a stable posture. Wearing over-tight clothing or unsuitable footwear may make this difficult. Ensure a good hold on the load. Where possible hug the load as close as possible to the body. This may be better than gripping it tightly only with the hands. 15 of 69

16 MH1 Moving and Handling Policy Moderate flexion (slight bending) of the back, hips and knees at the start of the lift is preferable to either fully flexing the back (stooping) or fully flexing the hips and knees (full/deep squatting). Don't flex the back any further while lifting. This can happen if the legs begin to straighten before starting to raise the load. Avoid twisting the back or leaning sideways especially while the back is bent. Keep shoulders level and facing in the same direction as the hips. Turning by moving the feet is better than twisting and lifting at the same time. Keep the head up when handling. Look ahead, not down at the load once it is held securely. Move smoothly. Do not jerk or snatch the load as this can make it harder to keep control and can increase the risk of injury. Don't lift or handle more than can be easily managed. There is a difference between what people can lift and what they can safely lift. If in doubt, seek advice or get help. Put down, then adjust. If precise positioning of the load is necessary, put it down first and then slide it into the desired position. 16 of 69

17 MH1 Moving and Handling Policy Appendix 4 - Risk Assessment Form To be used for inanimate loads and complex patient/equipment handling Example of Moving and Handling of Loads: Assessment Checklist 17 of 69

18 Appendix 5 - Risk Assessment Form Example of Manual Handling of loads: Pushing and Pulling Checklist

19 Appendix 6- SS10A community hospital and community setting only HANDLING ASSESSMENT SUMMARY AND PLAN REMEMBER! Frequency (approx.) X severity = risk The purpose of this handling plan is to describe the assessed handling needs of the patient/service user named below and to specify how these should be met to reduce the risks of injury to both carers and service user (refer to Risk Assessment and Manual Handling Policies). Patient/Service User Detail Name:. Ward/Location:. Address:.. / / Date of Birth:.. GP: Patient Number:. CareFirst Number:. Initially Assessed by:. / / Initial Assessment Date: Disability/ Height:.. Weakness: Weight: BMI:.. Initial assessment Yes No Equipment Can they co-operate/communicate effectively? Can they weight bear/stand? Have they got standing balance? Can they walk? Can they maintain sitting balance? Can they get into/out of bed? Can they sit up in bed? Can they move up in bed? Do they have any attachments (e.g. catheter?) Are they receiving medication which may affect movement? Do they have a history of falling/ Refer to falls team Do they use any mobility aids? If you need to add any further details, please use the Additional Information section on Page 3. Service User Risk Level Date: / / / / Patient unable to assist in any way, due to unconsciousness, likely to be unpredictably, may be heavy, or have high level of disability RED High/Significant Risk Able to co-operate and can move with assistance and/or requires the use YELLOW moving aids. Needs minimal assistance, supervision, or guidance Medium Risk GREEN Low Risk Data Protection Act: Details you have provided have been used to inform this handling plan and identify any agreed actions. This information m on computer and will be shared with other agencies working with us to meet the agreed needs within your Care Needs Summary and Care Plan. These recommendations have been agreed by the patient/service user or representative: Patient/Service User Signature:. Initial Assessor Signature: Designation: Date:.././. 19 of 69

20 Type of Transfer/Activity Assessment Repositioning in Bed DAY NIGHT Getting in/out of Bed DAY NIGHT Getting on/off a Commode/chair/ wheelchair DAY NIGHT Getting on/off the Toilet DAY NIGHT Sitting/standing DAY NIGHT Walking/General mobility DAY NIGHT DAY Getting in/out of the shower/bath and washing Other transfers (where applicable) NIGHT DAY NIGHT Dressing/Undressing With help Independently Method Note: All providers of care are responsible for on-going risk assessment and monitoring as change occurs. If problems arise, contact your manual handling worker/assessor or Social Services Handbook. 20 of 69

21 Information/equipment required for service user 1. Hoist: Specify type Sling: detail size, type and loops used 2. Small handling aids 3. Toilet and/commode 4. Bed and Chair: specify types/heights/mattress 5. Equipment usage demonstrated to carer: 6. Additional information: Assessor s Signature:. Date: / / Designation: Review Date: /../. Copies sent to: Adult & Community Services Patient/service user Carer(s) Service Provider(s) Health worker(s) File Other (please specify) Sent by: Date sent:././.. 21 of 69

22 Appendix 7: HANDLING ASSESSMENT SUMMARY AND PLAN REMEMBER Frequency (approx) X severity = risk The purpose of this handling plan is to describe the assessed handling needs of the Child/Young Person named below and to specify how these should be met to reduce the risks of injury to both carers and Child/Young Person (refer to risk Assessment and Manual Handling Policies). Within Torbay Council and Torbay & Southern Devon Care Trust Child / Young Person User Detail Name: Ward/Location: Address: NHS Number: Paris Number: Date of Birth: / / Initially Assessed by: GP: Initial Assessment Date: / / Disability/ Weakness: Height: Weight: BMI: Service User Ability Yes No Details Can they co-operate/communicate effectively? Can they weight bear/stand? Have they got standing balance? Can they walk? Can they maintain sitting balance? Can they get into/out of bed? Can they sit up in bed? Can they move up the bed? Do they have any attachments (e.g. catheter pegs)? Are they receiving medication which may affect movement? Do they have a history of falling? Refer to falls team. Do they use any mobility aids? If you need to add any further details, please use the Additional Information section on Page 3 Service User Risk Level Date / / / / Patient unable to assist in any way, due to unconsciousness, likely to behave unpredictably, may be heavy, or have high level of disability RED High/significant Risk Able to co-operate and can move with assistance and/or requires the use of small moving aids Needs minimal assistance, supervision, or guidance YELLOW Medium Risk GREEN Low Risk 22 of 69

23 Data Protection Act: Details you have provided have been used to inform this handling plan and identify any agreed actions. This information may be stored on computer and will be shared with other agencies working with us to meet the agreed needs within your Care Needs Summary and Care Plan. These recommendations have been agreed by the patient/service user or a representative: Child/Young Person or Parent/Carer with parental responsibility Signature Initial Assessor Signature Date: / / Designation Type of Transfer/Activity Repositioning in bed/cot Day Night Assessment Getting in/out of bed/cot Day Night Getting on/off a commode /chair /wheelchair /buggy Getting on/off the toilet/ potty Day Night Day Night Sitting/standing Day Night Walking/general mobility Day Night Getting in/out of the shower/bath and washing Other transfers (where applicable) Getting in/out of the car/car seat Day Night Day Night Day Night Dressing/Undressing With Help Independently Method Note: All providers of care are responsible for on-going risk assessment and monitoring as change occurs. If problems arise, contact your manual handling worker/assessor or Social Services Handbook. 23 of 69

24 Information/equipment required for service user 1. Hoist: Specify type Sling: detail size, type and loops used 2. Small handling aids 3. Toilet and / or Commode 4. Bed and Chair: Specify types/heights/mattress 5. Equipment usage demonstrated to carer: 6. Additional information: Assessor s Signature: Date / / Designation: Review Date / / 24 of 69

25 Bed to bed/trolley using 2 Or three people Patslide and sliding sheet Rolling over using sliding sheet Slide up bed in supine position Sit up in bed using 1 or 2 people Rolling over to side lying Lying or sitting Hoisting Sliding Board with Supervision Sliding Board and 1 Not able to: Not able to: Not able to: Able to: Able to: Able to: Not able to: Able to: Able to: co-operate, possibly unconscious co-operate passively or actively move any body part due to rigidity, unconscious or behavioural problems bend forwards over hips co-operate in sitting forwards without support co-operate in manoeuvre bend trunk and head forwards over hips hold long sitting posture with minimal support co-operate in manoeuvre cross 1 leg over other or bend knee / rotate pelvis and move pelvis / turn head and upper trunk / reach across trunk with arm co-operate in rolling over passively or actively roll onto side / flex legs to 90 degrees at hips assist with arms to push up / assist to lower legs over side of bed: balance in sitting on edge of bed co-operate or assist in any part of the transfer due to cognitive, physical or behavioural difficulties sit on side of bed without assistance of 2 set up for safe transfer / place sliding board place own arm / move towards arm transferring bottom across board remove board and maintain unsupported sitting balance flex trunk and transfer weight in sitting / place feet on floor place own arm and assist with arm in direction of movement Sliding Board (Sliding Sheet) and 1 Sliding Board (Sliding Sheet) and 2 Sit to Stand Crouch Standing Transfer with 2 Standing Transfer/ Walking with Supervision Standing Transfer / Walking with 1 Standing Transfer / Walking with 2 Able to: do all the above / maintain placed arm assist in the direction or movement Able to: sit on bed with minimal assistance of 1 / flex forward in trunk place feet on floor / place 1 arm in the direction of movement co-operate with the transfer Able to: weight bear through 1 or 2 feet / maintain sitting balance bring trunk forwards over feet, then bring pelvis forwards over feet, straighten legs Able to: This transfer must only be used after a thorough risk assessment and under guidance of a key trainer sit unsupported / place feet on floor / initiate sit to stand with 1 move to edge of chair with 1 / assist with weight transfer in crouch / standing with assistance from behind and in front. Able to: move to edge of chair / sit to stand / stand unsupported and transfer weight / step with both legs achieve the transfer with some verbal prompting only Able to: sit to stand with 1 / maintain standing balance with 1 transfer weight in standing release either leg to initiate stepping Able to: sit to stand with 2 / maintain stand with 2 transfer weight in standing with 2 Able to: release leg to initiate stepping maintain sitting balance / place 1 or 2 feet on turntable pull up into standing position / maintain standing with Turner Standing Transfer With Stand Turner Able to: maintain sitting posture / co-operate in manoeuvre Standing Transfer with extend both legs / grasp hoist with at least 1 hand Standing Hoist All providers of care are responsible for on-going risk assessment and monitoring as change occurs. 25 of 69

26 Appendix 8 Acute Setting Only Patient Handling, Falls & Bed Rail Assessment To be completed WITHIN 6 hours of admission, if patient s condition deteriorates, on transfer or post fall Surname... (Attach name label) Forename.... Hospital N o Date of Birth...Age... Weight...kg scale weight estimate Height...cm BMI... Ward/Area... Width at waist. cm Patient History tick appropriate column Yes No Details Is the patient uncooperative/have inadequate comprehension? Is the patient receiving medication which affects movement? Is the patient s centre of gravity altered, e.g. stroke? Does the patient have fixed/swollen/flaccid limbs? Does the patient have attachments e.g. catheters/iv? Falls History tick appropriate column Yes No Details Is the patient confused/disorientated? Yes? Intentionally round Is the patient unsteady of his/her feet? Yes? Intentionally round Is there a history of falls one year prior to this admission? Yes? Intentionally round Has the patient fallen since admission? Yes? Intentionally round Record of falls since admission: please circle More (N o ) Patient ability tick the appropriate column No Yes Assistance req d Can the patient turn over in bed? Can the patient sit up in bed? Can the patient move back up the bed? Is the patient able to maintain a sitting balance? Can the patient get into/out of bed? Is the patient able to weight bear/stand? Is the patient able to walk? Does the patient use mobility aids and require assistance? Initial Review Review Overall Assessment ass t based upon answers & clinical judgement review if any changes Date 1 Date 2 Date 3 Follow Falls & Patient Manual Handling HIGH RISK Assessment Plan Follow Low Risk Strategies & Basic Falls Advice & Patient Manual Handling Assessment Plan Low Risk Strategies & Basic Falls Advice Introduce patient to ward environment, washing & toilet facilities Remind patient to request assistance as required Check environment for slip/trip hazards & other obstacles Ensure hearing aids are working & spectacles clean & within reach Teach patient to use bed controls and call bell (leave within reach) Check patient has supportive, well fitted footwear with a non-slip sole If no one is available to bring in footwear use top-up slippers Ensure walking aids are kept within patient s reach LOW RISK Assessor.Sign.. Designation.Date/Time. High Risk Strategies & Interventions Complete Manual Handling Plan & Falls Assessment Yes No Comments Tick 26 of 69

27 Activity Walking N.B. Ensure that patient is included in safety brief/handover as high falls risk Is Patient being observed? (Tick as appropriate) Intentional Rounding Cohorting 1 to 1 nursing Should patient be moved to observable area? N.B. High priority for patients with evidence of confusion Is Yellow Falls Symbol above bed & on Nurse Information Board? Is night lighting required for patient? ECG required? Is patient on >4 medications, anti-hypertensive, sedatives or anti-psychotics? N.B. If Yes, arrange review by Medical staff or Pharmacist. If evidence of /risk of fragility fracture, refer to medics/fls for calcium, vitamin D and/or bisphosphonate consideration If evidence of /risk of fragility fracture, refer to medics/fls for calcium, vitamin D and/or bisphosphonate consideration Has a lying/standing BP been recorded? Postural Hypotension Leaflet N.B. If Systolic differential is >20 mm Hg arrange review by Medical staff. Consider use of bed/chair sensor pads & Hi-Lo bed Leaflets given to patient (Tick as appropriate) In-patient falls Staying Steady Is patient incontinent? (If yes consider referring to Continence Advisory Service) If patient is symptomatic, take urinalysis to exclude UTI? Manual Handling Plan Activity Moving in bed/movement up bed Complete relevant activities ONLY - AVOID UNDERARM LIFTING - Review any changes Assessment N o N o of Equipment required Additional information & Date staff Manual Handling Plan Complete relevant activities ONLY - AVOID UNDERARM LIFTING - Review any changes Assessment N o N o of Equipment required Additional information & Date staff 1 Sit up on side of bed Sit to stand 2 3 Assessor.Sign Designation Date/Time 27 of 69

28 immobile Patient 2 is confused & A Use bed rails with care Bed rails not Bed rails not Mental disorientated recommended recommended state Patient 3 is drowsy B Bed rails recommended Use bed rails with Bed rails not care recommended Patient 1 is alert & C Bed rails recommended Bed rails Bed rails not Transfers orientated recommended recommended (Bed to Chair 2 Chair to chair) 3 1 Bed Rail Assessment Patient is very immobile (bedfast or hoist dependent) Mobility Patient is neither independent nor Patient can mobilise without help from staff Other transfers (Detail) Lateral Transfer Hoisting Detail hoist used Sling size/type Bariatric Equipment Required Bed Chair Commode Hoist & Sling (size) Walking aid Other Assessor.Sign.. Designation Date/Time of 69

29 Patient is unconscious D Bed rails recommended N/A N/A Please use the risk matrix above in conjunction with nursing judgement, remembering:- To assess, consider Mental State score in combination with Mobility score, e.g. A1, C3, etc. Patients with capacity can make their own decisions about bed rail use. Patients with visual impairment may be more vulnerable to falling from bed. Patients with involuntary movements (e.g. spasm) may be more vulnerable to falling from bed, and if bed rails are used, may need additional support systems or protection. Assessment Score & Date 1 Additional Information 2 3 Physio/OT/S&LT/Dietitian referral req d Yes / No Details Yes / No Details Dementia Awareness Further information Data Protection Act: Details that you have provided have been used to inform this assessment and identify any agreed actions. This information will be shared with other agencies working with us to meet these agreed needs within your Care Needs Summary and Care Plan. These recommendations have been agreed by the patient or their representative: Patient signature Date/Time.... Assessor..Sign.. Designation.Date/Time.. 29 of 69

30 Appendix 9 Guidelines to Therapeutic Handling in Therapy Treatment These Guidelines are designed to assist therapists to use informed clinical reasoning behind using therapeutic activities that may increase the risk of injury to the therapist. These guidelines must be used in conjunction with the Therapeutic Risk Assessment form and the patient-handling plan. All therapy staff must work within their own level of competence and ability; Refer to (CSP Rules of Professional Conduct and Standards, CSP Guidance in Manual Handling for Chartered Physiotherapists (CSP 2008), Guidance on Manual Handling in Treatment, (ACPIN MH Working Party 2001), Trust Moving and Handling Policy. All handling tasks must be explained to the patient and informed consent given prior to any moving and handling activity. Patient Specific Assessment Protocol 1. Assess the patient clinically 2. Consider realistic clinical goals and functional outcomes if possible in discussion with the patient 3. Does the proposed treatment/therapeutic handling involve hazardous manual handling? 4. Can the hazardous manual handling be avoided while still meeting the patient s clinical and functional goals by using aids or equipment? 5. If the hazardous manual handling cannot be avoided then a full risk assessment using the TILE process must be carried out. 6. Reduce the hazardous manual handling activity by adapting the technique, assistance of appropriate trained colleagues or use of equipment. 7. Record risk assessment and risk management protocols or 8. Re-evaluate and consider competence to proceed. Reconsider the goals. IF THE THERAPIST FEELS THAT A PARTICULAR TECHNIQUE IS THE ONLY ONE POSSIBLE AND THAT HE/SHE CAN EXECUTE THIS TECHNIQUE SAFELY, THE CLINICAL REASONING BEHIND THE DECISION NEEDS TO BE DOCUMENTED. THE THERAPIST MUST MINIMISE, AS FAR AS IS REASONABLY PRACTICABLE, THE RISK OF DAMAGE TO THEMSELVES, STAFF AND PATIENTS WHILE STILL ENABLING THE PATIENT S PROMPT PROGRESS TOWARDS FUNCTION. MOVING AND HANDLING CSP of 69

31 Rolling over Clinical Reasoning Experiencing movement with a low centre of gravity Facilitate rotation in the trunk Facilitate trunk and head righting and equilibrium reactions To achieve a functional goal Patient Criteria Patient is medically stable Patient can co-operate in rolling supine to side lying Patient has no pathology that would negate rolling, e.g. hip replacement, acute back injury. Patient can be facilitated to: Place left leg in flexion Facilitate left arm across the trunk Turn head in direction of rolling Facilitated from pelvis and shoulder girdles to roll from supine to right side lying Possible Hazards Patient fearful of moving. Surface the patient is rolling on is unstable or soft and low to the ground Therapists have to work in poor postures Temptation to pull the patient over into side lying rather than facilitate, this is usually due to the therapist not using their own dynamic movement to facilitate the patient activity. Lying to Sitting Therapist will use guidelines to roll patient over to side lying. Single therapist facilitation Therapist in front of patient in side lying With other hand flex knees to 90º and tip feet over edge of bed Places hand on pelvis Therapist moves laterally pressing down on pelvis and stabilising shoulder girdle, facilitates patient into a sitting position Double therapist facilitation If 2 assistants are needed the therapist behind the patient kneels on the bed close to patient One hand on lower shoulder girdle, one hand on rib cage Therapist in front has one hand on top of pelvis and one hand supporting lower limbs Front therapist pushes down through pelvis, back therapist facilitates trunk up over pelvis into a sitting position 31 of 69

32 Modifications Head of bed could be raised to bring patient into more of a sitting position Number of assistants needed may vary depending on the head control and tone of patient, level of postural control, number of attachments etc. Patients arm position may vary depending on ability to assist If bed height can vary it may be more beneficial to start with bed high and then lower when patient in a sitting position to put their feet on the floor Hazards Change in medical status Co-operation of patient may change during manoeuvre Tonal changes Low plinth/bed Soft/Air mattresses Potentially poor postures Cluttered environments Maintain Sitting Clinical Reasoning Facilitate righting and equilibrium reactions Accept base of support with hips and lower limbs Experience mid line orientation Free upper limbs for reaching and placing To achieve a functional goal Patient Criteria Patient is medically stable Able to be placed up against gravity Able to facilitate trunk into extension over pelvis Able to place one or both upper limbs at 90º Patient co-operative both physically and cognitively Therapist behind kneels on supporting surface or stands behind supporting surface Therapists place patient on a stable supportive surface Therapist behind stabilises upper trunk The pelvis is placed so that equal weight bearing is experienced through the hips The hips and knees are at 90º with the feet on the floor under the knees The thighs are in contact with base of support and placed parallel to each other The trunk is facilitated into extension over the pelvis The shoulder girdles are aligned over the hips Reaching with the upper limbs across midline while keeping the body s centre of gravity with in the base of support may assist to create midline orientation The second therapist may sit or kneel in front of patient and facilitate from the pelvis and align lower limbs 32 of 69

33 Hazards Patient can become medically unstable Patient may push into extension Tonal changes in response to gravity Base of support is not sufficiently stable for the patient and therapist i.e.; use of unstable pressure mattress or soft mattress Therapists adopt sustained/ poor posture Modifications Use a side supported sitting position on more active side Use of low back upright chair Therapist behind can sit on a ball that supports patients trunk in preparation for mobilisation Sit to Stand Clinical Reasoning Experience movement into extension over feet Access righting reactions As preparation for walking and transfers Building a background of extensor postural tone Patient Criteria Weight bear through 1 or 2 feet Maintain sitting balance Move trunk forwards over feet Tilt pelvis forwards over feet Straighten legs Patient facilitated to move forwards in chair Patient can maintain unsupported sitting using their hands or facilitation from proximal key points Patient s feet can be placed on floor with more than 90º at ankle Patient can be facilitated to move trunk over feet Patient can be facilitated to move pelvis forwards over feet Patient can maintain standing with centre of gravity over base of support 33 of 69

34 Modifications Use of equipment Patient stands down from high plinth More than one person needed to facilitate patient Use of patient s upper limbs Hazards Tonal changes patient may thrust backwards, pull into flexion, or lose feet off floor Patients behaviour/co operation Attachments to patient e.g. drips, tracheostomy Medical status Staff level of skill and competence Height relationship of therapists to each other and the patient Crouch Transfer This is a high risk activity and must be thoroughly risk assessed as the only option to use therapeutically and documented Clinical Reasoning To be actively involved in transfer To weight bear through all four limbs Increase awareness of affected side To access lateral weight transfer through rotation To achieve a functional goal Patient Criteria To be able to place feet on floor To be able to maintain sitting balance To be able to place hands To be able to initiate sit to stand To be able to transfer weight laterally through hips Patient facilitated from proximal key points to move forward in the chair Patient s hand is placed on transfer surface that they are moving to Patient s other hand is placed on supporting surface Patient s feet are placed on floor in direction of transfer Patient is facilitated from proximal key points to bring weight over feet Patient is facilitated to transfer pelvis laterally to new supporting surface Patient s pelvis and trunk are aligned on new seating surface 34 of 69

35 Modifications Number of facilitators required Use of sliding board and handling belt Stand aids Hazards Therapists in poor posture Therapists unbalanced Therapists skill and competence Level of co-operation and ability of patient Tonal changes Attachments to patient Heights of transfer surfaces Changing types of base of support Standing Transfer through 90degrees Clinical Reasoning Access righting and equilibrium reactions Experience displacement through gravity using rotation through midline Initiate stepping Preparation for walking To achieve a functional goal Patient Criteria Able to sit unsupported Able to place feet Able to sit to stand Able to maintain Standing Balance Able to achieve single leg stance Able to step with either leg sideways, forwards, and backwards Patient can be facilitated sit to stand from proximal key points Patient can be facilitated to transfer weight to one leg Patient can release non standing leg Patient can be facilitated to step through rotation with non-standing leg Patient can be facilitated to transfer weight diagonally over stepping leg Patient can be facilitated to step backwards with non-weight bearing leg Patient can be facilitated to stand to sit Modifications Use of equipment Number of facilitators required Facilitation from different key points Assistance for correct foot placing Patient s use of Upper Limbs 35 of 69

36 Hazards Changing medical status of patient Therapist s freedom of movement and balance Therapist s level of skill and competence Change in Patient s co-operation and behaviour Tonal changes during transfer Patient attachments; e.g. drips etc. Functional Walking Clinical Reasoning Access Righting and Equilibrium Reactions Access stepping reactions Experience displacement through gravity Improve balance mechanisms To achieve a functional goal Patient Criteria Able to sit to stand Able to maintain standing Able to transfer weight to left and right Able to orientate to midline Able to initiate stepping forwards, backwards, and sideways Patient medically stable Patient can co-operate physically and mentally Patient can maintain standing with assistance Patient can be: Facilitated sit to stand from the pelvis and shoulder girdle Facilitated to transfer weight to right and left Facilitated to step with alternate leg forwards, backwards, and sideways Modifications Number of facilitators required Use of equipment Assistance to correct foot placing Patients use of upper limbs Hazards Changing medical status of patient Therapist s freedom of movement and balance Therapist s level of skill and competence Change in Patient s co-operation and behaviour Tonal changes during transfer Patient attachments e.g.drips etc. 36 of 69

37 Patient Facilitated off the floor Clinical Reasoning Access righting and equilibrium reactions Reduce fear of falling Re-educate independence to get down to and up from floor Improve upper and lower limb functional movement Patient Criteria Be able to maintain sitting balance Able to flex hips and knees to 90º Able to weight bear through all four limbs Able to kneel with or without support Able to co-operate with instructions Facilitate patient into side lying Facilitate patient into side sit Facilitate the patient into 4 point kneeling Facilitate the patient to kneel Facilitate the patient to weight transfer onto one knee Bring other foot onto floor into ½ kneeling Facilitate patient into standing Modifications Stool/chair in front patient facilitate to crouch stand and turn pelvis to place in chair Patient facilitated to crawl to piece of furniture in preparation to sit When patient is in ½ kneel put small stool under the right angle hip, allow patient to sit back onto stool A pillow is placed under knees in 4 point kneeling to relieve pressure/pain Equipment e.g. Air cushion, hoist Hazards Patient co-operation Tonal changes Weakness in lower limbs Painful joints Stairs Clinical reasoning To increase ability to transfer weight To strengthen anti-gravity muscles To improve exercise tolerance To increase confidence in balance To achieve a functional goal 37 of 69

38 Stairs with 2 Patient Criteria Able to sit to stand with assistance of 1 Able to stand with assistance of 1 Able to step up and over a block with assistance of 1 (with or without arm support) Able to walk with assistance of 1 +/- walking aid Able to control knees to maintain extension during weight bearing Going Upstairs Patient is positioned in standing at edge of stairs with appropriate arm support One therapist is positioned behind the patient and one in front of the patient The therapist in front faces the patient and is the lead. They can gain eye contact, and communicate with the patient and watch their facial expression. They can also make sure the hands are placed on any appropriate support and shoulders stay forward The therapist behind the patient stands on the step below the patient, and is responsible for placing the patient s foot on the step and facilitating the pelvis if necessary. Going down stairs One therapist stands behind the patient and one therapist in front of the patient about 2 steps below them facing the patient. The therapist behind is responsible for keeping the patient s shoulders and back in extension. While the patient places their hand appropriately on the stair rail. The front therapist guides the patient s foot onto the lower step and stabilises hip when necessary. Stairs with 1 Patient Criteria Able to sit to stand with supervision Able to stand with supervision of 1 Able to follow commands Able to step up and over a block with supervision of 1 (with or without arm support) Able to walk with close supervision of 1 +/- walking aid The patient has good trunk control, and can use own upper limb for support if needed. Going upstairs therapist takes the position and function of the therapist behind the patient (Stairs with 2). Going downstairs the therapist takes up the position and function of the therapist in front of the patient (Stairs with 2) Stairs with supervision Patient Criteria Able to step up and over a block with or without arm support Able to walk with or without aid May require verbal prompts to achieve any of the above but physically independent 38 of 69

39 Modifications Patient s use of upper limbs Number of stair rails used May need to facilitate from different key points and therefore vary hand position as outlined above Therapist s position in front may vary Consideration of whether patient should be in suitable footwear or bare feet Stair technique may vary Hazards Change in patient s co-operation and behaviour during activity Therapist may have an unstable base of support Therapist may adopt a flexed posture Tonal changes in patient during activity Therapist walking backwards down the stairs 39 of 69

40 Appendix 9: Therapeutic Handling Assessment Name Address Height: Area seen: DOB Weight: Name of Therapists: Named Task and Clinical Reasoning Date/Time Signature Individuals assisting Job title/grade persons assisting where relevant Client Details Relevant to risk Clients ability criteria Environment Record details relevant to risk not just location of task Risk Reducing Measures Date and reason no longer applicable 40 of 69

41 Named Task and Clinical Reasoning Date/Time Signature Individuals assisting Job title/grade, person/s assisting where relevant Client Details Relevant to risk Clients ability criteria Environment Record details relevant to risk Risk reducing measures Date and reason no longer applicable 41 of 69

42 Appendix 10 Hoist and Sling Provision Prescribing Hoists The several of hoists; hydraulic(these are rare today but you may come across one) mobile hoists, electric mobile hoists, gantry and track hoists. From a moving and handling perspective the track hoists are the favoured in the community, as they reduce the risks to care assistants by avoiding the need to push a heavy load possibly on carpet (See HSE guidelines Moving and handling Operations Regulations revised 2004). However, these can be restrictive and so the mobile hoist may be more appropriate in a given situation as they are more flexible. There are a variety of sizes of each type of hoist, when prescribing the size the smallest and lightest possible should be prescribed after taking into account: weight of service user and heights of lifting surfaces. Larger hoists will require more space to manoeuvre (Always a problem in the community) and will make the load heavier. Where space is limited a number of pushing and pulling manoeuvres need to take place to avoid twisting. The start of any pushing or pulling manoeuvre requires more effort to overcome inertia than the continuation. (Newton s first law of motion) (The guide to the Handling of People, Chapter 6, Page 57, P Leggett) Twisting is particularly stressful on the back. The HSE have given guidelines that suggest where the spine is twisted it takes 10-20% less force to injure it. (HSE MHOR Guidance on Regulations 2004) Where possible an overhead hoist should be prescribed to avoid the need for pushing and pulling the hoist plus service user and so reducing the risk of injury as described above. The Hydraulic hoist increases the risk of neck and shoulder injury to the care assistant. This is due to the repetitive movements, under load, of the upper arm required to pump up a hydraulic hoist and the difficulty of maintaining a safe posture while doing so (Wilson 2002). The heavier the service user, the more pressure required to pump the hydraulic lever. If there is only one care assistant involved, it is very difficult to lower the service user into a sitting position, and position them correctly at the same time, while maintaining a good posture. This activity can take several seconds to complete with the care assistant maintaining a poor posture, often stooping and twistinthis static posture combined with twisting and stooping increase the risk of a back injury considerably. With an electric hoist the service user can sometimes take control of the lifting and lowering so that the care assistant can move around to care for the service user s positioning. Or the care assistants can control the lifting and lowering and care for the service user in more appropriate postures. The mechanism of a hydraulic hoist uses the repeated pumping of a lever to lift the boom of the hoist and its load. If this is only done once or twice a day by a fit person, and he/she is aware of the dangers and so minimizes them by being in a good position, the risks are low. However, domiciliary care staff may well be going from one moving and handling task to another with little rest between and could well end up being at high risk of injury if they have several service users with hydraulic hoists. Employers of care staff have a responsibility to ensure that staff are not put at risk in this way. If there are problems with recharging the batteries reliably on an electric hoist, a hydraulic one may be the more appropriate. This should be documented in the risk assessment. It is therefore recommended that only in exceptional circumstances should a hydraulic hoist be prescribed instead of an electric one. Once a need for a hoist has been identified; if there are no electric hoists available, but there are hydraulic ones, then it would reduce the risk to the care assistant to use the hydraulic hoist rather than attempt to lift the service user. This should be a short term measure until an electric one can be delivered. 42 of 69

43 It is important to do a thorough risk assessment when providing a hoist and make sure control measures are in place to reduce the risks of using the equipment. The carers or care assistants must be trained and able to use the equipment safely. Slings There have been some falls nationally from hoists due to poor compatibility of slings and hoists, inappropriate laundering of slings, inadequate type of sling for service user, and inadequate maintenance. Action There should be a thorough risk assessment before prescribing a sling and hoist. This should ensure: The sling is compatible with the hoist, i.e. it should have the correct attachments. The appropriate sling for the service user s needs Transfers that will be carried out with it. For advise on types and use of slings please contact:- o Moving and Handling Team at Horizons Moving and Handling o CES/PLUSS/NRS o Independent Living Centre Newton Abbot o Disabled Living Foundation o Individual Company Representatives All hoists and slings are visually inspected before use and removed from service if defects are found. Slings should be laundered according to manufacturer s instructions. Please note single use slings should not be laundered. All hoists and slings are used and maintained according to manufacturer s instructions and inspected by a competent person every six months as outlined in the Lifting Operations and Lifting Equipment Regulations (LOLER). Summary Hoists and slings should only be prescribed after careful risk assessment. Slings and hoists should be compatible with each other and appropriate to the service user and transfer they will be used for. 43 of 69

44 Appendix 11 Procedure for getting a fallen patient off the floor. Acute Patient Falls Assess using post fall checklist in falls care plan. Hip Injury Suspected Assess for hip and spinal injury (see guidance) Spinal Injury Suspected Do not hoist Immobilise Contact PORTERS to bring Scoop Stretcher OR Hoverjack No sign of fracture or other injury If patient able talk up from floor If unable, access scoop stretcher or consider hoisting if patient consents Do not Hoist Access Spinal Board Immobilise 44 of 69

45 45 of 69

46 Appendix 12 Group A Trunk Neck REBA: Scoring Use Table A Use Table B + + L R Upper arms L R Lower arms L R Group B Legs Load/Force Coupling Wrists Score A Use Table C Score B Score C Activity Score + REBA Score Source: Hignett, S., McAtamney, L. (2000) Applied Ergonomics, 31, Professor Alan Hedge, Cornell University, September of 69

47 Appendix 12A 47 of 69