Leicestershire Partnership NHS Trust Moving and Handling Level 2 Update 2018/19
Introduction Welcome to your Moving and Handling Level 2 Update for 2018/2019. This session forms part of an on-going programme of training for all patient handling staff. The aim of this programme is to provide staff with the knowledge that will assist them to reduce their risk of back injury in the workplace. Much of this information also applies outside the workplace; staff will be encouraged to consider this during these situations. You will be required to update your knowledge on a 2 yearly basis. Contents Introduction aims, objectives, and ground rules. Summary of relevant legislation. Back injury and the NHS. Risk Assessment. Summary of anatomy and physiology. Principles of safe handling. Unsafe / High risk moves. Practical work: approved techniques and problem solving, including reference to: Anatomy & Physiology: Risk Assessment, Principle of Safe Handling. Training records and evaluation. Useful Links References
Aims and Objectives Aim The aim of this session is to review and build upon the practical application of manual handling in the workplace. Objectives At the end of the session you will be able to: Explain the importance of risk assessment in relation to patient handling. Demonstrate what measures you might consider when moving and handling patients that would reduce the risk of injury. Participate in a problem solving approach relevant to your area. Ground Rules PLEASE READ THIS SECTION CAREFULLY. These rules are designed to make the training session safe for all participants. You are expected to be fit enough to undertake this training. You must inform the trainer, prior to the practical session, if for any reason you are unable to participate fully in this part of the training, this could be for health, medical issues, pregnancy or if you have given birth within the last 6 months. This information will be treated in strict confidence. However, your training is not complete until you have successfully taken part in the practical session, and the words unable to take part in the practical session training incomplete will be added to your training record and you will be recorded on ULearn as not completed. You are strongly advised to notify your manager of any illness or injury, which prevents you from safely undertaking manual handling duties, in line with your legal and contractual responsibilities. You are required to wear your usual work clothing and appropriate footwear flat heeled, nonslip, fully enclosed shoes for the practical session. You must only perform manoeuvres under the supervision of a trainer. Trainers can at any time, stop you taking part in an activity in the interests of safety.
Summary of Relevant Legislation Health and Safety at Work Act 1974 Employers have to: Protect the health and safety of their employees Protect the health and safety of others who might be affected by the way they go about their work. Employees have to: Take care of own health and safety and that of others. Co-operate with their employer Management of Health and Safety at Work Regulations 1999 Employers have to: Assess health and safety risk to employees and others, to identify the precautions required by health and safety law. Take particular account in their assessment of risks to new and expectant mothers and their unborn and breast feeding children. Provide employees with adequate training and instruction. Employees have to: Use equipment provide by their employers as instructed.
Back Injury and the NHS In the NHS, manual handling accidents account for 52% of all sickness absence. Ref: MHOR 1993 amended 2002 The total annual cost to the NHS is 400 million pounds per year, enough to employ 16,000 nurses. Ref: Back Care 2011 (Cited Nursing Times) The highest compensation paid to date is 803,000. According to the Royal College of Nursing: 1.5 million working days are lost every year because of back injuries to nurses 80% of nurses have time off with back problems each year; 3600 healthcare workers are forced to retire early as a result of back injury (Back Care (cited Nursing Times 2011)) It s not only nursing staff that experience back pain: As many as 1 in 6 physiotherapists may move speciality or leave the profession as a result of injury. Ref: Guidance in Manual Handling, Chartered Society of Physiotherapists, 2002 30% of catering, domestic and portering staff in the NHS experience back pain regularly. Ref: Back in Work Sheet No 1, Department of Health, 2002
Risk Assessment A moving and handling risk assessment is a way of examining our work activities that relate to moving and handling with the purpose of helping us decide: 1. How to perform a job without endangering ourselves AND 2. What safety precautions we need to use. The Management of Health and Safety at Work Regulations (1999) impose a requirement upon employers to undertake an assessment of any risk to the health and safety of their employees. This piece of legislation is supported and extended by the Manual Handling Operations Regulations (1992), which have established a hierarchy of measures in order to reduce manual handling risks: AVOID handling where ever possible. Many manual handling tasks are performed without an assessment that might indicate that equipment could be used, or that the patient could be encouraged to help themselves. In essence we should ask ourselves the question does the task need to be done? ASSESS the risks of those tasks that cannot be avoided. REDUCE the risk as far as reasonably practicable. PROVIDE INFORMATION for example on the weight of the load to be handled Knowing if there is a risk to injury is a matter of judgement in each case. However there are things to look out for, such as bad postures, awkward or heavy loads, cramped working areas, excessive fatigue or history of back problems. Staff can often highlight which activities are unpopular or difficult. Manual handling risk assessments offer many benefits and may potentially: Protect the staff and patients Reduce injures Stop some injuries occurring Change the culture of an organisation Identify equipment needs Training is very important but remember that, on its own, it cannot overcome a lack of mechanical aids, unsuitable equipment and inappropriate systems of work. Risk assessments will be an asset in partnership with training.
Summary of Anatomy and Physiology 7 Cervical Vertebrae 12 Thoracic Vertebrae 5 Lumbar Vertebrae 5 Fused sacral Vertebrae 4 Fused coccygeal Vertebrae
Summary of Anatomy and Physiology The spine is a column of 33 bones called vertebrae separated from one another by cushions of elastic tissue the intervertebral discs. The spine has 3 main functions: - To support the upper body - To allow mobility - To provide a protective casing for the spinal cord The spine of a newborn baby is C shaped having two primary curves in the chest and sacral regions. Once the infant lifts its head and, later begins to walk, the secondary curves of the neck and the lower back regions develop, and the spine takes on its characteristic 3 curved S shape. With the exception of the intervertebral disc, all the structures of the vertebral column have a liberal nerve and blood supply. Each intervertebral disc is comprised of a fibrous outer ring - the annulus fibrosus -, which holds in place the inner jelly like nucleus pulposus. The discs act as hydraulic sacks that dampen the shock of spinal actions and allow limited movement between vertebrae. It is the combined actions of each disc all the way up the spine that provides the remarkable ability of the back to stretch and move.
The Intervertebral Disc
Principles of Safe Handling Apply these principles whenever manual handling is required: Whenever moving or handling movable objects you need to remember your posture and balance. Wide stable base Feet about hip-width apart, one foot slightly in front of the other, and with weight balanced evenly between them. Once the load has been moved or lifted, the feet should move in the direction of the load. Keep natural curves of the back Do not bend or twist and remember, this includes your neck. Elbows in Keep your elbows tucked into the side of your body, to avoid increased stress on the neck. This will also, automatically, bring the load in close to your body. Bend knees Use your powerful leg and buttock muscles Bend your knees, but avoid squatting: it puts great strain on your knee joints Head up/chin in Look face on to the load to avoid twisting your neck. Hold your chin in slightly to avoid extending your head back. Lead off the lift with your head where the head goes the rest of the body will follow. Hold load close The closer the load is held to the body, the less stress there is placed on the back. Health and Safety Executive (2003)
Unsafe / High Risk Techniques There are a number of traditional techniques which are now considered unsafe / high risk, and which must no longer be used. Legally it is the Manual Handling operations Regulations, 1992 - made under the Health and Safety at Work Act 1974 which govern all manual handling activities, and to which reference should be made; the important publication here is Manual Handling operations Regulations1992 Guidance on regulations L23 (Health and Safety Executive, 1992). All unsafe / high risk moves have either caused injuries to NHS and private sector patients, handlers, or both and as a consequence, have featured in court cases. They are no longer considered to be good practice AND MUST NOT BE USED for planned moving and handling interventions. However not every manual handling situation can be planned for in advance, for example, when there is a sudden exceptional, life-threatening incident (e.g. flood, building collapse or explosion) and one or more of these unsafe high risk moves might be used. A cardiac arrest is certainly life-threatening to the patient, but would not be considered an exceptional circumstance in a healthcare setting and you should follow the Resuscitation Guidelines for handling a collapsed person. Only approved moves are to be used by organisation staff for planned moving and handling interventions. Trainers and Manual Handling Key Workers should use this document as a reference and/or contact the moving and handling advisor if they are in any doubt regarding the safety of any moves. IT IS ORGANISATIONAL POLICY THAT STAFF DO NOT USE NON-APPROVED MOVES. You should not lift patients because: They weigh too much and are unpredictable It is difficult or impossible for staff to get into a safe position to lift Staff are at risk of injury in all manual handling techniques Most lifts include a risk of injuring the patient Manual lifts are not therapeutic; they do not improve the patient s mobility.
Unsafe / High Risk Moves The Drag Lift - This includes any way of handling the patient in which the handler places a hand or an arm under the patient s axilla (armpit), whether the patient is being moved up the bed, sat up in the bed, being assisted from sitting to standing, or being assisted to change from one seated position to another and regardless of whether the handler is facing or behind the patient, or whether there is more than one handler. An example of a drag-lift
An example of the worst kind of drag-lift
The Orthodox Lift - a two-person lift, in which the handlers place one arm around the patient s back and the other under the patient s thighs. The handler s may clasp each other s wrists, or they may hold the far side of the patient. Handling slings are sometimes used. In all cases these lifts are dangerous. The orthodox lift Two-sling lift - (not shown) with slings placed under the patient s lower back and thighs, the handlers stand either side of the patient with one knee on the bed; this is a total body lift. The shoulder lift - (shown below) Also known as the Australian lift, regardless of whether the Free arm is placed on the bed for support or placed around the patient.
Front transfer with one nurse - this includes the pivot transfer, the elbow lift and the Bear Hug, regardless of whether a belt or sling is used An example of the bear hug lift You should not lift people because: They weigh too much and are unpredictable It is difficult or impossible for staff to get into a safe position to lift Staff are at risk of injury in all manual handling techniques Most lifts include a risk of injuring the patient Manual lifts are not therapeutic; they do not improve the patient s mobility. For recommended patient handling techniques, refer to the Leicestershire Partnership NHS Trust document PROCEDURES FOR THE MOVING AND HANDLING OF PATIENTS
Useful Links All policy documents are available via the Policy Document Store available on E-source. References Manual Handling Policy Using Hoists to Move Patients Policy Procedures for the Moving and Handling of Patients Heavy Patient Pathway Code of Practice for the use of Electric Profiling Beds Backcare in collaboration with The Royal College of Nursing and The National Back Exchange. (cited Nursing Times) 2011 The Guide to the Handling of People a systems approach 6th Edition 2011 BackCare. Chartered Society of Physiotherapists (2000): Manual Handling for Chartered Physiotherapists. Available from: http://admin.csp.org.uk/admin2/uploads/-38c9a362-ed71ce5fa5-77d7/gimh4cp.pdf;last Reviewed Jan 2001. Health and Safety Executive (2004) Manual Handling Operations Regulations (1992) (As amended), Guidance on Regulations, 3rd Edition London:HMSO Back in Work, Sheet No 1, Department of Health (2002) Contacts Moving and Handling Advisor, Leicestershire Partnership NHS Trust, For details of training records contact the Learning and Development Administration Services Learninganddevelopment@leicspart.nhs.uk