MANUAL HANDLING POLICY Policy GOV 17 February 2007
Document Management Title of document Manual Handling Policy Type of document Policy GOV 17 Description Target audience Policy gives managers and staff information and guidance and measures to avoid hazardous manual handling operations ; assess any hazardous manual handling operations that cannot be avoided and reduce the risk of injury so far as is reasonably practicable. All staff Author Department Directorate Gavin Wilson Risk and Business Continuity Corporate Services and HR Approved by Governance Date of approval 12 September 2007 Version Number 1.3 Next review date October 2008 Related documents Health & Safety Policy; Risk Management Strategy Superseded documents Internal distribution External distribution Availability Yes No All ratified policies, strategies, procedures and protocols are published on the Trust Intranet and Public Website. Contact details (of main contact for this document) Name: Leann Gray Address: York House, Isebrook Hospital, Irthlingborough Road, Wellingborough NN8 1LP Tel: 01536 494483 E-mail: leann.gray@northants.nhs.uk 2
CONTENTS Page 1. POLICY STATEMENT 4 2. OVERVIEW OF THE REGULATIONS 4 3. DEFINITIONS 4 4. HIERARCHY OF MEASURES 4 5. RESPONSIBILITIES FOR THE PROVISION 5 6. RISK ASSESSMENT 5 7. TRAINING 6 8. EQUIPMENT PURCHASE, MAINTENANCE AND TESTING 6 9. REPORTING MANUAL HANDLING ACCIDENTS/INCIDENTS 6 10. HEALTH SURVEILLANCE AND REHABILITATION 6 11. STAFFING LEVELS 7 12. MONITORING EFFECTIVENESS 7 13. FURTHER SPECIALIST ADVICE AND GUIDANCE 7 Appendices: Manual Handling of Loads Risk Assessment Appendix 1 8 Guide to Use the Risk Assessment Form Appendix 2 10 Risk Consequence Table Guidance Appendix 2a 12 People Moving & Handling Risk Assessment Appendix 3 12 Information for Risk Assessment Appendix 4 16 Impact Assessment Appendix 5 27 3
1. POLICY STATEMENT Northamptonshire Teaching Primary Care Trust recognises and accepts its responsibilities and duties as an employer under the Health and at Work Act 1974, to do all that is reasonably practicable to secure the health, safety and welfare of all its employees and to adopt corporate policies and procedures, which set out safe systems of work to ensure compliance with relevant statutory provisions and best practice. This duty extends to the Manual Handling Operations Regulations 1992 (MHOR). Additionally, employees are reminded that they have a responsibility to take reasonable care of themselves and others, and to co-operate with the Trust with regard to the Manual Handling Policy. 2. OVERVIEW OF THE REGULATIONS The Regulations place an explicit duty on employers to avoid the need for manual handling operations and wherever possible mechanical aids and devices are to be used. Where manual handling operations cannot be avoided a suitable and sufficient assessment of the risk must be carried out, to ensure that the risk is reduced to the lowest level possible. The Regulations should be read in conjunction with: LOLER Lifting Operations and Lifting Equipment Regulations 1992 PUWER Provision and Use of Work Equipment Regulations 1998 MHSWR Management of Health and Safety at Work Regulations 1999 HSAWA Health and Safety at Work Act etc. Act 1974 The Guide To The Handling Of Patients 5 th edition, National Back Pain Association/Royal College of Nursing 2004 3. DEFINITIONS Manual Handling Operations means any transporting or supporting of a load either directly or indirectly (including the lifting, putting down, pushing, pulling, carrying or moving thereof) by hand or bodily force. A load means a discrete moveable object. This includes a patient receiving medical attention, items of equipment, files/records, trolleys wheelchairs etc. 4. HIERARCHY OF MEASURES The Regulations establishes a clear hierarchy of measures: Avoid hazardous manual handling operations so far as is reasonably practicable Assess any hazardous manual handling operations that cannot be avoided Reduce the risk of injury so far as is reasonable practicable. Review any assessment if there is reason to suspect that it is no longer valid, if there has been change in the manual handling operations or an injury has occurred. 4
5. RESPONSIBILITIES FOR THE PROVISION Managers have a responsibility to: - Identify manual handling risks and ensure that suitable and sufficient risk assessments are carried out for all manual handling operations where a risk has been identified. The risk assessment must be reviewed regularly or when change occurs. Ensure staff avoid the need for hazardous manual handling operations and use mechanical aids where necessary Ensure that all staff attend manual handling training in accordance with Trust Policy. A record must be kept of any staff training undertaken (see section 7 Training) Ensure any manual handling equipment is in a good state of repair and maintained in accordance with the manufacturers instructions and LOLER Regs Ensure that all accidents/incidents regarding manual handling operations are reported, investigated and appropriate remedial action taken. Ensure when any equipment faults are reported, the equipment is taken out of service and appropriate notification is undertaken. Employees have a responsibility to: - Take reasonable care for their own health and safety and that of others who may be affected by their activities Co-operate with their manager to enable them to comply with their health and safety duties. Attend training when directed Make use of appropriate equipment provided, in accordance with their training and the instructions the Trust has given them. Follow appropriate systems of work laid down by the Trust to promote safety during the handling of loads 6. RISK ASSESSMENT An assessment will be carried out prior to all manual handling tasks where the manoeuvre is such as to carry a risk of injury, as required by the MHOR Regs. To assist in the risk assessment process the following forms have been made available for your use. Manual Handling of Loads Risk Assessment Appendix 1 Guide to use the Risk Assessment Form Appendix 2 Risk Consequence Table guidance Appendix 2a People Moving & Handling Risk Assessment Appendix 3 Information for Risk Assessment Appendix 4 These must be used and completed for all manual-handling tasks that are not considered simple and obvious. 5
7. TRAINING The Trust has made provision for all staff to receive manual handling training. This is mandatory and all staff will attend. It is the responsibility of the line manager to ensure that all staff are released from the workplace to attend initial and refresher training within the prescribed time frame and to ensure that bank and agency staff are suitably trained in all aspects of manual handling prior to commencement of duties. The training provision is as follows: Clinical staff involved in patient moving and handling Initial 1-day people handling and safe use of mobile hoist foundation course plus annual 1-day refresher Portering, Hotel Services, Logistics and Estates staff 3 hour inanimate load handling training plus bi-annual refresher. Any further training, where required, following a risk assessment. All other staff 3 hour inanimate load handling training plus 3 yearly refresher 7.1 Monitoring Attendance and Non- Attendance on Manual Handling Monitoring of attendance at manual and Handling will be centrally recorded within the Training Dept and reported to the Governance Committee. The Line Managers will be notified of any of their staff who fail to attend. 8. EQUIPMENT PURCHASE, MAINTENANCE AND TESTING The purchase of manual handling equipment will be following an assessment of need. Following purchase all lifting equipment must be maintained as required by the manufacturers instructions and as required by LOLER Regs. Suitable and sufficient training must be provided prior to the use of new equipment. 9. REPORTING MANUAL HANDLING ACCIDENTS/INCIDENTS All accidents, injuries or near misses are to be reported using the Trust s standard Trust incident report form and sent to the Risk Manager. 10. HEALTH SURVEILLANCE AND REHABILITATION Staff reporting an injury, suffering back pain or other symptoms as a result of manual handling should report to their manager for a referral to the Occupational Health Department to: Assess suitability to return to full duties Re-assess the working environment with the designated manager where necessary Establish a suitable rehabilitation programme and reinforce the principles of good back care where necessary. 6
11. STAFFING LEVELS No employee should be expected to manually handle patients or other loads in circumstances likely to cause injury. Staffing levels will be such as to facilitate safe handling and to enable a reasonable distribution of such tasks throughout the work period. Guidance levels of these numbers should come from risk assessment. Staff levels insufficient to meet this criterion should be officially reported to management and action taken. 12. MONITORING EFFECTIVENESS A robust system for the monitoring of implementation and effectiveness of Manual Handling training is carried out by the Training Department. This enables the PCT to ensure that the training remains current and relevant, in order to ensure that all staff are supported and protected with regard to Manual Handling. Actions identified as a result of monitoring will be implemented through the development of action plans. The results of the monitoring process are reported to the Governance Committee on a quarterly basis. 13. FURTHER SPECIALIST ADVICE AND GUIDANCE For further specialist advice and guidance contact the Trust s Moving and Handling Trainers accessible through the Training and Education Office on 01604 615368 7
Appendix 1 MANUAL HANDLING OF LOADS RISK ASSESSMENT Name of Assessor Designation Assessment Date Review Date Signature Operations Covered By This Risk Assessment Diagrams/Other information MANUAL HANDLING RISK LEVEL In each of the sections Task, Individual Capability, Load and Environment tick the appropriate box. A yes indicates that further action is required to reduce the risk. Location/Area Task To Be Performed Personnel Involved The Tasks do they involve Yes No The Loads are they Yes No Holding load away from the trunk Twisting Bulky/unwieldy > 75cm in diameter Stooping Reaching upwards Difficult to grasp no conventional hand holds Large vertical movement Long carrying distance Unsteady/unpredictable Harmful e.g. sharp, hot, Strenuous pushing or pulling contaminated Unpredictable movement of load Repetitive handling Insufficient rest and recovery Work rate imposed by a process Individual Capability does the job Yes No The working environment are there Yes No Require unusual capability Constraints on posture i.e. Hazard those with a restricted space, low work surface health problem Poor floors e.g. uneven, slippery, Hazard those who are pregnant unstable Call for special training and/or Variations in levels e.g. stairs information Strong air movements Poor lighting conditions Hot, cold, humid 8
Risks Identified 1. 2. 3. 4. 5. 6. Assessment of risk (likelihood x consequences) See-Risk Likelihood Table Guidance Catastrophic Major Moderate Minor Insignificant Other factors Is movement or posture restricted by clothing or personal protective equipment Control Measures Already in place FREQUENCY OF TASK Record the number of times the task takes place during one working shift. Number of staff involved in the task Additional actions to control risk Responsible Person Projected Completion Date Date Completed/ Signature Please use additional blank sheet if necessary Risk Rating Score After Control Measures & Actions Implemented Catastrophic Major Moderate Minor Insignificant 9
Appendix 2 GUIDE TO USE THE RISK ASSESSMENT FORM 1. Write down the step-by-step details of the task for which the assessment applies e.g. moving equipment. 2. Identify the staff that are likely to be involved in the task. 3. Assessment of Risk consider the headings Task, Individual Capability, Load, Environment. Tick the appropriate box that that reflects most accurately what is involved in the manual handling task. 4. Record the estimated number of times that the task takes place during one working shift. The frequency of task may identify that the need for additional control measures e.g. more appropriate equipment required. Make reference to the number of staff involved. 5. Taking into account the assessment of risk in step (3) list the risks identified. 6. Document the Risk Rating Score; this will determine the urgency in which controls measures need to be put in place. 7. List control measures put in place e.g. staff training, written information, protocols. List any equipment in use. 8. Additional actions to control risk should be documented in the action plan with an expected completion date. Once the actions have been completed, re-evaluate the Risk Rating Score. EVALUATION OF RISK In order to effectively and accurately evaluate the level of risk, the risk owner should multiply the consequences by the likelihood (e.g. possible likelihood (3) and moderate consequences (3) give a risk rating of 9 which falls into the amber category as a significant risk. The table below illustrates how to determine the grading of risks and should be used in conjunction with the Risk Consequence Table and the Risk Likelihood Table. Risk Likelihood Table - Guidance 1 2 3 4 5 Descriptor Rare Unlikely Possible Likely Almost Frequency Probability Not expected to occur for years Expected to occur at least annually Expected to occur at least monthly Expected to occur at least weekly Expected to occur at least daily < 1% 1-5% 6-29% 21-50% >50% Will only occur in exceptional circumstances Unlikely to occur Reasonable chance of occurring Likely to occur More likely to occur than not Risk Grading Matrix LIKELIHOOD ALMOST CERTAIN 5 INSIGNIFICANT 1 5 (Yellow) MINOR 2 10 (Amber) CONSEQUENCE MODERATE 3 15 (Red) MAJOR 4 20 (Red) CATASTROPHIC 5 25 (Red) LIKELY 4 4 (Yellow) 8 (Amber) 12 (Amber) 16 (Red) 20 (Red) POSSIBLE 3 3 (Green) 6 (Yellow 9 (Amber) 12 (Amber) 15 (Red) UNLIKELY 2 2 (Green) 4 (Yellow) 6 (Yellow) 8 (Amber) 10 (Amber) RARE 1 1 (Green) 2 (Green) 3 (Green) 4 (Yellow) 5 (Amber) ACTUAL RISK OUTCOME 10
LOW (Green) MODERATE (Yellow) SIGNIFICANT (Amber) HIGH (Red) 11
Risk Consequence Table Guidance Appendix 2 (a) Consequence 1. Insignificant 2. Minor 3. Moderate 4. Major 5. Catastrophic Service/Business Interruptions Interruption in a service, which does not impact on the delivery of patient care or the ability to continue to provide service. Immediate on-site containment. Short-term disruption to service with minimal impact on patient care. Locally contained situation. Some disruption in service with unacceptable impact on patient care. Non-permanent loss of ability to provide service. On-site containment with outside assistance. Sustained loss of service, which has serious impact on delivery of patient care resulting in major contingency plans being invoked. Regional environmental repercussions. Permanent loss of core service or facility. Disruption to facility leading to significant knock on effect across local health economy. National environmental consequences. Financial Cost/Loss < 100 > 1,000 > 10,000 > 100,000 > 1,000,000 Patient Feedback/ Litigation Adverse Publicity/ Reputation Unlikely to cause complaint. Litigation risk is remote. Unlikely to warrant coverage in media, little effect on public confidence/staff morale. Complaint possible. Litigation unlikely. Local Media short-term. Minor effect on staff morale/ public attitudes. Litigation possible but not certain. High potential for complaint. Local Media Long-term impact on staff morale and public perception of trust. Litigation expected/certain. National Media <3 days. Public confidence in organisations undermined. Usage of services affected. Litigation expected/certain. National Media >3 days. MP Concern (Questions in House). Quality of the Patient Experience/Outcome Unlikely to impact on quality of patient care. May impact on patient experience readily resolvable Mismanagement of patient care, short-term effects (less than a week). Mismanagement of patient care, long-term effects (more than a week). Totally unsatisfactory patient outcome or experience. Performance Targets Injury/Harm No impact on targets No injuries or adverse outcome. Insignificant impact on local or national targets. Short-term injury/illness. < 3 days sickness. Adverse effect on local or national targets. Adverse event, which impacts on small number of people. RIDDOR reportable. Long Term sickness. Semi-permanent injury/ illness. Failure to meet local or national targets. Will have adverse effect on ratings. Permanent injury. Long-term adverse effect. eet statutory obligations. Enforced Management of Trust. Incident leading to unexpected death or major permanent injury to 1 or more person. 13
Appendix 3 PEOPLE MOVING & HANDLING RISK ASSESSMENT Date of assessment Assessors name block caps FUNCTIONAL CAPABILITIES State: Independent/Assistance/Dependant Normal Present Signature Use addressograph if available Patient s name Address/dept Patient Record Number Date of Birth Weight/height Chair to bed Walking On/off toilet/commode On/Off Bed Movement in Bed Bathing/showering Male/Female Sitting to Standing Refer to Physio Yes/no Date referred Stairs HANDLING CONSIDERATIONS (please tick if applicable) Refer to Guidelines 1. Equipment 2. Environmental Risk Factors 3. Staff 4. Bed Type Normally Used Responsibilities Wheelchair Walking Aid Transfer Belt Bath Aid Hoist Sliding Sheet Splint Callipers Other Floor Surface Poor Lighting Restricted Space Obstacles Unsuitable Furniture Pets Other Risk? Yes It is the individuals personal responsibility to refer to their line manager if any of the below apply. Health Problems Pregnancy Training Required Divan Static height Pressure mattress Double Hospital bed Other Risk? Yes 5. Pain 6. Skin 7. Equipment/Infusion 8. Communication 9. Behaviour/psychological state Tissue Joint Nerve Skin Other Bruises easily Fragile Lesions Risk? Yes Catheter Drain IV infusion/tube Syringe Driver Stoma Hearing Impaired Unable to Talk Unable to Express Language Barrier Risk? Yes Risk? Yes Risk? Yes 10. Physical Problems Special Comments/Instructions Poor Upper Body Movement Liable to Spasm Poor Balance Visually Impaired Paralysis Weakness of Limbs Unconscious / Sedated Incontinent Paraplegia/hemiplegia Amputation Osteoporosis History of falls/collapse Risk? Yes If a risk is identified a moving and handling action plan must be completed Unpredictability Confusion Nervousness Aggression Depression Dementia Un/semi-conscious Uncooperativeness Other Risk? Yes 14
Guidance on completing people moving and handling risk assessments and action plans. An assessment form and action plan must be completed when staff are required to move or handle a person. This should be completed within 24hrs in a hospital setting or by the next visit in a community setting. The admitting member of staff is responsible for completing the risk assessment. If there is more than one professional involved in the patient s care, then one person will take responsibility for its completion. Only one assessment and action plan per patient is required at any one time. All staff must understand how to read the assessment and all staff must follow the safe system of work laid down in the action plan. (95% of staff expected to perform the task should be able to do so) All staff must check the action plan prior to implementing a manoeuvre. Should the patient s condition at the time necessitate a change to the system of work indicated then this should be documented. If the patient s condition changes significantly, then a new assessment and action plan must be drawn up. HISTORY OF FALLS? If yes a safe method of removal from the floor must be documented. Complete a falls assessment 1. EQUIPMENT USED (Remember equipment used in a patient s home may differentiate to NHS equipment, which may increase potential risk factor e.g. Oxford hoist at home, Arjo in hospital). Is it in good condition, and maintained regularly? Is it suitable for the purpose it is needed? Is it the correct size for the patient? Have the patient and carers been trained in the use of the equipment? 2. ENVIRONMENTAL RISK FACTORS Complete the environmental risk factor form if risk identified If you not able to move furniture away from the working area, posture may be compromised. The floor surface, door threshold may restrict the movement of equipment e.g. hoist. Are bed lights working? Will furniture need raising? 3. STAFF RESPONSIBILITIES The manoeuvres required must be within 95% of all the staffs capabilities. In the event of a member of staff being unable to perform a specific task i.e. health problems, pregnancy etc., a personal risk assessment needs to be carried out. 4. BED TYPE A non-variable height bed will compromise working posture. A moving surface e.g. pressure mattress will make the task more difficult. Will the patient be able to get in/out of bed if a pressure mattress is used? A double bed will make some tasks unachievable. SPECIAL COMMENTS/INSTRUCTIONS Does the patient have variable abilities e.g. post seizure, day/night requirements If yes this must be reflected on the action plan. Two action plans may be required. 5. PAIN May be increased by certain handling techniques or use of equipment 6. SKIN The slightest friction may damage the skin Lesions special equipment may be required e.g. padded sling 7. EQUIPMENT/INFUSION Any external lines into the body will make movement more difficult. 8. COMMUNICATION/COMPREHENSION PROBLEMS Does the patient understand the task about to be undertaken 9. BEHAVIOUR Will the patient resist the move? 10. PHYSICAL PROBLEMS Any physical problem will make movement more difficult FUNCTIONAL CAPABILITIES Normal capabilities required when patients mobility is expected to improve. 15
PEOPLE MOVING & HANDLING ACTION PLAN Patient s Name.. Date of Birth. DAY TIME MANOEUVRE Recommended method CHAIR TO BED EQUIPMENT No OF STAFF DATE & SIGNATURE WALKING/STANDING ON/OFF TOILET/COMMODE ON/OFF BED MOVEMENT IN BED BATHING/SHOWERING SITTING TO STANDING STAIRS OTHER E.G. OFF FLOOR NIGHT TIME MANOEUVRE TECHNIQUE EQUIPMENT No OF STAFF CHAIR TO BED DATE & SIGNATURE WALKING/STANDING ON/OFF TOILET/COMMODE ON/OFF BED MOVEMENT IN BED BATHING/SHOWERING SITTING TO STANDING STAIRS OTHER E.G. OFF FLOOR IF A PATIENT S CONDITION CHANGES OR THERE IS A NEED TO CHANGE THE METHOD OF MANOEUVRE PLEASE DOCUMENT BELOW IF THE PLAN IS CHANGED MORE THAN 5 TIMES, THE PATIENT MUST BE RE- ASSESSED AND A NEW ACTION PLAN COMPLETED MANOEUVRE TECHNIQUE & EQUIPMENT REASON FOR CHANGE DATE & SIGNATURE 16
ENVIRONMENTAL RISK FACTORS FOR USE IN THE COMMUNITY AND IN EXCEPTIONAL CIRCUMSTANCES Patient s Name.. Date of Birth Potential Risk Area Hazard Identified Action Taken Date & Signature Space constraints on movement of handler/equipment Access e.g. bed/bath/wc passageways Steps/stairs/access for delivery of equipment Flooring e.g. thick pile carpet, door thresholds, rugs Slips/trip hazards Furniture bed height/moveable/condition Temperature/humidity/lighting Equipment power supply Other 17
Appendix 4 Information for Risk Assessment 18
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Appendix 5 Policy Impact Assessment Screening Tool Name of Directorate: Corporate Services & HR Policy being assessed: Manual Handling Policy Date of Assessment: 6 September 2007 Assessment Carried out by: Leann Gray As Above Policy Title Who is affected Statutory requirements Full Assessment Needed Yes / No Staff Volunteers Carers Health & Safety at work Act 1974 Manual Handling Operations Regulations 1992 Yes Priority High / Medium / Low High Lifting Operations and Lifting Equipment Regulations 1992 Provision and Use of Work Equipment Regulations 1998 Management of Health & Safety at Work regulations 1999 Standards for Better Health 2004 NHS Litigation Authority Risk Management Standards for PCT s 27
Appendix 2 Policy Impact Assessment Full Assessment Tool Name of Directorate: Corporate Services & HR Policy being assessed: Manual Handling Policy Date of Assessment: 6 September 2007 Assessment Carried out by: Leann Gray 1. What consultation process will be undertaken? 2. Where will records of this consultation be kept? Health & Safety Committee, Governance committee. Electronically, Risk Team records. 1. What existing monitoring arrangements are in place? 2. Are these sufficient? 3. Are any additional arrangements required 1. How will the results of the assessment be published? Risk assessments are done regularly by each department. Monitoring of incident forms are done within the risk team. Yes audits done regularly. Via Health & Safety Committee. 28
Policy aims and outcomes Evidence for assessment Difference in Outcomes Assessing Impact Proposed action Policy gives managers and staff information, guidance and measures to avoid hazardous manual handling operations; assess any hazardous manual handling operations that cannot be avoided and reduce the risk of injury so far as is reasonably possible. Statutory requirement. Policy reviewed annually or sooner if national guidance changes. The policy is seen as a useful reference tool for staff when undertaking manual handling tasks and understanding correct techniques and postures for manual handling. No adverse impact identified. Review as necessary. 29