Manual Handling of the Heavy Patient Guidelines
Policy Title: Guidelines for the Manual Handling of the heavy patient Executive Summary: Supersedes: Version 1 Description of Amendment(s): 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) Equipment updates The bariatric person is also referred to as the plus size person, following consultation with the client group from National Back Exchange This policy will impact on: All staff, clinical practice and health and safety Financial Implications: Possible financial impact for extra resource provision if identified during the risk assessment process Policy Area: Corporate Document ECT002279 Reference: Version Number: 2 Effective Date: 25/03/2015 Issued By: Review Date: March 2018 Author: Manual Handling Manager Impact Assessment Date: N/A APPROVAL RECORD Committees / Group Date Consultation: Risk management sub committee 25/03/2015 matrons 25/03/2015 Approved by Director: Received for information: Director of Organisational Development and Learning Risk management sub group 25/03/2015 2
Contents Page Guidelines on the manual handling of the heavy patient (Bariatric) 4 - Purpose of the guidelines 4 - Organisational roles and responsibilities 4 - Associate Directors roles and responsibilities 4 - Ward/Department Manager s roles and responsibilities 5 - Manual Handling Team s roles and responsibilities 5 - Employees roles and responsibilities 5 - Assessment of the patient 6 - Manual Handling of the heavy (Bariatric) patient 6 - Communication with other wards/departments 7 - Equipment for the heavy (Bariatric) patient 7 - The collapsed heavy (Bariatric) patient 7 - Planning to stand/walk a heavy patient who is High Manual Handling 7 Risk - The deceased heavy patient 8 Appendix 1 Trust Equipment for manual handling of patients in excess of 9 160 kg s (25 stones) hospital Appendix 2 Hire of equipment for the heavier patient, hospital 11 Community service line use choice equip Appendix 3 - Flow Chart 13 Appendix 4 Bariatric Risk Assessment and Care Plan 14 3
Guidelines on the Manual handling of the heavy patient (Bariatric) 1. Purpose of the guidelines These guidelines have been produced to provide trust staff with guidance on the management of heavy 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. 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. 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 4
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 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. Assessment of the patient (see Appendix 3, flow chart) 5
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). 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 9-16.30, 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. 5. Communication with other wards/ depts. 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. 6
6. Equipment for the plus size (Bariatric) 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. 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 7. The collapsed plus size (Bariatric) 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 5 & 6 Arjo maxi-move 227 kgs(36 stone) Aston ward Arjo maxi-move 227 kgs (36 stone) 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. 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. 8. Planning to stand/walk a plus size patient who 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. 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 In the event of a heavy 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. 7
Any deceased heavy patient who is on the floor should be lifted with a hoist. 9. 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 is more than 30 stone they are transferred to Leighton hospital. 8
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 arjo 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 maximove MK2, with scale ( use arjo slings) 227 kgs (36 stone) Ward 4 ARJO-use 227 kgs, (36 stone) 227 kgs, (36 stone) 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 Ward 6 ICU All wards should have a stock of sizes available ARJO slings Arjo maximove with scale ARJO use ARJO slings Arjo slings Ring ward 1002 Ring ward 3 1003 Ring ward 1004 Ring ward 6 1006 Ring 1032 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 9
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 Tele ex 3164 healthcare coopers Tele ex 3900 trulife Tele ex 3900 Viking XL hoist Hoverjack Flat lift kit 300kgs Medical equipment library. Undercroft theatres Use liko slings only Log out via medical equipment library. Wards need to purchase liko slings to use with Viking XL theatres 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 10
Appendix 2 - Hire of equipment for the heavy patient for MDGH staff 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. Nightingale Bariatric rental guide 24:7 hire 0800 879 9289 A range of bariatric profiling bedframes/mattress s, Viking XL hoist, Gantry, Commodes and seating options Huntleigh Healthcare 24 hour no. 08457342000 No Delivery charges Items available; Delivery time s upto 24 hours product Safe Working Load Rental price Enterprise 5000 bedframe 250 kg(39 stone) 9.50 Enterprise 8000 bedframe 250 kg(39 stone) 12.50 Enterprise 9000 250 kg(39 stone) 35.00 Contoura 1080 ( bariatric bed frame) 450 kg(71 stone) 76.00 per day Bariatric bedside chairs 254 kg(40 stone ) 20.00 per day Bariatric commodes 254 kg(40 stone) 12.86 per day Advice on appropriate pressure relieving mattress to be obtained via the tissue viability nurse. Mattress s are available for rental from the bed company to fit the rental bed. LIKO rentals 01453 827272 Delivery times within 24 hours Liko Viking hoist XL and slings 300kg (47 stone) 250.00 per week, plus 80.00 delivery charge Liko Gantry 400 kg(60 stone) 350 per week,plus 200 delivery charge Hill-rom rentals 01530 411000 extension 2, delivery times upto 24 hours Bariatric bed Totalcare Bariatric plus with built in scales and low air loss mattress Birthright Bed 227 kg(36 stone) 130.00 per day 11
1 st call mobility Rentals 24 hour no. 01279 425648 Delivery times 4 hours Minimal rental period 7 days Delivery charges 80.00 Collection charges 80.00 Bedframes Baros acute bed with mattress 410 kg (65 stone) 65.00 per day Ultra-low bedframes 455kg (70 stone) 65.00 per day 36-48 width Gantry hoists Upto 455 kg (78 stone) 50.00 per day Rise and recliner chairs Upto 455kg (70 stone) Upto 45.00 per day Static chairs Upto 385 kg(60 stone) Uptp 26.00 per day Commodes Upto 385 kg(60 stone) Upto 15.00 per day Bariatric turning mattress Upto 455 kg( 70 stone) Upto 65.00 per day Wheelchairs Optional powerpack Upto 455 kg( 70 stone) Upto 44.00 per day Benmor medical Rentals 24 hour no.0333 800 9000, 80.00 delivery charge 80.00 collection charge Items available; Delivery times 4 hours Bedframes Aurum expandable bed and air/foam Scales and weigh service available Treatment couch Wheelchairs Optional power pack available 410 kg(65 stone) Upto 320 kg (50 stone) Upto 320 kg ( 50 stone) 65.00 per day 160.00 ( free of charge if bed rented) 26.00 per day Rise and recliner chairs Upto 320 kg ( 50 stone) Upto 36 per day commode Upto 450 kg (70 stone) 10.00 per day Gantry Hoist Upto 400kg ( 63 stone) 50 per day 12
The Community service line 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 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 If no equipment is available, hire of equipment must be arranged following discussion with the matron or senior nurse At any point please contact the manual handling team for further advice, please have the initial assessment completed. MDGH Telephone 3681 3973 Bleep 1339 For hire, see appendix 2 Ensure R/A is completed to assist in receiving the correct equipment 13
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 HANDLING Options available to PROBLEMS reduce the risk IDENTIFIED General mobility Please affix patient s label here 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 14
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 HANDLING PROBLEMS IDENTIFIED ASSESSMENT 2 RISK LEVEL HIGH MEDIUM LOW ACTION Equipment, number of handlers, etc. HANDLING PROBLEMS IDENTIFIED ASSESSMENT 3 RISK LEVEL HIGH MEDIUM LOW ACTION Equipment, number of handlers, etc. Date, Name & Signature: Date, Name & Signature: 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 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 15 Any follow up action, by whom? Date when equipment is in place and signature
Overhead hoist/mobile hoist Slings Slide sheets Rise/recliner chair Bedside chair Commode/shower chair Other 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. 16