Clinical Skills Taking Care of Your Manual Handling Course devised by the Clinical Skills Team Training delivered by Cardiff & Vale UHB (Health, Safety & Environment Unit)
Aims & Outcomes Aims & Outcomes The aim of this module is to raise awareness of the importance of taking care of your back, identify the risks associated with manual handling in clinical practice and introduce solutions for safe practice The learning outcomes are: Identify the causes and risks of musculoskeletal injury in relation to your clinical practice Describe your personal and professional responsibilities in helping to reduce injury and promote safe working practices Identify manual handling interventions which are based on the principles of safe handling Practise and improve some of the manual handling skills and demonstrate the principles of safe practice during the practical session
Introduction Introduction Manual handling is defined as the transporting or supporting of loads including lifting, putting down, pushing, pulling, supporting, carrying or moving by hand or by bodily force Musculoskeletal injuries/discomfort remains the most commonly reported work related illness of which constituting more than a third of all over-three-day injuries reported each year to the Health and Safety Executive (HSE) and local authorities are caused by manual handling. Health and social care occupations have higher than average prevalence and incidence rate, second only to agriculture workers. 60% of the workplace incidents/accidents relate directly to patient handling. An estimated 12.3 million working days are lost to work-related MSD s with each sufferer taking approximately 17 days off in a 12 month period.
At Risk At Risk Manual handling injuries can occur wherever people are at work. Many factor increase the risk of sustaining a manual handling injury: Lifting heavy inanimate/patient loads, particularly with the load away from the body Lifting with a starting or finishing position near the floor Working in awkward, unstable or crouched postures e.g. patient examination Tasks include excessive forward flexion or backward extension Twisting the spine without moving the feet Prolonged static postures e.g. Clinical procedures such as lumbar puncture Tasks are repetitive, with insufficient rest breaks e.g. CPR Stressful living and work conditions Existing injuries Weak abdominal and pelvic floor muscles Pregnant or breastfeeding
Legislation Legislation Health & Safety At Work Act 1974 Employers Duties: Section 2(1)...ensure as far as reasonably practicable the health, safety and welfare at work of all employees Section 2(2)...provide information, instruction and supervision to ensure as far as is reasonably practicable the health and safety at work of his employees......provide and maintain safe work systems... Health & Safety At Work Act 1974 Employee Duties: Section 7...while at work take reasonable care of the health and safety of his/herself and others who may be affected by his/her acts or omissions...make use of equipment, in accordance with their training and instructions...co-operate with employer in performing duties...
Legislation Legislation Manual Handling Regulations 1992. Revised 2002 Employer Responsibilities: Section 4...so far as is reasonably practicable, Avoid, Assess, Reduce Inform and Review manual handling risks... Provide information, instruction and training Manual Handling Regulations 1992. Revised 2002 Employer Responsibilities: Section 7...co-operate with employer in using safe systems... Attend training
Legislation Legislation The Workplace Health Safety & Welfare Regulations 1992 The employer must meet minimum standards of provision for lighting, temperature, ventilation and drinking water Reporting of Incidents Disease & Dangerous Occurrences Regulations (RIDDOR) 1995 The employer must notify HSE about certain occupational injuries and dangerous events The employer must provide information and training on the use of an Accident Reporting Procedure The employer must investigate reported accidents/near misses and provide feedback Provision and Use of Work Equipment Regulations (PUWER) 1998 The employer must ensure that equipment provided for use is suitable safe and maintained to set standards Lifting Operations and Lifting Equipment Regulations (LOLER) 1998 The employer must ensure the equipment and accessories used fro lifting is strong, stable and is marked with its safe working load
Risk Assessment Risk Assessment There are 2 main types of manual handling Risk Assessments; 1. Generic Risk Assessment (completed by Managers of each Department for general risks e.g hoisting) 2. Patient specific Risk Assessments (completed for each patient on admission by Nurses on their individual mobility) All Risk assessments usually have a scoring system such as the 5 x 5 matrix and are ergonomically designed taking the whole situation into account. A common acronym used to assess this is TILEO TASK Individual Capability Load Environment Other Does it require strenuous pushing/pulling, lifting, height?.. Does it affect those who are pregnant, require specialist training?.. Heavy, bulky, difficult to grasp Lighting, temperature, weather, flooring Use of personal protective equipment, disruptions
Ergonomics Ergonomics...about fitting the job to the person and making the most of their capabilities Task Physical Environment Worker Organisation and Procedure Workplace
Potentially Harmful Movements Additional Risk Factors Sustaining Repeating Loading Twisting Jerky Movement = Lower back
Stooping Stooping To prevent stooping when working at the bedside, the bed should be raised to the Staffs waist height Muscles anchoring the body
HSE Risk Assessment Filter Guideline Weights
Safer Moving & Handling Principals Safer Moving & Handling Principals Stop and think Assess the load Prepare the area Maintain stability and balance Maintain a natural upright position Bend knees & hips to go to low level Keep head up & lead with head when rising Avoid twisting Ensure a secure hold Keep load close to body
Workstation Adequate illumination Screen/work surface glare and reflection free Balanced head position (chin in) Screen can tilt and swivel Screen at comfortable height Keyboard detached, flat Shoulders relaxed Upper arm vertical Forearms approximately horizontal Adequate lower back support at belt level Adjustable backrest (height, angle) Adjustable height chair (gas lift) Feet flat on floor or footrest Stable base
How to Reduce Risk (SECS) Ergonomics Equipment needed, environment Self Help What can the patient do for themselves? Safety Safety of equipment, environment and people Communication Commands. Teamwork, explain to patients
Team Handling & Communciation Team Handling & Communciation To reduce the risk when handling as part of a team; 1. Identify a leader 2. Use a clear commands 3. Work with someone of a similar height 4. Plan & assess before the activity To reduce the risk, ensure that communication is clear and the following commands are used; Ready, Steady, GO (or any other command word such as lift, stand, roll etc..)
Information For Students Information For Students Please ensure that you wear appropriate footwear and clothing when attending the classroom-based training as the session will be practical in nature. Please declare any injuries etc. If anyone does have an injuries/pregnancy etc, please could you bring it to the trainers attention when you arrive. Please remember to print out and bring your E-Learning certificate to your classroom based training session.
Principles of Safe Manual Handling Wear appropriate shoes and clothing Know your limitations and only perform tasks within your level of capability. E.g. do not use manual handling equipment if not trained to do so Never manually lift all/most of the patients weight except in life threatening circumstances Think TILEO Select the appropriate equipment or technique for the task Ensure the handling area is safe Ensure you had the correct number of staff to complete the task - for example when completing a lateral transfer (transferring a patient lying down from one surface to another (bed to trolley)) best practice is 4 staff HOWEVER THERE SHOULD BE A MINIMUM OF 3 STAFF
Manoeuvre Sitting to Standing Patient must be weight bearing Explain procedure to patient Patient shuffles to the edge of the chair Patient feet apart and flat on the floor Patient leans forward looking ahead/up. They place both hands onto the arms of the chair/base of the surface and push themselves into standing Stand to one side of patient, facing forward Bend your knees Put nearest arm around patient, palm on their opposite hip Sandwich patient s near shoulder between yours and your other palm Head up and give command Ready, Steady, Stand, placing forward pressure on patients back and moving forward and up Patient pushes down on the arms of the chair and comes into standing When performing any techniques with the patient never drag them under the arms as this is unsafe
Manoeuvre Standing to Sitting #1 is team leader and co-ordinates Adjust bed to hip / waist height Ensure bed brakes are locked #2 on side of bed (torso and legs), a person at legs may not be required depending on patient ability Explain procedure to patient Patient s head faces direction of turn Near arm bent and resting on bed with palm uppermost Far arm is placed across chest Torso person places one palm on patient s far scapula and one on patient hip Legs person places on palm above torso person s palm on hip Patient s far knee is bent with foot flat on the bed (if can tolerate) Adopt walking stance with front thigh touching the bed, knees bent, On the command Ready, Steady, Roll Only need to roll approx. 30 o The patient is supine
Manoeuvre Lateral Transfer 1 of 2 Manoeuvre Lateral Transfer from Trolley to Bed/Bed to Trolley (Minimum of 3 People) but 4 is recommended Designate team leader to co-ordinate transfer Position team leader at the patient s head if head support is required (#1) If head support not required leader joins #2 Handler B stands beside patient and is responsible for pushing patient towards the receiving bed or trolley #3 and #4 are positioned beside the receiving bed/trolley and are responsible for pulling the patient towards them Explain the procedure to patient Place patient s arms across chest Adjust bed and trolley to the hip/waist height of the shortest person Make sure patient is laying on a sheet to assist with transfer #2 rolls patient 30o towards them #3 and #4 working at top and bottom of bed/trolley position pat-slide, with slide sheet on top, underneath patient The pat-slide with slide sheet should be positioned level to the patient s head and straight down the near side of the patient s spine so that at least one buttock is resting on the equipment The slide sheet must be flat against the patient Both heels are placed on the slide sheet
Manoeuvre - Lateral Transfer 2 of 2 Manoeuvre Lateral Transfer from Trolley to Bed/Bed to Trolley (Best practice) 2 staff roll patient towards them whilst the other 2 staff place the slide sheet and patslide under the patient Patient then rolls back and the slide sheet is adjusted Then bring in the receiving surface Ensure pat-slide straddles the gap between the two surfaces Check bed and trolley brakes are locked 2 staff on the pushing side gently push the patient across using open palm holds 2 staff on the pulling side will hold the slide sheet palms up and take a slow step back whilst pulling (using their full body and not just arm power) before stepping back into the bed The command Ready, Steady, Slide should be used by the leader (people nearest the patients head) Once the patient is on the receiving surface, handlers final adjustments to the patient s position whilst the slide sheet is still in situ after removing the other surface and pat slide Staff to then remove slide sheet
Falling Patient Falling Patient Try and avoid the accident but planning the move and getting help. Be aware of the following: Trends in the patients clinical observations Pharmaco-dynamics of any medications History of falls Underlying medical conditions, etc If the patient starts to fall, try to guide the patient down your body or protect their head if you can, BUT NEVER try to catch the patient, you WILL put unnecessary strain on your back Play Assiting a falling person (video) Or type the following URL into your browser address bar: https://hml.cardiff.ac.uk/play.aspx?videoid=1898
Safe Handling During Resuscitation Safe Handling During Resuscitation Working group of the Resuscitation Council (UK), Guidance for Safer Handling During Resuscitation in Healthcare Settings. November 2009, Resuscitation Council (UK) London. http://www.resus.org.uk/pages/safehand.pdf#search=%22safer%20handling%20during%20resu scitation%22
Equipment Gallery Equipment Gallery Mobile Hoist Standing Aid Patslide Handling Belt Slide Sheet Hoverjack Scoop Stretcher Electric / Profiling Bed Skip
Mobile Hoist Mobile Hoist
Patslide Patslide
Slide Sheet Slide Sheet
Scoop Stretcher Scoop Stretcher
Standing Aid Standing Aid
Handling Belt Handling Belt
Hoverjack Hoverjack
Electric / Profiling Bed Electric / Profiling Bed
Managing Acute Pain Preventing Musculoskeletal Pain Reduce Stress Tension often results in back, neck or shoulder pain so try to make time each day to relax and unwind. Change position regularly, avoiding sitting or standing in the same position too long. When working at a computer, take regular breaks to allow you body to change its posture. Try a plan of aerobic, flexibility and strengthening exercises. Following the advice from manual handling training will also reduce the likelihood of injury. If pain/injury occurs Take analgesia, apply a heat/cold pack, keep as mobile as possible and seek medical advice if necessary
References & Links References The Health and Safety Executive (HSE), Getting to Grips with Manual Handling A Short Guide (September 2011), http://www.hse.gov.uk/pubns/indg143.pdf Resuscitation Council (UK), http://www.resus.org.uk Care, http://www.backcare.org.uk Disabled Living Foundation, http://www.dlf.org.uk National Exchange, http://www.nationalbackexchange.org.uk The Royal College of Nursing (RCN), http://www.rcn.org.uk The Royal Society for the Prevention of Accidents (RoSPA), http://www.rospa.com All Wales NHS Manual Handling Steering Group, All Wales NHS Manual Handling Training Passport and Information Scheme. 2008, NHS Wales, Welsh Assembly Government, Health and Safety Executive, http://www.wales.nhs.uk/sites3/docmetadata.cfm?orgid=433&id=107187