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Back pain

6

Basic lifting

12

Ceiling hoist

29

Communication

18

Condemned moves 18

the

Moving & Handling training handbook

David Olley

Fallen person

35

Hoists and slings

29

Introduction

2

Lateral transfer

26

Legislation

3

Load sharing

11

M/S injury

4

PAT slide

26

Policy

15

Position

7

Risk assessment

10

Sit to stand

21

Slide boards

24

Slide sheets

24

Slings

31

Slipped disc

6

Small handling kit

19

Spine, the

5

Static loading

8

Stedy

27


Back pain

6

the

Basic lifting

12

Moving and Handling

Ceiling hoist

29

Communication

18

training handbook

Condemned moves 18 Fallen person

35

Hoists and slings

29

Introduction

2

Lateral transfer

26

Legislation

3

Load sharing

11

M/S injury

4

PAT slide

26

Policy

15

Position

7

Risk assessment

10

Sit to stand

21

Slide boards

24

Slide sheets

24

Slings

31

Safety Publishing Ltd

Slipped disc

6

483 Green Lanes London N13 4BS

Small handling kit

19

Spine, the

5

Static loading

8

Stedy

27

info@safetypublishing.co.uk www.safetypublishing.co.uk Contains public sector information published by the Health and Safety Executive and licensed under the Open Government Licence V1.0

Š2013 Safety Publishing Ltd. All rights reserved. No part of this publication may be reproduced in any form or by any means without the written permission of Safety Publishing Ltd


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Moving & handling Introduction Employers must ensure that wherever possible manual handling tasks that could involve a risk to the health and safety of their employees are avoided, so far as is reasonably practicable. Where these tasks are unavoidable training of the workforce should be in place to minimise the risk. The aim of this training is to provide a basic knowledge necessary for the employee to reduce the risk of injury to themselves and to others. More than a third of lost time accidents at work result from manual handling. Over 1 million people in the UK suffer from musculo-skeletal disorders caused or made worse by their jobs. This leads to over 12 million working days lost per year, in addition to the pain and suffering caused to the individual by these conditions.

Accidents in the workplace by type Manual handling Falls Trips Hit by object Hit by vehicle Other

The risk The risk of injury occurring may depend on several factors: ▪ The task to be performed. ▪ The environment in which the task is to be performed. ▪ The level of fitness or health of those performing the tasks, including previous history of injury. ▪ Changes in intensity or duration of work, brought about by factors such as staff shortages. ▪ Availability of help. ▪ Availability of mechanical aids. ▪ Level of training. Some of these factors can be modified and others have to be accepted.


Moving & handling The law covering moving and handling Management of Health and Safety at Work Regulations 1992 (MHSWR) This sets out the general duties for improving health and safety and introduces the requirements of a risk assessment and risk management. Workplace (Health Safety and Welfare) Regulations 1992 (HSWR) This sets out general requirements to improve the working environment. Provision and Use of Work Equipment Regulations 1998 (PUWER) This covers minimum requirements for equipment used in the workplace. Lifting Operations and Lifting Equipment Regulations 1998 (LOLER) Covers requirements for inspection and maintenance of lifting equipment in the workplace. Health and Safety (Display Screen Equipment) Regulations 1992 (DSER) Lays out minimum health and safety requirements for work involving display screens. Personal Protective Equipment at Work Regulations 1992 (PPEWR) Gives advice on the selection and appropriate use of personal protective equipment. Manual Handling Operations Regulations 1992 (MHOR) Outlines the general duties upon employers concerning the moving of loads.

Employer’s duties Avoid: avoid so far as is reasonably practicable the need for their employees to undertake any manual handling operations at work which might involve the risk of injury. Assess: where it is not possible to avoid any manual handling, they should make a detailed and thorough assessment of the risk. Reduce: using the findings of the risk assessment, steps must be taken to reduce the risk to the lowest practicable level. Review: undertake reviews of the risk assessment whenever there has been a significant change in the circumstances and implement any appropriate changes in procedures, based on the review. Provide information: provide clear instructions and training to employees based on the risk assessment and ensure adequate supervision.

Employee’s duties Each employee, whilst at work, shall make full and proper use of any system of work provided for their use by their employer. The employee’s duties will include: Co-operate: with their employer on health and safety issues. Take care: that proper working systems are followed and that appropriate safety equipment is used. Inform: the employer if they identify any dangerous practices.

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Moving & handling Musculo-skeletal injury These are the most common type of injuries that result from manual handling. They may include injury to the bony skeleton such as fractures and dislocations but more commonly referred to injury to the soft tissues, such as the muscle, tendon, ligament and cartilage – sprains and strains. The most common type of work-related musculo-skeletal disorder which then goes on to cause lost time injury is back injury.

Site of injury Back Hand Arm Rest of the body

Type of injury Strains Contusions Lacerations Fractures Superficial Other

Sprains and strains Strain occurs when a muscle or tendon has been overloaded or stretched, resulting in the tearing of some of the fibres. Sprain occurs when the ligaments that support a joint are overstretched and torn. It is commonly caused by rotating or twisting the ankle

Torn ligament


Moving & handling The spine The spine is a column of 33 bones called vertebrae stacked one on top of the other. The vertebrae are separated by pads of cartilage called intervertebral discs. The discs consist of a tough fibrous shell with a softer jelly-like inner and they function as cushions or shock absorbers.

Cervical vertebrae

Thoracic vertebrae

Running in the space behind the vertebral bodies is the spinal-cord. The spinal-cord is the main cable that carries information from the body to the brain and directions or instructions from the brain to the body.

Lumbar vertebrae

Branching out from the spinal-cord at the level of each vertebrae there are spinal nerves that carry the information in and out of the cord.

Sacrum & Coccyx

It is possible to injure the spine without damaging the spinal-cord and it is also possible to damage the cord without fracturing the spine.

The natural “S� shape of the spine is designed to provide strength and stability, so as the spine is moved from this shape it becomes less stable, the forces acting on it are increased and its ability to support loads is decreased.

Spinal structures Vertebral Body Spinal Nerve

Vertebral Body Spinal Nerve Spinal Cord

Spinal Cord Inter vertebral Disc

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Moving & handling Back pain Back pain is very common. Four out of five of us are likely to experience one or more episodes of back pain at some time in our lives. Most sudden back pain is due to muscle spasm caused by tiredness or strain injury, but it may also be due to a slipped disc, wear and tear on the joints or a trapped spinal nerve. A sudden attack of back pain may be very painful but it is not often very serious and it does not usually require medical attention. In most cases the best treatment is to keep as mobile as the pain will allow. Bed rest or lying still for days will make the muscles seize up and begin to waste away. This means that they will take much longer to recover. Things that may provoke back pain include: ▪ heavy manual activity. ▪ lifting and carrying. ▪ poor posture. ▪ reaching, twisting and lifting. ▪ repetitive handling tasks. ▪ slips or trips. Although back pain isn’t usually serious you should see a doctor if you have any of the following: ▪ you feel ill or have a high temperature as well as severe back pain. ▪ you feel numb or have pins and needles in both legs, around the genital area, the inside of the tops of the thighs or around your back passage. ▪ both of your legs feel weak or you are unsteady on them. ▪ you become incontinent. ▪ the pain is getting worse for no apparent reason.

Prolapsed (slipped) disc In this condition, properly called a prolapsed intervertebral disc or PID, the disc, usually in the lower back, ruptures and bulges into the space occupied by the spinal nerves. The effect of this is to cause pain which may travel along the pathway of the affected nerve. The most commonly affected nerve is the sciatic nerve in the leg (sciatica) but if it happens in the neck then you may suffer similar pain in the arm on the affected side.

Pressure on Spinal Nerve

Prolapsed Disc


Moving & handling Position The mechanical loading on the spine and its supporting muscles and ligaments will increase with the following factors: ▪ the weight being lifted or carried. ▪ the amount the trunk is bent forward. ▪ the distance of the load from the spine. This means that a light load held at arm’s length will place the same load on the spine as a much heavier load held close to the body. If the individual is leaning forward at the same time the muscles and ligaments situated close to the spine have to compensate for an apparent increase in the body’s weight. The diagram below gives suggested safe weights in kilograms that may be lifted in each position. These figures, taken from the HSE’s Manual Handling Operations Regulations, show clearly that it is better to carry any size load at waist height and close to the body. Tasks outside these boundaries may well result in significant risk of injury and would require detailed assessment of risk. Even tasks that fall within these boundaries should be assessed and eliminated where possible, although where assessment shows that it is safe to do so, these limits may be exceeded. The figures are for tasks performed in good conditions, where the load is compact, stable and easy to grasp and hold close to the body, the lift is not performed more frequently than twice a minute and does not require twisting the trunk. These figures may have to be reduced if all of these factors are not present.

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Moving & handling Position Bending at the knees keeps the centre of gravity of the body low down towards the pelvis and makes the body more stable and so reduces strain on the muscles and ligaments. Twisting the back when lifting stretches the muscles and can place shearing forces on the discs, particularly if you are bending and twisting at the same time.

Static loading Our bodies work better when they’re moving than when they are standing still. Staying in one position particularly with arms raised or outstretched, is likely to lead to muscle spasm and back pain. This state of prolonged muscle contraction is called static loading and can be particularly dangerous. It places a great strain on muscles and tendons and may cause mechanical damage to the discs of the spine. It is extremely tiring and could result in a much greater strain on the heart. For these reasons the reduction of static loading should be a priority in the workplace. Activities which lead to static loading may include: ▪ working with your body leaning forwards or sideways. ▪ trying to move objects that are too heavy for you. ▪ carrying heavy objects for any length of time. ▪ trying to hold a load still or to support it.

Lifting whilst sitting Lifting whilst sitting is also particularly dangerous, although many mistakenly believe that it may be safer than lifting when standing up. ▪ When sitting the lower spine loses its shape which makes it less able to tolerate loads. ▪ The work is being performed by the relatively weak arm muscles instead of the much stronger muscles of the legs. ▪ The arm muscles will get tired more quickly and this leads to other muscles having to compensate.


Moving & handling Assessing risk – flowchart Does the task involve manual handling?

No

Yes Is there a risk of injury?

No

No further action

Yes

Change how the task is to be performed

Yes Carry out an initial assessment of risk

Is it practical to avoid the task? Can changes be made to reduce the risk? No Does a significant risk of injury remain? Yes Carry out specific manual handling risk assessment

Identify ways of reducing the risk (safe system of work)

Implement the safe system of work

Review regularly

Update initial risk assessment

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Moving & handling Assessing risk An employer’s risk assessment will need to consider all of the aspects of the manual handling tasks that an employee would be asked to perform. The assessment should be based upon the experience of the tasks involved and should include consultation with the employee.

The task Does the task involve: ▪ holding or moving loads at a distance? ▪ bad posture or body movements such as: q stooping? q twisting? q reaching? ▪ excessive movement, particularly: q excessive carrying distance? q excessive lifting or lowering distance? ▪ excessive pushing and pulling of loads? ▪ precise positioning of loads? ▪ frequent or prolonged physical effort? ▪ insufficient rest or recovery periods?

Are the loads? ▪ ▪ ▪ ▪ ▪

very heavy? large bulky or difficult to manage? difficult to grasp? unstable, or could the contents move? sharp, hot or otherwise potentially harmful?

The working environment Are there: ▪ space problems which might prevent a good working posture? ▪ uneven or slippery floors? ▪ differences in heights and levels of floors or working surfaces? ▪ extremes of temperature or humidity? ▪ problems with gusting winds or ventilation? ▪ poor lighting conditions? ▪ Is safe movement likely to be hindered by the use of personal protective equipment or by clothing?


Moving & handling Individual ability Does the job: ▪ require unusual height or strength? ▪ create specific hazards for those with a particular health problem? ▪ require specific training for it safe performance?

The task Does the load really need to be moved? If so how can the risk be reduced? Can you: ▪ provide mechanical handling devices? ▪ use more people? ▪ improve the work routine?

Load sharing It would seem to make sense to share the load between two or more people whenever possible. However, problems may arise when those involved are not used to working together or as part of the team. There may also be an issue concerning who is in charge as well as problems associated with differing statures or abilities. It is vital that all members of the team should have adequate space to move easily and that all members can see where they are going. All members should be able to take a secure grip so that they will not suddenly lose grip causing the load to shift. Individuals should be able to get close enough to the load to hold it close to their bodies without stretching or twisting. Whenever possible, teams should practice together and should be made aware of the team leader’s commands so that they can lift smoothly together. When giving commands the leader should avoid a command such as one – two – three etc as individuals may misinterpret them, some lifting on three and some after. It is better to use commands such as:”ready – steady – lift”

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Moving & handling Basic lifting technique Plan before you start the lift ▪ Do you have to make the lift at all? ▪ Can you use any handling aids to make the lift easier or safer? ▪ Will help be needed and is it available? ▪ Is the load an awkward shape or badly balanced? ▪ Is the load hot, sharp or otherwise dangerous to handle? ▪ Where is the load being moved to and where will it be placed? ▪ Is the route clear? ▪ Can you rest the load on a raised surface to readjust your grip if necessary? Prepare ▪ Stand with the feet shoulder width apart. ▪ One foot slightly forward and alongside the load if possible. ▪ Be prepared to move your feet during the lift to maintain your balance. ▪ Ensure you are wearing suitable footwear with good support and grip. ▪ Ensure that clothing or personal protective equipment will not impede the lift. Get into position ▪ Bend the knees to get down to the level of the load. ▪ This keeps the centre of gravity of the body low down toward the pelvis. ▪ This makes the body more stable and reduces strain on muscles and ligaments. ▪ Keep the back balanced rather than rigid. ▪ Slight bending of the back, hips and knees is better than fully flexing the back (stooping) or fully flexing the hips and knees (squatting).


Moving & handling Basic lifting technique Get a grip ▪ Tilt the load slightly away from you and grasp the corner closest to you. ▪ With your other hand grasp the opposite corner furthest from you. ▪ Get the load as close to your body as possible. ▪ Be careful not to bend your back while lifting. ▪ This can happen if your legs start to straighten before the load begins to move.

Keep the load close ▪ Before starting the lift breathe in through the nose and then as you lift breathe out through the mouth. ▪ There is a tendency to hold your breath whilst lifting but this causes tension, so keep breathing during the lift which will help you to keep relaxed. ▪ Keep the load as close to your body as possible while lifting and carrying. ▪ Keep the heaviest side of the load next to the body.

Avoid twisting the back ▪ Especially when the back is bent in lifting. ▪ Shoulders should be kept level and facing in the same direction as the hips. ▪ Turning by moving the feet is safer than twisting and lifting at the same time. ▪ Keep movements as smooth as you can and avoid jerking.

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Moving & handling Basic lifting technique Heads up ▪ Walk steadily, keeping the load as close to your body as possible. ▪ Keep your head up. ▪ Avoid looking down at the load. ▪ Keep moving smoothly. ▪ Don’t attempt to lift or handle more than you can easily manage. ▪ Be aware of where you can safely rest the load should you need to.

Put the load down ▪ Putting the load down should be a reversal of lifting it. ▪ Keep the load close to the body and use your legs rather than shoulders and arms. ▪ If precise positioning of the load is necessary, put it down first and then slide it into the desired position. ▪ Be aware of the risks of static loading.

Remember There is a difference between what you can lift and what you can lift safely!


Moving and handling Moving and handling Moving and handling people is a form of manual handling and is covered by the same legislation. It differs from other manual handling tasks because it has an element of risk to the employee but also offers an element of risk to the person being moved. In the past, people handling skills have focused on health care professionals working in hospitals, but with more care taking place in the community the risk is now more widespread. When working in the community, employees will probably have to cope with less than ideal conditions in terms of space, access to beds, fixed height beds,, availability of mechanical aids and also the availability of help. The aim of this training is to provide the basic knowledge necessary for the employee to reduce the risk of injury to themselves and to those in their care.

Policy An organisation’s policy on the manual handling of people must: ▪ meet the requirements of the MHOR 1992. ▪ be written clearly and in such a way that it is easily understood by everyone involved. ▪ be available to all of the staff that are affected by it. ▪ be written in such a way that it can be easily enforced. ▪ be regularly revised and updated, at least annually, either by adding further information as an insert or by reprinting the entire document. ▪ The policy should address the issue of whether to move people manually or with equipment. ▪ The policy should promote the independence and dignity of those receiving care, as well as the health and welfare of those providing it. The following issues will need to be addressed: ▪ General risk assessment. ▪ Individual risk assessment. ▪ Principles of safe practice. ▪ Training requirements. ▪ Methods of monitoring effectiveness.

Training ▪ Provision of suitable training is fundamental to implementing policy. ▪ Training programs should incorporate the aims and expected outcomes of the organisation. ▪ An appropriate amount of time must be allocated. ▪ The training should be to recognised standards. ▪ The training should be available to all members of staff involved in moving and handling of people. ▪ All managers of staff involved in moving and handling should receive training in risk assessment. ▪ A record should be kept of staff who have attended training.

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Moving & handling Risk assessment Risk assessment is undertaken to identify potential risk so that preventative measures can be put in place to make the situation as safe as possible. Risk could be categorised as:

High

Harm is likely and injury would be severe.

Medium

Harm is likely and injury would be significant.

Low

Harm is possible but unlikely.

High-risk activity requires immediate action to reduce the level of risk.

Care plans These are produced by the employer based on the findings of the risk assessments. They apply to each individual client and every client must have their own care plan. The relevant part of the care plan, that which covers safety and moving and handling, must be made available to you before you commence any handling of the client. This care plan forms your safe working system when dealing with that client. It should identify the handling tasks and safe methods for performing those tasks. Where a particular method or mechanical aid must be used it would be identified in this document. Remember that this is your safe system of work, you are obliged by law to follow these instructions. You should have time to inspect this document and discuss its contents with your manager or supervisor before meeting the client for the first time. This is the opportunity to identify and discuss any problems or issues you may have with the content.

Risk assessment-TILEE TILEE stands for: Task – what you have to do. Individual – about the person performing the task (you) Load – about the person to be moved. Environment – the area in which the task is to be performed. Equipment – what, if any, equipment is to be used. This part of the risk assessment is designed to help you to identify situations that may be dangerous or to allow you to think through the task before starting.


Moving & handling Risk assessment-TILEE Moving and handling of people is particularly difficult because: ▪ people are heavy and may be difficult to grasp. ▪ people may make sudden movements and may suddenly become unstable. ▪ people have a mind of their own. ▪ there is a risk of injury to the person being handled as well as to the handler.

Task ▪ ▪ ▪ ▪

How far do I have to move the person? Where am I moving them to? Will I be able to move safely through all parts of the lift? Do I have to bend, stretch or reach

Individual ▪ ▪ ▪ ▪ ▪

Have I performed this task for this person before? How am I feeling? Do I have any health or pain problems? Am I suitably dressed for the task? Have I been trained for this task?

Load Overall weight to be moved? Any constraints from injury or pain? How much can the subject assist themselves/level of independence? Any behavioural constraints? Clothing or attachments?

▪ ▪ ▪ ▪ ▪

Environment Is there enough room to perform the movement safely? Is the floor clear? Is the floor slippery? How and where will I put the person down? Are there changes in levels to negotiate? Can I see where I’m going clearly?

▪ ▪ ▪ ▪ ▪ ▪

Equipment ▪ ▪ ▪ ▪ ▪

What equipment is required? Is it properly maintained and free from defects? Have I been trained in its use? Are any additional pieces that I may require close to hand? Is the equipment being used for its intended purpose?

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Moving & handling Condemned moves In recent years certain moves have been condemned as potentially hazardous for the carer or client. In particular, no one should now be attempting to lift all or most of a client’s weight with any lift. Current best practice suggests that the following lifts or moves should no longer be used. ▪ The drag lift – includes any move where the carer uses the client’s armpit to move or to lift. ▪ The orthodox lift. ▪ Any lift where the client places their arms around the carer’s neck. ▪ Any lifts with pole and canvas. ▪ Any form of “Australian” lifts. ▪ Horizontal lifts using handling slings. ▪ Any “through arm” moves. ▪ Pivot transfers. ▪ Standing transfers using “bear hugs”. ▪ Drag lifts from seat to standing. If you are unsure about what you are being asked to do then check with a manager or supervisor who has had up-to-date training.

Communication Moving or lifting people requires that you get very close to them and touch them in a way that may make them feel frightened or uncomfortable. Their natural reaction would be to tense up and possibly pull away from you. If they do this whilst you are trying to move or lift them then this could lead to injury, if there was a sudden change in the position of the load. To avoid this it is vital that you communicate your intention to the client and make sure that they have understood you. ▪ Before doing anything tell the client what you intend to do. ▪ Discuss with them what help they can give you and ask what help they feel that they need from you. ▪ Explain clearly to them what the procedure will consist of and what commands will be given and check that they have understood. ▪ Think about alternative methods of communication if the client’s condition dictates it (deaf, partially sighted etc). ▪ Think about your tone of voice and body language. Clients with comprehension difficulties or dementia may pick up on these signals and misunderstand the situation. ▪ Ask the client (or others) if there are any new problems you need to be aware of, such as pain or sensitive areas of skin. ▪ Encourage the client to help in the movement as much as possible, even though this may take longer than doing it yourself. This helps to maintain the client’s independence and may reduce the physical effort required from you.


Moving & handling Mechanical aids When you have a new client who uses a mechanical aid, or when a new mechanical aid has been provided to a client, you should receive training in its use. Be wary of using new equipment based solely on instruction from a colleague or the client themselves. Remember, you have a legal obligation to take reasonable precautions to protect the safety of yourself and others. You are obliged to follow the instructions issued in the care plan.

Small handling equipment A range of small handling equipment is available to make the handling of people safer and easier. Many of the handling techniques used in the training involve the use of various items of small handling equipment. If you have clients that you feel would benefit from the provision of such equipment then you should approach a supervisor to get the clients needs re-assessed. Bed ladder A ladder made from strong material which is attached to the foot end of the bed. It enables clients with sufficient arm strength to sit up and lay down by pulling themselves up on the rungs. Fabric turntable Consists of two pieces of material joined at the centre. The fabric has low friction inner surfaces so that it can be used to enable the client seated upon it to turn more easily. Useful for getting in and out of bed or in and out of cars. May be used independently by the client or with the assistance of a carer. Handling sling A wide fabric strip with handles at each end. This enables carers to obtain good purchase at the client’s shoulders and is a useful aid for moves such as assisted sits. Normally used by two carers, the device should never be used for lifting.

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Moving & handling Small handling equipment Leg lifter Stiff sling similar to a large dog lead which has an open loop on one end. The client can hook this over their foot and use it to raise and move their legs on and off beds or wheelchair foot rests.

One-way glide sheet A special slide sheet which moves easily in one direction, but locks up in the other direction. It is useful for supporting clients in a sitting position when they may slide down in the chair. It also makes it easier for the client to reposition themselves. Handling belt A broad and strong padded belt that is fastened around the clients waist to provide a secure hand hold. It may be used in a variety of ways to assist sliding transfers and to offer support to stand and walk. It should never be used as a lifting device.

Transfer board These are wooden or plastic boards with a smooth low friction surface. They allow a client with good sitting balance to transfer from wheelchair to bed or chair to chair etc by sliding along them from one end to the other. It may be used if the client has good arm strength and balance. Hand blocks These are flat bottomed plastic handles for use in bed. They enable clients who have sufficient upper body strength to reposition themselves in bed by pushing down onto the bottom sheet. They have a non-slip lower surface and they add length to the client’s arms, making their efforts more efficient and more effective.


Moving & handling Sit to stand For most people, standing up from a sitting position is a common movement, performed automatically, but for individuals with decreased mobility it may present many problems. Assisted standing is probably the most common procedure carried out by carers. If performed badly it offers a risk of injury to the client and to the handler. Things to consider before assisting to stand would be the individual’s personal symptoms such as reduced balance, reduced muscle tone or strength and reduced joint mobility. Other factors may include the type of seating (chair, bed, toilet etc) the amount of space and the attitude and training, if any, of the handlers. The individual should be encouraged to be as independent as possible and in some cases all that may be required would be raised seats or handrails. Where assistance is required this should,after proper assessment, be appropriate to the individual’s needs.

Unassisted sit to stand

The person should be mobile enough to move themselves to the edge of the seat, to move their feet and to take their full weight when standing. They move their bottom closer to the front of the chair and lean forward. The position of the upper body is adjusted so that the centre of gravity is over the feet. By pushing onto the arms and straightening the legs the centre of gravity is moved forward and upward, into the standing position.

Sit to stand - minimal assistance The person must be able to place their full weight on their feet and balance once standing. They move their bottom forward on the seat and place their hands on the arms of the chair. The feet should be moved into position to allow them to take their weight on standing. The handler adjusts their own feet into the step position, one foot in front of the other, facing in the direction of movement.

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Moving & handling Sit to stand - minimal assistance, continued

The handler faces the direction of movement and places their nearest arm across the client’s back at around waist height, leaving the hand open against the back. They should not grasp the person or clothing. They should ensure good contact between their arm and the person’s back. The handler’s other hand can be placed onto the front of the nearest shoulder for guidance. The handler should tell them to lift their head and to lean forward to start the standing movement. At the same time the handler should push on to their back to assist in the normal standing movement. The handler should use their own weight to guide them forward and upward, transferring their weight from the rear foot to their front foot. Once the move is completed the handler should move their feet to stand at the side of them. The transfers may be carried out with the use of handling belt The handler may wish to use a forearm or hand support if the client finds that more comfortable.

The handler may perform the transfer from either side of the client. The most important part is the forward and upward pressure on the person’s back as they rise into the standing position.


Moving & handling Sit to stand - two helpers The person must be able to place their full weight on their feet and to balance once standing. They move their bottom forward on the seat and place their hands on the arms of the chair. Their feet should be moved into position to allow them to take their weight on standing. The handlers adjust their own feet into the step position, one foot in front of the other, facing in the direction of movement. The handlers face the direction of movement and place the nearest arms across the person’s back at around waist height, leaving their hands open against the back. They should not grasp the person or clothing. They should ensure good contact between their arms and the person’s back. The handlers other hands can be placed onto the front of the nearest shoulder for guidance. The handlers should tell the client to lift their head and to lean forward to start the standing movement. At the same time the handlers should push onto the person’s back to assist in the normal standing movement. The handlers should use their own weight to guide the person forward and upward, transferring their weight from the rear foot to the front foot. Once the move is completed the handlers should move their feet to stand at the side of the person.

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Moving & handling Using a slide board

Slide boards allow for sliding in a seated position from one seat to another, or between a bed and seat. ▪ Remove one armrest and the leg rests from the wheelchair and apply the wheelchair brake. Lay the board securely across the gap between the chairs. ▪ Keep the gap between the two surfaces as small as possible. ▪ The board should be fitted under one buttock and the client supports themselves with one hand on the further end of the board or chair seat. They should push themselves across a bit at a time. ▪ When they reach the other chair they grasp the armrest and pull themselves into position. ▪ The board can then be removed from under them and they can be made comfortable. ▪ The same technique can be used to transfer between chair and the bed.

Slide Sheets A slide sheet is a smooth low friction sheet of material designed to be used beneath the person in bed and to help them slide over a surface instead of being lifted or dragged. They come in various sizes and may be used in pairs or singly. Some come with handling loops sewn into them to help the handler to grasp them securely

Slide sheets - uses ▪ ▪ ▪ ▪ ▪

To help people to remain independent and mobile in bed To move persons up in the bed. To turn persons on to their side. To help in lateral transfers from bed to stretcher. To move persons who may have fallen into awkward spaces to open space where mechanical aids may be used.


Moving & handling Slide sheets – advantages ▪ Comfort and simplicity in use. ▪ Sliding a person is generally easier than lifting and reduces the likelihood of injury to individual and handler.

Slide sheets – disadvantages ▪ Heavy individuals may still require excessive force to move them. Mechanical hoists may be more appropriate. ▪ A badly performed slide may turn into a lift. ▪ Infection control may be an issue when the same sheet is used for more than one person. ▪ Slide sheets do not bridge gaps and may have to be used in conjunction with a slide board. ▪ Sliding may cause pain or discomfort for some individuals. ▪ There may be extra effort and handling tasks in order to position the sheet underneath the person.

Using a slide sheet Slide sheets may be found in tubular or roller form. These have low friction inner surfaces that glide easily over one another. Some roller sheets have a one way slide so they move easily in one direction but not the other. This would help in moving a person up in the bed or chair but prevent them from sliding back down. An independent person can use a roller slide sheet to move themselves up in bed, particularly if used in conjunction with bed blocks to give more grip.

Slide sheets can be used in lateral transfers from one surface to another, as from a bed to a stretcher. A PAT slide would be used to bridge the gap between the two surfaces.

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Moving & handling Positioning a slide sheet

▪ The person is carefully rolled onto their side using a log rolling technique. ▪ The sheet is rolled lengthways to approximately half its width and the rolled edge is tucked beneath their back. ▪ They are then gently rolled back over the folded part of the sheet. ▪ The folded part is then gently pulled through, leaving the person lying centrally on the sheet.

Using a slide sheet and PAT slide ▪ Position the person on a full-length slide sheet. ▪ If a pillow is used, make sure that the slide sheet is beneath the pillow. ▪ Adjust the height of the bed to the height of the trolley if necessary. ▪ Tip the person slightly and insert the edge of the PAT slide beneath them and the slide sheet. ▪ Move them back so that they are lying half on the PAT slide. ▪ Attach extension handles to the slide sheet. ▪ Bring the trolley into position next to the bed. ▪ Ensure that you apply the brakes to both bed and trolley. ▪ The handler at the head gives verbal commands. ▪ The handlers tension the pulling straps and inform the person that the movement will start.


Moving & handling Using a slide sheet and PAT slide ▪ By leaning back the handlers can use their body weight to slide the person onto the trolley. ▪ Once the person is on the trolley the handlers use the slide sheet to complete the movement. ▪ The PAT slide and slide sheets can now be removed and the person made comfortable. ▪ Keep movements smooth and gentle. ▪ Avoid sudden or jerky movements as these are more likely to cause injury to the handlers and to be less comfortable for the person being moved. ▪ Always ensure that brakes are applied and working effectively. ▪ If either the bed or trolley should move during the transfer, the risk of dropping the person onto the floor is high.

Using a STEDY To use this equipment the person needs to be able to sit unsupported, to pull themselves into a standing position and to balance and support their weight when standing. There must be adequate space around the bed or chair and the area should be free of obstacles.

▪ The STEDY is positioned directly in front of the person, the seat flaps are lifted and they place their feet on the foot platform. ▪ The brakes of the STEDY are engaged and the handler supports the STEDY using the handgrips. ▪ The client should grip the coloured bar in front of them and lean forward, bringing themselves into a standing position and bringing their knees into contact with the knee support pad. ▪ The flaps of the seat should be lowered allowing them to sit.

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Moving & handling Using a STEDY ▪ The STEDY can then be manoeuvred carefully by the handler using the handgrips. ▪ The handler should use appropriate pushing and pulling techniques to avoid personal injury. ▪ Movements should be slow and steady to allow the person a feeling of security and safety. ▪ Position the STEDY so that the backs of the person’s legs are touching the front of the chair. ▪ Apply the brakes and ask them to stand by pulling on the coloured hand bar. ▪ Once standing the seat flaps can be raised. ▪ They now lower themselves onto the seat of the chair, supported by the hand bar or possibly by the arms of the chair. ▪ Before moving the STEDY away make sure that they are not holding on to it and that their feet are not on the foot rest.

Using an active hoist To use an active hoist the person must be able to stand and support their weight as well as to be able to sit unsupported. The hoist will have a footplate, knee support and handholds for the person to support themselves. There will also be a sling that goes behind their back to support them Place the sling in position behind their lower back. Bring the hoist into position in front of them. Ask them to place their feet on the foot rest. Apply the hoist’s brake. Ask them to grasp the hoist’s handholds. Raise the hoist until they are standing upright. Release the hoist’s brake and using correct pushing/pulling techniques move the hoist into position. ▪ Reassure them during the manoeuvre and check that they feel secure at all times. ▪ ▪ ▪ ▪ ▪ ▪ ▪


Moving & handling Hoists The use of mechanical or powered hoists, together with appropriate slings, can encourage independence and contribute to the dignity of the individual, as well as reducing the risk of strain or injury to the handler. It is important that the correct hoist and sling combination is used and that users are well-trained and competent. The use of hoists and slings is covered by legislation: PUWER1998 (provision and use of work equipment regulations) LOLER 1998 (Lifting operations and lifting equipment regulations)

Ceiling track Hoist Traditional ceiling hoists run along permanently fixed tracks, so they offer less flexibility in use than a mobile system. On the other hand, they do not occupy floor space as a mobile hoist does, and they may be operated by the user independently – which is not possible with any floor standing system. They are generally less arduous for a carer to operate than a mobile hoist and are more suitable for longer distance transfers. Thought also needs to be given to structural considerations: ceiling joists may need to be reinforced and doorways altered to accommodate the track. Ceiling track systems may either have a permanently fixed hoist or a portable one that can be detached and carried by the operator to be used on another track elsewhere in the building, particularly useful in nursing home environments. The hoist unit may be quite heavy to move around though – portability is a relative concept! Many ceiling track systems are powered by mains electricity for the transfer, with either a manual or powered raising and lowering mechanism. There will either be a battery backup for emergencies, or a manual wind down facility, to enable the client to be lowered to a flat surface. Alternatively, the system may be powered by rechargeable batteries– which is useful in that it is independent of the power supply and also removes the need for a cable running along the track to provide power to the hoist from the mains. The disadvantage is that the batteries need to be kept well charged up, by returning them to the charging point at the end of the track – and it is quite easy to forget to do this.

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Moving & handling Portable overhead hoist (gantry hoist) A more portable alternative to a ceiling track hoist is also available in the form of a portable hoist and gantry arrangement, such as the one shown on the right. This is particularly suitable for situations where a hoist is required in a particular place for a short amount of time, such as when a disabled person is travelling, or perhaps for use by health professionals working in the community.

Mobile Hoist Being self-contained units, mobile hoists don’t require any track installation so offer more flexibility of use. They do, however, demand more of the carer and are not really designed for moving people long distances. A wheelchair or shower chair is better for this, or possibly a ceiling track hoist. In selecting a mobile hoist thought needs to be given to the environment where it will be used; whether there is enough room to manoeuvre it into the right position; if the legs of the hoist will fit under or around any furniture, such as a bed, bath or chair or whether the floor surface is smooth enough to allow it to operate easily. Thick carpet or threshold strips are difficult to move over. It is also important to check that they have sufficient operating range to lift the person clear of any surface and perhaps also to pick them up from floor level in an emergency. They will need to be stored when not in use, preferably in an area where they are out of the way and with a charging point for their battery. There are smaller mobile hoists with narrower bases which are easier to move in more confined areas. These have a maximum load of perhaps 100Kg or a bit more, and are useful in the domestic environment. Larger hoists which are capable of lifting up to 250Kg give more flexible hoisting in hospital and nursing home situations with a range of patients and more space to work with.


Moving & handling Hoist slings Selecting the right sling is as important as choosing the right hoist and equally requires careful professional assessment to ensure that the person is properly supported and comfortable and that the sling is suitable for the task being undertaken. Most hoist suppliers will provide a standard range of slings in different sizes, generally including hammock style, divided leg, toileting/access, dressing and amputee slings. It is also possible to have special designs made to order to suit an individual’s needs. There are specialist sling manufacturers who can provide slings for use with different manufacturers hoists: it is important to check compatibility as well as all the other factors. Slings that can be easily laundered and ones with a protective antibacterial coating are useful in multi-user facilities. Single user or disposable slings are becoming increasingly popular as a means of preventing cross contamination. The latest development in this area are made from 70% polyester and can therefore be used in baths and pools as they don’t disintegrate when wet. This means that the sling can be used throughout a patient’s stay in hospital for respite care, rather than being thrown away after a single use: much more cost-effective.

Deciding on a hoist There are numerous issues to take into account when assessing for a hoist: The tasks ▪ Activities – is the hoist needed for one particular task/transfer or several e.g. in and out of bed, on and off a chair? ▪ Is it for one transfer in a specific area or is flexibility important so that transfers can take place anywhere in the room? ▪ Frequency – is the hoist for emergency use only, e.g. lifting from the floor after a fall, or is it for daily use? The home environment ▪ Space – is there enough space to manoeuvre the hoist and user safely and easily? ▪ Furniture – will a mobile hoist base go around or under furniture? ▪ Floor surfaces – are these suitable to move a mobile hoist across? ▪ If these factors cause repeated difficulties, consider an overhead hoist that runs on a straight or curved ceiling fixed track.

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Moving & handling Deciding on a hoist (continued) The hoist user ▪ Type of disability – what is the person’s diagnosis and prognosis? ▪ Is their condition stable or likely to fluctuate or deteriorate? ▪ Size – check that the hoist and sling is suitable for the user’s size and weight. ▪ Confidence – is the carer confident in the use of specialist equipment such as hoists? ▪ Physical strength – consider the size and strength of the carer. It requires quite a lot of effort to turn and move a mobile hoist. ▪ If the person needs to be carried over a distance, it is advisable to use an overhead track hoist or specifically designed wheeled equipment.

Using a hoist Before using a hoist check: ▪ for signs of wear, damage, loose parts etc. ▪ that it is properly assembled with spreader bar properly fixed. ▪ the date of the last inspection. ▪ that the wheels and brakes are in proper working order. ▪ that the safe working load is not exceeded. ▪ the emergency stop and lower system is functioning correctly. ▪ the legs/chassis move and open correctly. ▪ that the handlers are trained in its use.

Transfer using a hoist

▪ The correct size and type of sling is selected and placed beneath the person, using the log roll technique. ▪ They are rolled back over the sling and the sling is pulled through. ▪ The various elements are adjusted for a comfortable fit.


Moving & handling Transfer using a hoist

▪ Leg straps are looped together to prevent slipping and over tightening. ▪ The spreader bar is positioned over the patient and the sling loops are securely attached. ▪ As the lift begins the slings are checked for fit and comfort.

▪ They can be steadied and manoeuvred using the handles attached to the sling. ▪ As they are lowered into the seat the head is steadied and supported to make sure that it does not come into contact with the spreader bar. ▪ Once the patient is safely seated the sling can be removed. ▪ This is done by shifting the person from side to side or backward and forward and sliding the sling carefully underneath.

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Moving & handling Fitting the sling to seated person

▪ Ask them to lean forward if possible and place the sling behind them. ▪ Push the sling down toward the seat of the chair and let them lean back against the sling. ▪ Carefully feed one leg piece under each thigh.

▪ Attach the sling to the spreader bar of the hoist. ▪ Take some weight on the sling and ask them if they feel comfortable. ▪ When they are happy, complete the transfer.


Moving & handling Assisting the falling person

If a person starts to fall it is best to let them slide gently to the floor. Do not try to hold them up but do try to slow the fall down to minimise any injury that may occur. ▪ As the person starts to slip do not attempt to grab their limbs or their clothing. ▪ Make sure that you are in a stable strong position with feet apart and well supported. ▪ Guide them toward you and let them slide down your body, if you can. ▪ Bend your knees and lower yourself to the floor with them. ▪ Just before they reach the floor, bend your knees further and try to support them against your legs. ▪ Support and protect the head.

Moving a person from the floor If they are not injured they may be able to get up again with minimal assistance from a carer. If they are not able to raise themselves with only minimal assistance then you will have to use a passive lift from a hoist or other lifting device. If they have fallen into an awkward place or confined space such as a bathroom, they may have to be moved to an open area where a lifting device can be used.

Moving a person from the floor– minimal assistance ▪ Ensure that they are uninjured and able to raise themselves with minimal assistance. ▪ Where available, fetch one or two chairs to give them something to support themselves on as they get up. ▪ Ask them to turn onto one side and bring themselves into a half sitting position.

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Moving & handling Moving a person from the floor– minimal assistance

▪ ▪ ▪ ▪ ▪ ▪

Bring the chair close to them so they can support themselves on the seat. Position the second chair behind them just touching their bottom. Tell them to bend one knee and place the foot flat on the floor. Encourage them to push up and backward to push their bottom onto the chair. You should hold the chair to prevent it from moving. Allow them some time to regain their composure before moving again.

Moving a person from the floor–passive lift ▪ Place the person on a sling and adjust the straps. ▪ Manoeuvre the hoist so that it reaches over the fallen person. ▪ Lower the spreader bar and connect the straps. ▪ Tell them that movement is about to begin. ▪ Raise the hoist slightly and check for comfort. ▪ Move them to a bed or chair as appropriate. ▪ Complete the transfer and make them comfortable.


Moving & handling The emergency lift cushion

▪ The inflatable emergency lift cushion consists of connected air cells made from very strong plastic material connected via tubes and valves to an electric pump. ▪ When unpacked it lays flat for easy insertion beneath the fallen person. ▪ Once inflated it will lift the person into a sitting position. ▪ Chamber connectors and inflation tubes are colour coded so that the chambers inflate in the correct sequence.

▪ ▪ ▪ ▪ ▪

Take the unit to the fallen person. Using a log roll technique place the flat deflated cells beneath them. Explain to them what will happen. Begin to inflate the cells in sequence. Continue to reassure them during the lifting procedure.

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Moving & handling The emergency lift cushion

▪ Continue to reassure the person as they are raised to a sitting position. ▪ They can easily be assisted to stand from this position. ▪ Heavy duty units are available for bariatric use.

Recovery from a confined space

People may fall into awkward or confined spaces making helping them difficult. They will usually have to be moved into a more open space where they can be assisted to stand or where a hoist can be used for a passive lift. This is most easily done by using a slide sheet. Once they are on the slide sheet, extension straps are fitted to the sheet handles. Using their body weight and leaning back the handlers can slide the person into an open area where access is easier.


Moving & handling Notes

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Moving & handling Notes


The

Moving and Handling Training Handbook Contains simple, accurate and up to date information

Conforms to all latest guidelines Filled with clear, easy to follow illustrations and photographs Popular with instructors and students alike Ideal as an ongoing reference book


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