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practice in moving and handling Further editions followed in 1987, 1992, 1997, 2005 and 2011 as best practice manual moving and handling methods evolved and the range of moving and handling aids and equipment extended and became more readily available, accessible and user friendly. These developments, alongside the enactment of updated legislation and emerging case law, the latter influenced by the guidance set out in the HOP series, have ensured that each edition in its turn has become the gold standard of its time, each providing a historical record of “where we were then”. By 2005, the 5th and later the 6th (2011) editions moved significantly towards a more evidence-based and peer reviewed approach and have been endorsed by leading relevant organisations including the HSE, National Back Exchange, RCN, NHS Employers, Chartered Society of Physiotherapy and the College of Occupational Therapists. Since that first edition, there has been a paradigm shift in care delivery from the NHS to community care, so that now there are arguably more workers delivering care that may involve moving and handling in the community (in care facilities, supported living and people’s own homes) than in the NHS, and not everyone who needs help is a “patient”. To reflect that shift, the fifth and sixth editions of the publication were retitled The Guide to the Handling of People to Image: iStock/ alvarez
risk factors listed above. The prevalence of low back pain in nursing, and the consequent cost to the NHS, has long been recognised and in 1979 the Royal College of Nursing (RCN) published their first guide, Avoiding Low Back Injury Among Nurses, that made a number of recommendations aimed primarily at prevention strategies including the avoidance of lifting. Recognising a need, the (by then) Back Pain Association (BPA), working in conjunction with the RCN, set about gathering a multiprofessional group of relevant experts to produce best practice guidance on recommended methods of assisting or moving patients, emphasising the importance of skills development so that, once trained, nurses could “accurately assess each situation and make the correct decision about patient movement, even in an emergency, to protect not only the nurse but also the patient”. The dual aims of managing risks to the worker, whilst also meeting the assessed needs of the patient, remain as relevant today. The resultant guidance document was published by the BPA in collaboration with the RCN in 1981 as The Handling of Patients (HOP), a Guide for Nurse Managers. It was quickly established as the gold standard guidance for the moving and handling of patients at a time when almost all care was delivered within the NHS.
include and address all relevant sectors. It seems appropriate that the latest revision in this established series, the seventh edition of the HOP series will be published in the summer of 2021, 40 years since the first, and 10 years since the last, publication. The approach and content of this new edition will focus on two significant aspects. The first is the ever closer focus on person-centred care that takes full account of the needs, choices, dignity and comfort of the person, and that takes an enabling approach to promoting the function and independence of the person being cared for as a clearer inclusion in the decision making process. This applies as much to meeting a person’s moving and handling needs as to any other aspect of personal and/or clinical care, including rehabilitation. Second, this edition has taken the step to underpin all of the guidance included with as much supporting evidence as is currently available. This includes other sources of practical guidance, academic literature and, where appropriate, equipment manufacturers’ recommendations. Over the past 40 years, the hazardous lifting of patients/people has been all but eradicated (except in dire emergency where there may be no reasonable alternative) due to greater understanding of the risks to both the handler and the person being handled, the growing evidence base for the safer handling methods set out in the publication (some of which are illustrated in this article) and also due to an ongoing evolution in equipment/technology development. Nevertheless, real, and sometimes new, challenges remain. Some examples of equipment designed to substantially avoid or reduce the risk from moving and handling include: Electric profiling beds (EPBs) have bases that are sectioned so the mattress can be profiled to achieve various positions, the height can also be adjusted. Movement is powered and controlled via a bedside handset by care staff, or by the user to facilitate independence. These beds enhance comfort, facilitate repositioning, reduce the risk of pressure continued on p24 >
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