Manual handling guidance Plus size patient

Transcription

1 Manual handling guidance Plus size patient

2 Policy Title: Executive Summary: These guidelines aim to complement current guidance and provide clear advice to staff on the management of heavy patients who exceed the weight limits of some items of hospital equipment, the aim of these guidelines is to maintain the safety of staff and patients, these guidelines comply with Health and Safety legislation and Manual Handling Operation Regulations (1992) Supersedes: Version 1 Description of Review appendixes and use new policy template Amendment(s): This policy will impact on: Financial Implications: Policy Area: Corporate Nursing Document ECT Reference: Version Version 2 Effective Date: March 2018 Number: Issued By: Manual Handling Review Date: March 2021 Manager Author: Manual Handling Manager Impact Assessment Date: APPROVAL RECORD Committees / Group Date Consultation: Workforce & OD Strategy Board April 2018 Matrons March 2018 Approved by Director: Director of Nursing, Performance May 2018 and Quality Ratified by: Workforce & OD Strategy Board April 2018 Received for Work Matrons force & OD April 2018 information: Strategy Board Manual Handling Manager 1

3 Table of Contents 1. Purpose of the guidelines 3 2. organizational roles and responsibilities 3 3. Assessment of the patient 5 1. Communication with other wards/departments 6 2. Equipment for the plus size patient 6 3. The collapsed plus size patient 7 4. Communication Page 7. Planning to stand/walk a plus size patient whom is a high manual 7 11 handling risk 8. The deceased plus size patient 8 Page 12 Appendix Appendix 1 - Trust MH equipment that s in excess of 25 stone Appendix 2-Bariatric rental companies (Acute) 9 11 Appendix 3 Flow chart 12 Appendix 4 Bariatric Risk Assessment and Care Plan 13 Manual Handling Manager 2

4 1. Purpose of the guidelines 1. Purpose of the guidelines These guidelines have been produced to provide trust staff with guidance on the management of plus size patients who exceed the weight limits of some items of trust equipment. Within the hospital environment standard manual handling equipment tends to have a safe working load of 159 KG (25 stone). The aim of these guidelines is to maintain the safety of staff and provision of high quality care for patients. These guidelines comply with the health and Safety legislation (Health and safety at work Act) and Manual Handling Operations Regulations (1992) The purpose of these guidelines is to minimise handling risk by ensuring that specialist equipment/advice is available. So far as reasonably practicable, these guidelines should be read in conjunction with the Trusts manual handling policy. For the purpose of these guidelines the plus size (bariatric) patient is defined as anyone who has limitations in health due to their physical size, lack of mobility, due to their size, weight or high body mass index. Body mass index is a simple index of weight for height that is commonly used to classify underweight, overweight, and obesity in adults it is defined as the weight in kilograms divided by the square of the height in metres (kg/m2) 2. Organizational roles and responsibilities 2. Organisational roles and responsibilities Chief Executive: The Chief Executive has responsibility for ensuring the health, safety and welfare of staff, patients and visitors to the health services premises within the Trust are in line with the Management of Health and Safety at Work Regulations. Delegated responsibility has been given to the Director of Nursing, Performance and Quality for ratification of this guidance. Director of Nursing, Performance and Quality: The Director of Nursing, Performance and Quality has delegated accountability for the final ratification prior to the guidance actually being implemented. The ratification will take place following a consultation and approval process. Deputy Director of Nursing and Quality: Manual Handling Manager 3

5 The Deputy Director of Nursing and Quality is responsible for the monitoring and communication of this guidance, ensuring the guidance is reviewed on an annual basis and audit takes place with findings being acted upon. All Directors: Directors are responsible for ensuring that where the principles described in these guidelines affect their area of accountability the guidance and standards described are complied with and integrated into practice. Heads of service lines/service manager/matrons are responsible for: Manual handling matters within their areas as follows:- Take all reasonable steps to ensure that funding is identified to implement risk reduction measures as indicated in the manual handling risk assessments Ensure that manual handling equipment is available and is maintained in a safe condition and is used effectively Make provision for adequate manual handling information, instruction training and supervision and ensure up to date records are kept for this in compliance with the Management of Health and Safety at Work Regulations 1999 and the Manual Handling Operations Regulations 1992 Ensure that manual handling risk assessments are completed and reviewed regularly Ensure manual handling incidents/accidents are reported and investigated as soon as possible. Ward/Department Manager s /Team leaders: All ward/department managers should identify hazards concerning manual handling of plus size (bariatric) patients, and ensure that the ward/dept risk assessments document all appropriate measures to reduce risks for these manual handling tasks. Managers have a duty to inform each employee of the manual handling risks identified by these assessments and should document preventative/protective measures put in place e.g. safe systems of work. All staff should be familiar with these assessments and they should be available for reference. All managers should ensure that all staff who handle plus size patients have suitable, sufficient and current information regarding individual patient s manual handling risk assessments and care plans. All ward managers should have local procedures in place for the management of any patient who exceeds the weight limits of any equipment/furniture in their own area, this could be information for staff on where to get manual handling equipment, large blood pressure cuff, gowns etc. All ward/department managers should compile and keep a list detailing the weight limits of every relevant item of equipment, i.e. beds, mattress s, trolleys, chairs, commodes/shower chairs. Where appropriate the weight limit should be clearly displayed on the item of equipment. Manual Handling Team: The Manual Handling team s roles and responsibilities can be found in the Manual Handling Policy. The Manual Handling Team can assist with the risk assessment process and provide advice on how the patient may be safely handled. They can offer advice on the type of Manual Handling Manager 4

6 equipment available, suitability and where it can be obtained. They may also offer training in safe manual handling techniques and the safe use of equipment. Employee: As an employee of the Trust, the post holder has a duty under the Health and Safety at Work act 1974 sections 7 and 8 and the Management of Health and safety at work regulations 1999 regulation 14 (1) and 14 (2) The Manual Handling Operations Regulations (1992) requires employees to co-operate and follow appropriate systems of work laid down by their employer to promote safety during the handling of loads. In particular employees should: Make known to their manager any factor which may place themselves or others at risk of injury Ensure that on commencing work in a new area they comply with the manual handling induction process and are familiar with all manual handling equipment/processes Ensure that before using any manual handling equipment i.e. trolleys, hoists, they have been provided with sufficient information, instruction training and supervision. If staff have any concerns regarding their competency in use of equipment or work processes, they should report their concerns to their manager immediately and contact manual handling for further guidance if required. Employees must attend the appropriate mandatory manual handling training programme specific to their job role as identified in the Trust s policy for the management of statutory and mandatory training for all staff. Employees have a responsibility to declare if they believe they are not fit enough to participate in practical training sessions, they should make their concerns known to their line manager or occupational health and to the manual handling advisors facilitating the session. Employees must have additional training where necessary, in skills relevant to their work place. This training should be provided by the manual handling advisors, manual handling link staff or the relevant equipment manufacturer. 3.0 Assessment of the patient All staff have a duty to follow these guidelines and ensure that the risk assessments/risk reducing measures for the ward have been taken. On admission of the plus size patient, all staff should ensure that the patient is assessed for manual handling risks, identify hazards and document risk reducing measures on the patients care plan. All staff have a responsibility to inform managers/colleagues of plus size patients with manual handling risks. Every patient must have a manual handling risk assessment completed, (see appendix 4) and include if possible the patient s weight, waist circumference, and waist/hip ratio. If the patient cannot be weighed promptly, due to their clinical condition, this should be documented on the assessment/patients notes stating the reasons why this has not taken place, (weight is important to ensure there is no risk of equipment failure). Manual Handling Manager 5

7 The risk assessment/care plan should identify: How the patient is to be moved Identify any manual handling equipment to be used Identify how many staff are required for the task Ensure that the environment is suitable to accommodate the patient and any equipment identified for their care Any other risk reducing factors should also be included. If staff need advice from the Manual Handling Team, please contact telephone extension 3973, bleep 1339, or 1340, Monday to Friday , other disciplines that may be able to offer advice are Physiotherapy or Occupational Therapy. Out of hours the on-site managers should be contacted for advice. If a patient weighs over 160 kgs (25 stones) wards/departments will need to make special arrangements for appropriate manual handling equipment, extra staff or increased bed space, this information should be recorded on the risk assessment/care plan. Discussion should be with the matron or senior nurse in the first instance. Out of Hours this should be with the on-site managers with reference to the Senior Manager on call if required. Not all patients will present with complex needs however this will enable staff to make provision for specialist equipment where necessary. 4. Manual handling of the plus size patient All staff should refer to the Patient Escort Policy (Available on the Trust intranet policies). When transferring a plus size patient, staff should endeavour to find the mode of transfer with the least risk involved for all concerned. Some patients may need transferring on their bed/trolley utilising any mechanical aids available, or with the required number of people. If the patient is to be transferred by wheelchair, assessment as to how many staff should assist with the transfer should be made. 4.0 Communication with other wards/departments The special needs of the patient and specific instructions regarding manual handling must be passed on from the ward/dept. to any of receiving dept., e.g. Radiology, Aston ward. If this instruction does not occur or you have any concerns, it should be discussed with the nurse or line manager responsible for the transfer of the patient. Please consider if a manual handling risk has been identified and not resolved, and then document further using the Trusts incident reporting system. Information on manual handling heavy patients should be passed on with as much notice as possible to allow other departments to plan for the patient s arrival. Reference should be made on the handover documentation regarding manual handling risks and specific care required. 5.0 Equipment for the plus size patient All trust mobile hoists will lift up to 25 stone (160kgs), please refer to list of equipment, Appendix 1, however specialist bariatric equipment is available via rental, see Appendix 2, after discussion with the matron or senior nurse. The Community service line use Choicequip for patient handling equipment, Choicequip will; Process equipment orders received from community staff. Manual Handling Manager 6

8 Ensure a service contract is in place for the maintenance and repair of all moving and handling equipment provided by them Circulate medical device alerts to all line managers regarding equipment Provide advice and information to community staff 6. The collapsed plus size patient There are 5 patient lifting hoists available to assist patients over 25 stone (160 kg) All patient handling areas can access the hoist from. (See Appendix 1) Ward 2 Arjo opera SWL 200kgs (31 stone) Ward 3 Arjo maxi-move SWL 227 kgs (36 stone) Ward 4 Arjo maximove SWL 227 kg (36 stone) Ward 9 Arjo maximove SWL 227 (36 stone) Ward 10 Arjo maxi-move 227 kgs(36 stone) Aston ward Arjo maxi-move 227 kgs (36 stone) (Congleton war memorial hospital) Every patient should be assessed prior to allowing them to stand up out of a bed or out of a chair. If the patient weighs or is thought to weigh more than the weight limit of the nearest available hoist then staff should contact the Matron or Senior Nurse to discuss hiring of appropriate equipment. Hoverjack/hover matt flat lift kit is available within Recovery dept. main theatres. Within the community staff should use assessed equipment that is already available within the patient s property, if there is no equipment available assistance will be required from emergency services. 7. Planning to stand/walk a plus size patient whom is a high manual handling risk This should be carefully planned and documented liaising with appropriate disciplines i.e. physiotherapy. Suitable and sufficient equipment should be available for supporting the patient if required i.e. heavy duty walking frame/overhead gantry hoist with walking pants/heavy duty Golvo or Viking mobile hoist with walking pants. Consideration should be given to the risks associated with allowing the patient to move themselves/or being moved by staff, i.e. going to the bathroom. If this move allows the patient out of the range of the heavy duty hoist, consideration should be given when selecting an appropriate bathroom/toilet area. Staff should ensure that the mobile hoist is suitable and that it could be used in that area. If the patient falls to the floor in a confined space, the patient should be assessed and medically fit to be moved. The patient would need to be positioned onto a emergency transfer/slide sheet, and then pulled along the floor pulling on the emergency transfer/slide sheet, with an appropriate number of staff, using safer principles of manual handling and weight transfer technique. The patient s sling can then be fitted and checked to ensure it is in the correct place before attaching to the hoist/gantry to lift them up. Manual Handling Manager 7

9 Another option would be to use an air assisted lift device that allows the person to remain in a supine position; the person is then raised to a level that will facilitate a lateral transfer onto a stretcher, bed or trolley, there is a hover jack/hover matt flat lift kit located in Recovery dept., main theatres. In the event of a plus size patient collapsing, unless he / she can get up unaided they should be cared for on the floor/in the chair and made comfortable until a suitable hoist or the hoverjack is brought to lift them onto a bed/trolley. Any deceased heavy patient who is on the floor should be lifted with a hoist. 8. The deceased plus size patient The deceased plus size patient The deceased patient should be moved onto the concealment trolley, using the hoist and flat lifting attachment, or using the lateral transfer technique, enough staff should be available for the transfer. Deceased patients weighing up to 30 stone can be managed in the mortuary using existing equipment, the mortuary has a LIKO ceiling track and flat lifting attachment, there are 2 body trolley lifts that lift up to 50 stone, one has scales, if a patient exceeds the safe working load of equipment they are transferred to a mortuary than accommodate the plus size patient. The mortuary can use the X cube concealment equipment to ensure dignity when transporting plus size patients to the mortuary. Manual Handling Manager 8

10 Appendix s Appendix 1 - Trust equipment for manual handling of patients in excess of 25 stone Item of equipment Arjo opera Hoist Arjo maximove Hoist Arjo maximove Hoist Arjo, maximove Hoist Arjo, maximove Hoist Slings; Only use Arjo slings with Argo hoists, 3 Theatre tables Toilets Beds Weight limit Location/ward Make of item How to get it 200kgs (31 stone) Ward 2 Arjo ( ensure arjo clip slings are used with this equipment) 227 kgs (36 stone) Ward 3 Arjo maxi-move MK2, with scale ( use ARJO slings) 227 kgs (36 stone) Ward 4 ARJO-(use ARJO clip slings) 227 kgs, Ward 10 Arjo maxi-move with scale (36 stone) (use Arjo clip slings) Ring ward 1002 Ring ward Ring ward 1004 Ring ward kgs (36 stone) Ward 9 Use ARJO clip slings Ring ward 9 All slings will have the SWL identified on the sling 2 Theatre tables SWL 250kgs (39 stone) 1 theatre table 350kg (55 stone) Toilet seats 146 kg ( 23 ½ stone) Toilet pan 380 kg ( 60 stone) The MDGH site currently has a number of enterprise 5000bedframes,distributed on wards, that have a SWL of 248 kg (39 stone), However depending on the body weight distribution, wider beds may be required to meet the needs of the larger patient All wards should have a stock of sizes available Arjo slings Purchase from Arjo Theatres Theatre tables Theatres need advance warning to ensure the appropriate table is prepared Ring wards. If none available contact matron or senior nurse to discuss the hire of equipment See appendix 2 Manual Handling Manager 1

11 Item of equipment 1 x bariatric ridgid walking frame Long elbow crutches SWL (physio equipment with a SWL of over 150kg will be marked with a B ) location Make of item How to get it Physio orthopaedics 190 kgs Physio orthopaedics Gutter frame 160kgs Physio orthopaedics 2 x folding 227kg Therapies ward bariatric 10 frames Gutter frame 160 kg Therapies ward 10 KCI medical Physio Orthopaedics Tele ex 3164 Days Physio healthcare Orthopaedics Days healthcare Tele ex 3164 coopers Tele ex 3900 trulife Tele ex 3900 Viking XL hoist Hoverjack Flat lift kit 300kgs Medical equipment library. Undercroft Theatres Recovery Use liko slings only Theatres Recovery Log out via medical equipment library. Wards need to purchase liko slings to use with Viking XL Women s and children s Examination couch 190 kg Scan machine couch 190 kg Large blood pressure cuffs Delivery and post-natal beds 180 kg Hilrom delivery bed 227 kg Bariatric gowns Access to operating table 250 kg Manual Handling Manager 2

12 Appendix 2 Bariatric Rental Company s (ACUTE) If there is no items available within the trust, Hire of equipment must be arranged following discussion with the matron or senior nurse. Out of hours the on-site managers should be contacted for advice. Ensure appropriate risk assessment is completed to assist in receiving the correct equipment. 24 hour rental 4 hours average delivery time A range of bariatric equipment including bed frames, hoists, bedside chairs and commodes NIGHTINGALE JUL-17.pdf ARJO HUNTLEIGH (option 1) file:///g:\mrf-132%20rental%20ad%20hoc%202017%20sap%20(2).pdf 1 st call mobility BENMOR MEDICAL file:///g:\process%20for%20hiring%20%20cancelling%20bariatric%20equipment.pdf file:///g:\rental%20guide%206mb.pdf LIKO The Community Directorate use CHOICEQUIP for patient handling equipment, Choicequip will; Process equipment orders received from community staff. Ensure a service contract is in place for the maintenance and repair of all moving and handling equipment provided by them Circulate medical device alerts to all line managers regarding equipment Provide advice and information to community staff Access Cheshire community Equipment service criteria for provision of rental and non-retail equipment phone choicequip@cheshireeast.gov.uk Dean Row Independent Living Centre. Tel option 3 Manual Handling Manager 3

13 Appendix 3 - Flow chart On admission of the heavy patient, risk assessment to be completed, # From the risk assessment. Identify how the patient is to be moved, identify any manual handling equipment that is to be used, How many staff are needed to carry out the task, Ensure the environment is suitable to accommodate the patient and any equipment that is identified for their care See appendix 1, to see what equipment may be available within the trust At any point please contact the manual handling service for further advice, Please have the initial assessment completed. Telephone Bleep 1339 If no equipment is available, hire of equipment must be arranged following discussion with the matron or senior nurse For hire, see appendix 2 Ensure R/A is completed to assist in receiving the correct equipment Manual Handling Manager 4

14 Appendix 4 Please affix patient s label here Bariatric Risk Assessment & Care Plan Manual Handling INITIAL ASSESSMENT Height Weight BMI Hip/waist ratio Impaired sitting balance: Yes Analgesia needed Yes No Communication: No Impaired standing balance: Yes No Sight: Hearing: Catheter: Yes No History of falls Yes No Comprehension: I.V. Drains, etc: RISK LEVEL Unable to assist in any way, may be unconscious and/or is likely to behave unpredictably. or does the persons weight impact on mobility, available space, staffing levels or necessitate specific bariatric equipment Able to co-operate and can move with assistance and/or requires the use of small moving aids please summarise in the boxes below Needs minimal assistance/supervision/guidance, please summarise in the boxes below MOVEMENT General mobility HANDLING PROBLEMS IDENTIFIED Options available to reduce the risk HIGH MEDIUM LOW ACTION Equipment, number of handlers, etc General mobility in bed Lying to sitting in bed Bed to chair transfers Sit to stand / stand to sit Chair to commode / toilet transfers Showering & bathing Manual Handling Manager 5

15 General mobility out of bed/walking Date & time: Print name: Signature: Other Risk factors; Would any specific staff group be more at risk handling this service user? Do the tasks require any special knowledge or skills? Is there any follow up action required? How Additional many staff Comments are required? / information: Do you need to refer to the manual handling team/physio or O.T.? Regular re-assessments Re-assess the manual handling needs every week, or earlier if the patient s condition alters, and record any changes below as appropriate. If there is no change in the manual handling needs then date and sign immediately below. If the patient s needs change complete ASSESSMENT 2 or 3 at bottom. Date Sign and print name Date Sign and print name ASSESSMENT 2 RISK LEVEL HIGH MEDIUM LOW ASSESSMENT 3 RISK LEVEL HIGH MEDIUM LOW HANDLING PROBLEMS IDENTIFIED ACTION Equipment, number of handlers, etc. HANDLING PROBLEMS IDENTIFIED ACTION Equipment, number of handlers, etc. Date, Name & Signature: Date, Name & Signature: Manual Handling Manager 6

16 Bariatric Moving and Handling Assessment Equipment checklist, This checklist is to ensure the service user has equipment with an adequate Safe Working Load What equipment is required? Bariatric/ profiling bed Mattress Overhead hoist/mobile hoist Slings Slide sheets Rise/recliner chair Bedside chair Commode/shower chair Other If on site, name the equipment and note the Safe working load If to be ordered, name the equipment/company, and name of senior nurse contacted for agreement Any follow up action, by whom? Date when equipment is in place and signature Training needs: Please check that all staff members involved with this patient s care are familiar with the use of the above equipment and adequate instructions are on site and necessary training is arranged. dix 2 Health and Safety Process Flow Chart For in patients use inpatient care admission booklet Manual Handling Manager 7