LEAFLET 07 MANUAL HANDLING

Transcription

1 LEAFLET 07 CONTENTS MANUAL HANDLING Foreword 1. Scope. 2. Introduction. 3. Responsibilities. 4. Definitions 5. Risk assessment. 6. Assessing the risk. 7. Control measures. 8. Review. 9. Arrangements and Training for Manual Handling Operations 10. Equipment 11. Related documents. Annexes A. Manual Handling Risk Assessment - Flowchart B. Guidance Weights C. Area Manual Handling form Appendices 1. Fallen Person Protocol Community (Lincolnshire Interagency Document) 2. Guidelines on the Falling Person (Lincolnshire Interagency Document) FOREWORD This leaflet is published under the authority of Lincolnshire Partnership NHS Foundation Trust (LPFT) Health and Safety Committee (HSC). This leaflet is for application across all areas of LPFT and reflects recent changes in legislation and or LPFT practices. 1. SCOPE 1.1. This leaflet describes LPFT s methodology for the assessment of risk arising from manual handling activities. It provides guidance for Line Management and staff on the risk assessment process and the responsibilities for implementing control measures in compliance with the Manual Handling Operation Regulations (MHOR) and to reduce the risk of injury from manual handling to a level that is as low as is reasonably practicable The term line manager is used throughout this Leaflet to mean the person with direct responsibility for the safe conduct of the work activity. Page 1 of 32

2 2. INTRODUCTION 2.1. Work related injuries resulting in musculoskeletal disorders (MSDs) account for about half of all work related ill-health, many of these are caused by the poor management and practice of manual handling. The MHOR require employers to risk assess the transporting or supporting of a load including lifting, putting down, carrying, pushing, pulling, moving by hand or bodily force, they also can arise of long periods in a static position (e.g. being seated at a desk for long periods) repetitive stooping or bending and they are often the result of a cumulative effect rather than being attributable to a specific incident, also to introduce management controls to reduce the risk of injury to a level that is as low as is reasonably practicable. 3. RESPONSIBILITIES 3.1. Line Managers It is the duty of the line manager to ensure, so far as is reasonably practicable, that systems of work are safe and without risk to health; therefore suitable and sufficient assessments of the risk to the health and safety of staff from manual handling activities are carried out by a competent person (Assessor) with the cooperation of supervisors and operators The Line Manager is responsible for ensuring that assessments are in place and that risk control measures are being adhered to and are continually monitored for effectiveness Line Managers will review Generic Manual Handling Risk Assessments on an annual basis for their area of responsibility. These will be broad based ergonomic assessments to identify manual handling hazards in relation to moving objects or people and to highlight the control measures needed to reduce the risks to the lowest level reasonably practicable Where the Line Manager have a complex MH problem they are to seek advice from the Health and Safety Advisor through the Responsible Manager, The Health and Safety Advisor will assess the problem and give advice or could request assistance from the Back Care Team Risk Assessors Wherever there is a potential of harm from manual handling activities, the risk must be assessed and evaluated by a competent person who must have knowledge of the process/activity, how and in what environment the activity is to be carried out and in conjunction with staff undertaking the activity. If the person assessing the risk is not the line manager, they must inform the relevant line manager of the findings of the assessment and, if appropriate, explain the risks and the required control measures to manage those risks. Where risks are identified this should be included in local risk register. Page 2 of 32

3 3.3. All Staff All staff are to comply with safe systems of work; training, etc. provided by line management for manual handling activities and report any deficiencies that may be evident. Staff engaged in manual handling operations are to inform their line manager or supervisor about any physical or medical condition that could affect their ability to undertake manual handling operations safely Specialist Advice Back Care Team Specialist advice on all aspects of manual handling including movement of people and loads will be available from the Back Care Team. This will include direct involvement with risk assessments where necessary as well as the provision of telephone advice and written information Telephone referrals for complex people handling situations will be accepted on the approval of the Health and Safety Advisor. All other referrals must be in writing to the Manager of the Back Care Team Representatives from the Back Care Team will also have strategic involvement through the Trust s Health and Safety Committee in compliance with the service level agreement Link Nurse /Therapist Network (High and Medium Risk Clinical Areas) All areas classified as high and medium risk will have nominated members of staff who will act as Link Nurses/Therapists for moving and handling. These staff will have additional responsibilities for moving and handling within their own work area as part of the overall risk reduction strategy. The role of the Link Nurse/Therapist is as follows: To attend meetings of the Moving and Handling Link Group on a quarterly basis. (Meetings lasting for approximately three hours). To act as a communication link between the Advisors from the Back Care Team and staff in the work area. To ensure that relevant information from meetings is passed on to staff in the locality/team. To assist in monitoring standards of practice for moving and handling within their local staff team and to report problems and hazards to their manager. To maintain an up-to-date inventory of moving and handling aids and equipment. (In-patient areas only). To ensure that all moving and handling equipment is stored safely. To regularly check the condition of patient handling equipment and report any problems immediately to the Facilities Department. This includes checking that patient handling equipment has been serviced/inspected on a six monthly basis in accordance with the Manual Handling Policy (See Section 10.) Page 3 of 32

4 4. Definitions To ensure, as part of the local induction process, that new staff are given all relevant information about the moving and handling techniques and equipment used in their work area. To maintain a current resource base including relevant publications, codes of practice and legislation. To assist in moving and handling assessments and problem solving within their local team and scope of professional practice. Manual Handling refers to the transportation or support of a load, including lifting, lowering, pushing, pulling, carrying or moving thereof by hand or bodily force. The Load is defined as something (equipment or plant) or somebody (person), which needs to be moved. The Person is the patient, service user, client, young person, resident, who requires assistance to be moved. A Competent Person is someone with sufficient training, experience and knowledge to undertake a particular task e.g. risk assessments. The Ergonomic approach is about fitting handling tasks to people to make them safer easier and more pleasant to perform. Manual handling is used broadly to cover other terms such as moving and handling, moving and assisting etc. 5. RISK ASSESSMENT 5.1. LPFT recognises that in the area of clinical services the risk from moving people varies greatly due to the nature of the services provided. A risk management approach has therefore been used to classify services according to the risk of injury from manual handling. These risk classifications will determine the level of staff training and the risk assessment processes for services within LPFT. Classifications are given in the table below: RISK CATEGORY HIGH RISK CLINICAL SERVICES Older Adult Inpatients Adult Inpatients Learning Disabilities Inpatients Long Leys Court MEDIUM RISK Specialist Services Inpatients (Forensic, Rehabilitation and Young People) Page 4 of 32

5 LOW RISK Community Services 5.2. Where specific load handling problems are identified which have a significant level of risk line managers also have the responsibility to perform specific assessment using the standardised assessment form using LPFT Load Handling Risk Assessment Form 5.3. Risk assessments for moving people will be performed according to risk classification, as described in section 5.1above. High Risk Clinical Areas ALL patients must have a documented person handling assessment LPFT Patient Moving Handling Form.pdf It is the responsibility of the named nurse to ensure that this is carried out as part of the admission process and reviewed on a regular basis It may be necessary for nursing staff to seek assistance with the risk assessment from other members of the MDT e.g. Physiotherapist, Occupational Therapist, and where appropriate the Back Care Advisor. Medium and Low Risk Areas A person handling assessment will only be completed for patients where the overall clinical risk assessment highlights a need for this. Once this need is identified it is the responsibility of the named nurse to ensure that this is carried out as part of the admission process and reviewed on a regular basis. The assessment must be recorded using the person handling assessment forms PATIENT MOVING HANDLING FORM It may also be necessary for nursing staff to seek assistance with the risk assessment from another member of the MDT e.g. Physiotherapist, Occupational Therapist, and where appropriate, the Back Care Advisor Before carrying out any risk assessment of manual handling operations, first determine whether it is reasonably practicable to avoid manual handling entirely by referring to the flow chart (Annex A). If, following this initial risk assessment, manual handling is no longer required; there is no need to carry out any further manual handling assessment If there is a requirement for manual handling then a risk assessment must be conducted. To determine whether a formal risk assessment is required, an Page 5 of 32

6 informal appraisal otherwise known as a Dynamic Assessment needs to be carried out; OPERATIONS REQUIRING NO FORMAL RISK ASSESSMENT 5.7. The dynamic assessment will be sufficient if: Loads weighing less than 3 kg unless task has a high frequency; and Package is not of unusual dimensions or awkward shape; and Temperature is within a comfortable range; and Lift does not involve extremes of movement e.g. twisting If the operation does not fit into all of the above criteria, then a formal Risk Assessment may be necessary. OPERATIONS THAT MAY REQUIRE A FORMAL RISK ASSESSMENT 5.8. Annex B shows the guideline weights for lifting and lowering for a fully fit adult. Loads that fall within those guideline weights may require a detailed risk assessment to be carried out, (if in doubt an assessment shall be carried out) but it is also necessary to look at the following: The nature of the load (weight, shape, size, ease of grip, etc.). The task or process involved (twisting or reaching, work frequency and process rates etc). The capability of the individual. (The ability to carry out manual handling safely varies between individuals; the published guidelines may be exceeded once the risk assessment process has been satisfactorily completed having taken into consideration the individual s fitness, age, gender, health and/or previous injuries etc.). The working environment (space, lighting, temperature, floor condition, etc.). Work frequency and process rates Where the line manager is satisfied that no additional risk is present as a result of the above list then there is no requirement to carry out a formal risk assessment. OPERATIONS THAT WILL REQUIRE A FORMAL RISK ASSESSMENT Where lifting or lowering results in the hands moving out of the zones shown in Annex B, i.e. exceeding the weights stated, a detailed assessment will be required It should be noted that the purpose of these guideline weights is to avoid wasting time and effort when conducting the risk assessment; they must not be regarded as safe weight limits for lifting. This is because there are too many other factors involved If a formal risk assessment is required, this must be completed by a competent assessor in conjunction with the line manager and the staff undertaking the Page 6 of 32

7 manual handling operation (this can be done using the LPFT Load Handling Risk Assessment Form 6. ASSESSING THE RISK 6.1. New assessments will be carried out using this guidance (which requires minimal training) and must be conducted by competent persons (Assessors) who have working knowledge of the processes and activities to be assessed Assessments must be carried out taking into account gender, age, and health etc. However, there is no need to assess every individual; it is quite acceptable to do a generic assessment that is common to a group of staff and/or for similar operations. The main point is to identify the risk of injury and highlight how to make practical improvements Special consideration should be given to new and expectant mothers and to Young People The assessment should consider activities and processes, the environment, the individual and the load as well as the interfaces and additive effects of their component parts. Therefore one of the first assessment activities is to: fully identify the task identify the load identify the environment in which the task is to be carried out identify who may be carrying out the task identify any other factors relevant to task e.g. wearing of PPE 6.5. The assessment must consider all circumstances in which the task may be undertaken, hence assessors must have working knowledge of these processes and activities in order to complete the required suitable and sufficient assessment The Assessment is recorded on LPFT Health Safety Manual Forms LPFT Load Handling Risk Assessment Form and Patient Moving Handling Form Once completed it should be passed to the line manager for implementation of the recommended actions If the manual handling operation is to be conducted as a multi-person task, the value of the load cannot simply be divided by the number of people involved in the operation If the number of people undertaking the manual handling operation doubles, the effective load value is assessed as 2/3 of the actual weight. (e.g. 90kg weight lifted by 2 people = 90 x 2/3 = 60kg per person). Page 7 of 32

8 The Task 6.9. Does the task involve; Holding loads at a distance from the body this increases general stress on the lower back. Twisting of the trunk - stress on the lower back is increased significantly if such postures are adopted, even worse is to twist whilst supporting a load. Stooping - this increases stress on lower back, either by bending or leaning forward with the back straight. To be avoided where possible. Lifting above waist height or lowering below mid-thigh - excessive reaching upwards and downwards places additional strain on arms and back. Control of the load becomes more difficult and because arms are extended they are more prone to injury. Lifts beginning at floor level should be avoided where possible and should finish no higher than waist height. Moving a load over excessive distances - large distances are more demanding than smaller ones. Moreover it is more likely to necessitate a change of grip part way, further increasing the risk of injury. Excessive pushing or pulling of the load - the risk of injury is increased if pulling or pulling is carried out with the hands much below waist height or above shoulder height. Repetitive handling - a small load handled very frequently can create as large a risk of injury as a one-off handling of a more substantial load. The effect will be worsened by jerky, hurried movements which can multiply the stress placed on the body. Frequent or prolonged physical effort resulting in insufficient rest or recovery periods - if physical stresses are prolonged during physically demanding work then fatigue will occur, and this increases the risk of injury. Consider rest breaks from task to allow recovery e.g. changing to another task, which uses a different set of muscles. NOTE: THE GUIDELINE WEIGHTS SHOWN IN ANNEX B ASSUMES THE PACE OF WORK IS NOT FORCED, THERE ARE ADEQUATE TIMES TO REST AND THE LOAD IS NOT HELD FOR ANY PROLONGED PERIOD OF TIME. THE WEIGHTS SUGGESTED MUST BE REDUCED IF THE OPERATION IS REPEATED MORE OFTEN. Individual Capability Does the task: Page 8 of 32

9 Stretch the employee s physical capabilities to the point of risking injury - In general the lifting strength of women as a group is less than that of men. To provide protection for working women, guidelines are usually reduced by a third (see Annex B). Individuals' physical capability varies with age normally peaking in the early 20 s and declining thereafter becoming more significant from the mid-40 s. Therefore the risk of injury may be higher for employees in their teens or in their 50 s or 60 s. Young persons (16-18) should be considered a significant risk and special consideration should be given towards that group. Pose a risk due to the employee s present state of health or pose a hazard for those who are new or expectant mothers. Allowances should be made where the LM has been made aware that a member of staff is a new or expectant mother or where the pregnancy is visibly apparent. Restrict the manual handling capability of an individual due to a previous history of a back, knee, hip condition, hernia or any other problem. Require additional knowledge or training for the task to be carried out safely The risk of injury will be increased where a worker does not have the information or training necessary for safe performance. Training should cover: How to recognise the risk in manual handling. Appropriate systems of work. Use of mechanical aids. Good handling techniques The Disability Discrimination Act places a duty on employers to make reasonable adjustments to the workplace or employment arrangements to ensure that disabled people are not placed at a disadvantage compared to an able bodied person. Allowances should be made for any health problem which the employer could be reasonably expected to be aware of and which might have bearing on the ability to carry out manual handling operations in safety. The Load Is the load: Heavy - consideration must be given to reducing the load and/or obtaining mechanical assistance. If this is not possible, then handling by two or more people may make possible an operation that is beyond the capability of one person, thus reducing the risk of injury to a solo operator. However, the load that a team can handle in safety is less than the sum of loads that individual team members could cope with when working alone. One person should plan and take charge of the operation ensuring that the movements are coordinated. Team members should preferably be of broadly similar build and physical capability. Bulky/unwieldy - the shape of the load will affect the way that it can be held and can often make it harder to get a good grip: If handlers have to lean away from a load to keep it off the ground they will be forced into unfavourable postures. Page 9 of 32

10 The bulk of the load can also interfere with vision, thus increasing the risk of slipping, tripping, falling or colliding with obstructions. Should the centre of gravity of the load not be central within the load, the risk of injury is increased. Difficult to grasp - if load is difficult to grasp because it is rounded, smooth etc, its handling will call for extra grip strength which is tiring and will involve inadvertent changes of posture. There will also be a greater risk of dropping the load. Unstable or contents likely to shift - if load is unstable because it lacks rigidity, the likelihood of injury is increased. The instability may impose sudden stresses for which the handler is not prepared. Intrinsically harmful (e.g. sharp/hot) - risk of injury can arise from the external state of a load. Such characteristics may also impair grip, discourage good posture or otherwise interfere with safe handling. The Working Environment Consider: Space constraints preventing good posture - if the working environment hinders working at a safe height or prevents good posture e.g. working in or moving through a narrow gap, the risk of injury from manual handling will be increased. Uneven, slippery or unstable floors - in addition to increasing the likelihood of slips, trips and falls, uneven or slippery floors hinder smooth movement creating additional risk. Variations in level of floors or work surfaces - the presence of steps, or slopes can increase the risk of injury. Hot/cold conditions - high temperatures, high humidity or cold can cause rapid fatigue. Inappropriate gloves and other protective clothing, which may be required, can also hinder movement, impair dexterity and reduce grip. Strong air movements - sudden air movements caused by a ventilation system or the wind can make large loads more difficult to manage safely. Poor lighting conditions - dimness or glare may cause poor posture. Contrast between areas of bright light and deep shadow can aggravate tripping hazards and hinder the accurate judgment of height and distance. Other factors These may include: Clothing, footwear or Personal Protective Equipment (PPE). Clothing, footwear and PPE must be adequate for the task being undertaken and allow free movement and posture for the manual handling process being undertaken. Goods deliveries and dispatch. Line managers should be aware of times, sizes of loads etc. The risk assessment should take into consideration events which may occur outside of the normal parameters (e.g. inappropriate delivery vehicles, damaged packaging etc). Page 10 of 32

11 7. CONTROL MEASURES 7.1. The Manual Handling Operation Regulations establishes a clear hierarchy of control measures. These are as follows: Avoid hazardous manual handling operations so far as is reasonably practicable by addressing the following questions: Can the movement of the loads be eliminated altogether e.g. can the workplace or task be redesigned to avoid moving loads or could delivery be arranged to the point of use? Can the operations be automated? Can mechanical devices be used (e.g. trucks, barrows, rollers, handling aids, forklift trucks, sack trucks)? Make a suitable and sufficient risk assessment of the risk of injury of any hazardous manual handling operations that cannot be avoided. Reduce the risk of injury for operations so far as is reasonably practicable. This can be done by improvements to the task and load, (e.g. reduce the load size and/or distance travelled; consider a team load.) NOTE: RISK ASSESSMENTS MUST SHOW THAT THIS HIERARCHY OF MEASURES HAS BEEN CONSIDERED. Recommended action to remove or reduce risk to the lowest possible level 7.2. If an item must be moved, the use of mechanical aids to eliminate the need for manual handling altogether should take primacy; if this option is not reasonably practicable then a review of the task should be undertaken to minimize the need for manual handling (e.g. reducing distance carried from point of delivery to end user) Adequate information, instruction and training should be given in order to undertake the task safely. The type of training comprise of a combination of the following: Making sure that all new staff attend Moving and Handling Induction Training as specified in the Moving and Handling Training Matrix (See Mandatory Training Policy PER25) Ensuring that all staff completes manual handling update training once every two years. Managers attending training themselves and acting as a role model for staff. Task specific training. Refresher training; this must be considered when risk assessments are reviewed Changing the task to remove the need for lifts from floor level, long carrying distances, twisting or stooping, etc Page 11 of 32

12 7.5. Reducing the size and or weight of the load and or the redesign of packaging to improve the ease of handling should be considered Improvements to the working environment should include the removal of obstructions, improvements to the flooring, lighting etc In some instances there will be resource or other implications (e.g. contractual), which prevent the immediate implementation of control measures. Therefore the short term, medium term and long term measures should be stated: Short-term measures may comprise stopping the activity, a briefing in safe lifting techniques, a removal of obstructions; Medium term measures could be the provision of mechanical handling aids; Longer term could be the relocation of the storage area due to a unit move or rebuild Line Managers are required to demonstrate that they have done all that is reasonably practicable in the circumstances to reduce risk, this may be demonstrated by raising any outstanding issues up through senior management. 8. REVIEW 8.1. An initial review of the risk assessment and working practices should take place shortly after implementation, in order to check the effectiveness of any new control measures and validation of progress that has been made towards implementation of medium and long term controls Subsequent reviews should be undertaken: When there has been a significant change in the task, procedure or technology. There is reason to suspect they are no longer valid, e.g. should an accident or incident occur. Annually but subject to the degree of risk. NOTE: EACH REVIEW SHOULD INCLUDE THE LINE MANAGER S ASSESSMENT OF THE EFFECTIVENESS OF CONTROL MEASURES, AND ANY FURTHER CONTROLS THAT MAY BE REQUIRED. 9. ARRANGEMENTS AND TRAINING FOR MANUAL HANDLING OPERATIONS 9.1. Arrangements for the organisational overview of the risk assessments for moving and handling of service users and objects will be as follows; Copies of risk assessments (people and loads) will be held at local level. Details of any significant problems or deficiencies arising from risk assessments which cannot be resolved at local level must be forwarded by the relevant divisional manager so that these can be recorded on the Divisional (Local) Risk Register Details of any manual handling risks held at Divisional Level will be reviewed by the General Manager and Divisional Management Team. Details of these risks will also be reported to the Health and Safety Committee which will be Page 12 of 32

13 responsible for developing, implementing and reviewing an appropriate organisational action plan to address the risks which have been highlighted Where there are serious risks that cannot be addressed by the Health and Safety Committee or Divisional Managers the Lead Director for Health and Safety will ensure that details of such situations are placed on the Corporate Risk Register It is recognised that at times clinical staff may have to deal with challenging situations and that high risk patient handling techniques e.g. manual lifting of the full body weight, may be required in a small number of cases particularly in exceptional circumstances or emergencies where the patient is at very high risk of harm e.g. Fire Evacuation For routine handling situations where high risk techniques are being employed a detailed risk assessment and written justification for the use of these techniques must be produced. Early referral to the Back Care Team must also be made so that a specialist can be involved in the assessment process and to approve the prescription of high risk techniques. The use of high risk techniques must be kept under review and employed as little as possible Resolving Differences of View People Handling Risk Assessments In some circumstances the person or their family may be reluctant to accept changes that have been recommended in the risk assessment. In these situations the assessor and the service manager will adopt a balanced approach where the person s assessed needs and wishes are considered as well as the safety of staff. They will endeavour to respect the person s wishes for mobility and support and as far as is possible, their independence and autonomy. Where there is a difference of opinion over methods of moving and handling it is recommended that a meeting be held with the person, the local manager and all other relevant people. The meeting should be used to outline the findings of the risk assessment and to seek a safe solution. Specialist advice from the Back Care Team must be requested. Limitation of service will be the final option and will only be used after all other possible solutions have been investigated and discussed with the person and other relevant people Manual handling training is mandatory for all staff. In order to meet statutory responsibilities the Trust will provide sufficient and appropriate training for all of the staff groups as outlined within the Trust Mandatory Training Matrix (See Mandatory Training in the Human Resources User Hand Book.) 9.4. All new staff must attend Moving and Handling Induction Training with the first month of employment. The training is modular in design (1 4) and level of attendance varies depending on job role. A breakdown of training needed for individual staff groups is shown in the Moving and Handling Training Matrix See Mandatory Training in the Human Resources User Hand Book.) Whenever possible this training should be completed before carrying out moving and handling duties in the workplace All staff must receive update training once every two years. More frequent training may be required in some areas depending on the findings of local risk Page 13 of 32

14 assessments or if there are changes to service delivery or on the introduction of new equipment Training programmes will be based on the ergonomic and problem solving approach to manual handling and include the following elements as a minimum requirement: The human, economic and legal costs of MSDs. Relevant legislation including HSAWA 74, MHOR 92 and HRA 98. The anatomy and function of the spine and the causes of MSDs. 24 hour back care. Basic ergonomic and manual handling principles. Assessment skills and knowledge of the risk assessment process. Relevant manual handling techniques and equipment Additional training must also be provided if new equipment is provided in the workplace or if there is a change in the work situation e.g. changes to the environment or changes in service delivery The Learning and Development Department will be responsible for agreeing the annual training programme with the Back Care Team and for disseminating details to staff and managers Full and accurate training records will be kept for all training courses provided by the Back Care Team. Copies of attendance sheets will be sent to the Learning and Development Department who will have responsibility for monitoring staff attendance and producing a quarterly report on training activity for the Health and Safety Committee The Health and Safety Committee will have overall responsibility for monitoring the delivery of the training programme and if necessary for producing an action plan to address serious problems The content of training programmes will be reviewed and monitored regularly by the Back Care Team and the Learning and Development Department to ensure that they continue to meet the needs of the organisation. The manual handling techniques and equipment used in training will be up to date and based on current best practice. Load Handling The techniques taught for the movement of loads including equipment where necessary will be based on those specified in the HSE publication Getting to Grips with Manual Handling: (A Short Guide HSE). ( Patient Handling The techniques used for moving and handling people including where necessary the use of equipment will be based on current best practice as defined in the Guide to the Handling of People - 5 th Edition (RCN 2005) Practical moving and handling training for people handling will be provided according to the level of risk in the clinical work areas. Page 14 of 32

15 9.13. The Learning and Development Department will follow up individual members of staff who do not attend and monitor the reasons for non-attendance. If serious problems develop with non-attendance and course cancellations the Training Department will bring this to the attention of Divisional Managers and the Health and Safety Committee The process for following up non-attendance is defined below: The Learning and Development Department will the member of staff and their manager requesting a reason for their non attendance and requesting that the member of staff is booked on the next available course. (see also Sec 5.2 of Mandatory Training policy PER25) The annual training programme and number of training days required to achieve compliance with training targets will also be reviewed in light of serious problems with attendance levels by the Learning and Development Manager and Manager of the Back Care Team. 10. EQUIPMENT All items of moving and handling equipment belonging to the Trust must be registered on the Facilities Inventory Database so that the appropriate servicing and maintenance can be organised centrally by the Facilities Department Staff must carry out a pre-use safety check (visual inspection) of equipment before use. This must include checking to see that the item of equipment has not exceeded its servicing interval. If any equipment is found to be faulty or out side of the recommended service interval this must be reported immediately to the Facilities Department. Details of servicing arrangements for patient handling equipment are listed in the table below. PATIENT MOVING AND HANDLING EQUIPMENT Mobile Hoists, Ceiling Track Hoists Standing Hoists, Hoist Slings SERVICE/INSPECTION INTERVAL LEGISLATION Beds Electric and Hydraulic Rotunda frames. Shower Trolleys and ECT Trolleys. Wheelchairs and Wheeled Seating. Wheeled Commodes. 6 Monthly 6 Monthly LOLER 98 PUWER 98 Page 15 of 32

16 10.3. Local Mangers and Moving and Handling Link Nurses/Therapists will check moving and handling equipment regularly to ensure that all relevant equipment is within the recommended service period. The Facilities Department must be informed immediately If equipment has exceeded the recommended service interval The effectiveness of the servicing arrangements will be reviewed at 6 monthly intervals by the Engineering Manager and the Manager of the Back Care Team. Any significant problems will be reported to the Health and Safety Committee and an appropriate action plan put in place to address any shortfalls The Facilities Department must be notified immediately if any equipment becomes faulty or unsafe to use so that the appropriate repairs can be organised without delay It is the responsibility of local managers to notify the Facilities Department of changes to the stock of equipment including new or replacement items and equipment which has been disposed of. This must be done by completion of the Disposal of Surplus Equipment Form. New items of patient handling equipment (type, design, model etc) should not be purchased without approval from the Back Care Team. Local managers have the responsibility to ensure that there is a sufficient stock of hoist slings and slide sheets for the demands of the work area and are responsible for ordering replacement items In situations where community moving and handling equipment is being prescribed by Occupational Therapy or Physiotherapy staff it is the responsibility of the prescribing Therapist to ensure where applicable that relevant risk assessment documentation is completed and that appropriate review arrangements are in place. 11. Related documents Health and Safety at Work etc Act Management of Health and Safety at Work Regulations Manual Handling Operations Regulations 1992 (as amended 2002) Lifting Operations and Lifting Equipment Regulations Provisions and Use of Work Equipment Regulations Guide to the Handling of people, 5 th Edition (RCN 2005). Other documents HSE INDG Getting To Grips with Manual Handling HSE L23 - Guidance on MHOR Regulations. HSG 60 Upper Limb Disorders in the Workplace Page 16 of 32

17 ANNEX A Manual Handling Risk Assessment - Flowchart Page 17 of 32

18 ANNEX B AREA MANUAL HANDLING RISK ASSESSMENT FORM Risk Assessment Checklist Comments (Including details of necessary actions) Section1 - Manual Handling of Loads Yes No Are there any manual handling tasks where staff have to use a high degree of physical effort to move, support or transport inanimate objects/loads? Are there any tasks which staffs have to perform where the weight of the load is considered to be heavy and exceeds guideline figures for lifting and lowering? (Please refer to guideline figures below) Are there any tasks where staff have to work in awkward or uncomfortable postures e.g. bending and twisting, over reaching, lifting at arms length? Are there any specific pushing and pulling tasks where staff have to use an excessive amount of physical effort to move the load? If the answer is yes to any of the four questions above, have specific manual handling risk assessments been completed using LPFT Load Handling Assessment Form. Are there sufficient mechanical aids e.g. trolleys, sack trucks available to help staff move inanimate objects? Is there adequate storage facilities available for supplies and equipment used within the department? Do staff wear the correct clothing and footwear when performing manual handling tasks which are hazardous, Page 18 of 32

19 e.g. low heeled enclosed footwear, PPE? Are there any specific manual handling tasks which may pose a risk to pregnant workers or staff with existing injuries or medical conditions working within the work area.? If yes, have individual risk assessments been completed for these members of staff? Are there any manual handling tasks which cannot be performed safely by one person, If yes, are additional staff available to assist where necessary? Section 2 Patient Moving and Handling Yes No Is there evidence that patient moving and handling assessments are being completed for patients who need assistance to move LPFT Patient Moving Handling Form Is there evidence that patient handling equipment has been inspected/serviced on a 6 monthly basis (Medequip service stickers should be displayed on hoists, electric beds, wheelchairs etc) Are there adequate storage facilities available for patient moving and handling equipment when not in use? Are adequate facilities available for electric patient hoists to be safely charged ready for use? Do staff know how to access the Moving and Handling Equipment Bank? Is fire evacuation equipment available where applicable? e.g. Ski Pads, Evacuation Chairs Is there sufficient space in patient handling areas e.g. bedrooms, toilets, bathrooms? If no, please give brief details. Are there suitable toilet/bathroom/shower facilities available for physically disabled patients? If no, please give brief details Is reference information available to staff on patient moving & handling? e.g. The Guide to the Handling of People 6th edition Do staff know who the Moving and Handling Link Nurse is for their area? Do staff know how to contact the Back Care Team for specialist advice? Page 19 of 32

20 Annex C Guidance Weights Page 20 of 32

21 Appendix 1 FALLEN PERSON PROTOCOL (COMMUNITY) Background Getting a fallen person up from the floor within the home environment can be a difficult and hazardous procedure and often involves a risk of injury to staff who are dealing with the situation and also the person being moved. This guidance is therefore intended for Community Health and County Council staff who may encounter a fallen person in the home setting so that these situations can be managed as safely as possible. Risk Assessment Staff at the scene must firstly carryout a risk assessment of the situation and the condition of the fallen person to determine whether it is an emergency. If in doubt the situation should be regarded as emergency and the Ambulance Service called as detailed below. Emergency Situations If the fallen person is injured, suspected injured or in any form of life threatening situation staff must call the Ambulance Service immediately by dialling 999 and follow the advice given by Ambulance Control. The person should be left in the position they were found in and not moved unless in imminent danger. Staff should then stay with the person and give reassurance until the Ambulance Service arrive at the scene. Resuscitation or other first aid procedures should be commenced as necessary provided that staff have the appropriate skills and training. On arrival at the scene the Ambulance Service will move the person in the most appropriate method once they have completed their assessment of the situation. The Uninjured Fallen Person If the risk assessment of the situation shows that the person is uninjured there are a number of different options for assisting an uninjured person from the floor. Where possible these should be used by staff rather than calling for assistance from the Ambulance Service. Before deciding on which option to follow staff should do a risk assessment of the situation taking account of all relevant factors. The options available to assist the uninjured person would include: The person getting up from the floor themselves with minimal assistance from staff. This may involve the use of a chair or where safe to do so by using the stairs. These approaches are illustrated below and should be followed in accordance with previous staff training. Fig 1. Getting up from the floor using a chair self assisted Page 21 of 32

22 Fig 2. Getting up from the floor by using stairs self assisted Page 22 of 32

23 The use of a hoist and an appropriate hoist sling to raise the person from the floor and lift them onto the bed or chair (mobile or ceiling track hoist depending on the situation and availability of equipment). This option must only be used when a sufficient number of trained staff are available to use the hoisting equipment and reference should be made to the person s Moving & Handling Assessment and Handling Plan. Use of an inflatable lifting aid if this is already available within the home and sufficient trained staff are available. Manual lifting of the person. This is a high risk activity which may injure staff or the person being moved and should be avoided unless the person is in imminent danger. If following the risk assessment none of these options are considered to be safe and the person is considered to be at risk then assistance can be requested from East Midlands Ambulance Service (EMAS) by ringing 999. The appropriate response will then be initiated by EMAS. Page 23 of 32

24 Whilst awaiting arrival of the Ambulance Service the uninjured person should be left on the floor, given reassurance and kept warm and comfortable. On arriving at the scene the Ambulance personnel will take charge of the situation and decide on the most appropriate method for raising the person from the floor. Whenever possible mechanical aids will be utilised including the inflatable lifting cushions Falls Risk Assessment Following situations where the person has fallen, the community staff who were involved at the scene should ensure that information about the person falling is passed on to the professional leading the persons care in the community e.g. District Nurse, Occupational Therapist, GP. The lead person should then ensure that the falls risk assessment is carried out or reviewed and that all necessary falls prevention measures are put in place to reduce the risks of the person falling again. This may include onward referral to the appropriate specialist or team e.g. Falls Clinic, Physiotherapist etc. Care Homes The Ambulance Service will respond to 999 calls from Care Homes where the person is in a life threatening situation, injured or suspected injured. These situations should be dealt with in the same way as described above for emergency situations in the community. If however the person has been assessed by a competent First Aider or other similar professional at the scene as being uninjured it is the responsibility of the Care Home to manage the situation. This should include having the appropriate procedures, staffing and equipment in place to safely move the person from the floor without assistance from the AmbulanceService. Page 24 of 32

25 Fallen Person Flowchart (Community) FALLEN PERSON IN THEIR OWN HOME COMMUNITY STAFF PERFORM RISK ASSESSMENT OF Is it a medical emergency or is the person injured or suspected injured? Yes No Dial 999 and follow the advice given by Ambulance Control. Stay with person until the Can the person get up safely on their own or with use of available equipment and assistance from staff? Ambulance Service provide appropriate treatment and transportation to hospital Yes Person gets up from the floor safely with assistance from staff as required No Leave the person where they are, make them comfortable. Dial 999 and stay with the person until the Ambulance Service Community Staff e.g. Registered Nurse, Occupational Therapist, Physiotherapist review falls risk assessment for the person and implement falls prevention measures where appropriate. Ambulance personnel perform risk assessment and move the person from the floor with the safest possible method Onward referral to appropriate specialists where indicated Page 25 of 32

26 LINCOLNSHIRE INTER-AGENCY MOVING AND HANDLING GROUP (ADULTS) GUIDELINES FOR THE FALLING PERSON 1. INTRODUCTION/BACKGROUND Dealing with falling and fallen people accounts for a large number of accidents and reported musculoskeletal injuries to staff within health and social care settings. A fall is commonly defined as an unexpected event in which the participant comes to rest on the ground, floor or other lower level. (Lamb et al, 2005). A third of people aged 65 and over will fall each year. This rises to 45 per cent in the 80+ age group (Campbell et al, 1981; Prudham and Evans, 1981). Research has shown that half of the individuals who have fallen will fall again within one year (Close et al, 1999). Annually, approximately 250 serious incidents to staff are reported nationally from the UK health care sector to the Health and Safety Executive (HSE). These typically result in a major injury. Between 2001 and 2005 the Health and Safety Executive recorded 957 injuries to health care staff caused by managing the falling or fallen person, which resulted in three days sickness absence or major injury (Mowbray et al 2006). Of these injuries 90 per cent resulted from involvement in a falling patient incident (HSE 2006). In light of all of the evidence it would be fair to say that every falls situation has a high risk of injury to both patient and staff. 2. AIM & OBJECTIVES OF THE GUIDELINES Aim Objectives To reduce the risks of injury associated with the falling person to the lowest level reasonably practicable. To highlight the importance of risk assessment procedures. To promote methods of falls prevention. To provide practical guidance to staff on how to respond to situations where the person is falling. 3. GUIDELINES STATEMENT These guidelines have been produced by LIAG which comprises of: Lincolnshire Primary Care Trust Lincolnshire Partnership NHS Foundation Trust Lincolnshire County Council (Social Care) United Lincolnshire Hospitals Trust St Barnabas Hospice Trust East Midlands Ambulance Service LIAG recognises that a positive approach should be taken to prevent musculoskeletal injury at work. The falling person has been clearly identified through analysis of accident statistics as posing a high risk of injury to staff attempting to manage falls. The organisations producing these guidelines are committed to following legal requirements and national best practice guidelines; and will achieve this via policy, planning, risk assessment, training, balanced decision making, clinical reasoning and where available evidence based practice. Page 26 of 32

27 4. PREVENTION OF FALLS Physical injuries resulting from a fall account for 400,000 visits to Accident and Emergency departments each year and the problem costs the Health Service an estimated 1.7 billion pounds per year (Golding & Ward, 2003). The key to a successful falls prevention strategy is understanding the causes of falls. It is the responsibility of staff and managers to assess the risk factors. This should be done within the framework of falls and manual handling risk assessments. The risk assessment of all people and associated handling tasks is a legal requirement under the Manual Handling Operations Regulations 1992 (amended 1998 and 2002). The causes of falls are multi-factorial and diverse. Causes can be due to both intrinsic and extrinsic factors (Cryer & Patel 2001). Intrinsic factors those that are due to the person s general physical and psychological state; e.g. Underlying medical condition postural hypotension, bradycardias, arrhythmias, and hypothyroidism. All these could cause dizziness or drop attacks. General decreased strength, balance and physical performance e.g. use of walking aids, poor gait and difficulty walking any distance. All these can occur as part of the natural aging process. Continence problems urgency, frequency or stress incontinence. Foot problems. Sensory problems e.g. visual impairments or sensory deficits in limbs due to peripheral or central nervous system problems. Medical conditions e.g. acute illness, stroke or other neurological disease. Psychological factors e.g. depression, fear of falling. History of previous falls, particularly three or more in the last year or previous fall with injury. Cognitive impairment e.g. Alzheimer s/dementia. Extrinsic factors external influences that may increase the risk of falling Hurrying. Medication e.g. side effects of polypharmacy. Altered environmental conditions. Variations in floor surfaces and levels. Space, furniture and layout of the area involved. Frictional variations between shoe and floor. Ill-fitting shoes/slippers. Mobilising on the stairs. Poor housing and lighting. Pets. (The Guide to the Handling of People 2005) Page 27 of 32

28 5. (i) MANAGING THE FALLING PERSON The Falling Person National best practice guidelines (The Guide to the Handling of People 2005) advocate a limited range of intervention options dependent on presenting criteria. These guidelines do not recommend that staff attempt to catch or support the full body weight of a falling person. Options for Intervention: 1) If the member of staff is close enough to the person and their weight i. or height are not prohibitive then the following lowering method can be ii. used. Release any hold on the person and move behind them. With both hands open, take a step back to maintain a stable base. Keep close to the person (picture 1). Hold around the person s trunk, not their arms (picture 1). Bend both knees and lower the person to the floor (pictures 2 4). Picture 1 Picture 2 Picture 3 Picture 4 Page 28 of 32

29 2) It must be noted that many fallers will be in a situation where they are beyond the point for intervention by staff. If the member of staff is too far away from the falling person or if the dynamic risk assessment deems that the person is too heavy or tall to be safely lowered as detailed in option 1, then the person may need to be left to fall taking into account point three. 3) When allowing a person to fall, wherever possible, hazardous objects must be moved away. The handler may also need to redirect the fall away from immovable or dangerous objects (The Guide to the Handling of People 2005). (ii) Risk Assessment Despite all preventative measures some people will still fall with risk of harm to themselves and their handler. A documented Manual Handling Risk Assessment and falls risk assessment should be completed in accordance with organisational procedures. Staff must also be aware that a dynamic risk assessment at the time of the fall will indicate the action to be taken. (iii) Stairs Assisting people on the stairs carries inherently high risks for both staff and people. 60% of falls in the home occur on the stairs resulting in almost 1000 deaths of older people every year (Health Promotion England 2000). Extreme care should be taken when considering assisting a person to mobilise on the stairs (The Guide to the Handling of People 2005). A suitable and sufficient risk assessment should be carried out when considering undertaking this task. People who cannot independently negotiate the stairs should consider other alternatives, e.g. having a bed downstairs, installing a stair lift or vertical lift etc. (iv) Handholds Holding a person s hand as in picture 5, or linking arms will place staff at risk if the person falls as they will tend to hold on. Injury to fingers, thumbs, arms and shoulders are therefore very likely. The risk can be reduced by holding the hand as in picture 6 (a palm to palm hold). By holding the whole hand the staff member can roll their hand away from the persons, in the direction of their fingers. This enables the handhold to be released. Picture 5 Picture 6 Page 29 of 32

30 6. INCIDENT REPORTING Staff involved in a falls incident should document it using the reporting system relevant to their organisation. 7. MANAGEMENT OF THE FALLEN PERSON See the Lincolnshire Interagency Fallen Person Protocol Page 30 of 32

31 PERSONAL EMERGENCY EVACUATION PLAN (PEEP) ASSESSMENT SHEET PERSON S NAME.. DOB. NHS NUMBER Date of Assessment Evacuation Method Select the appropriate method and tick the corresponding column below Additional Comments Ambulant Wheelchair Bed Ski Pad Evac Chair The person s PEEP assessment must be reviewed and updated when there is a significant change to the person s level of mobility or a change to the room/bed allocation. The information on this sheet should be used as guidance. If emergency evacuation is required the situation must still be assessed at that time and the appropriate evacuation method utilised. Page 31 of 32