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Policy: M5 - West London Mental Health Trust

1. In an environment where the patient is on a fixed low bed with access on one side only the carer may put one knee on the bed and use either of the above procedures dependent upon their maintenance of good posture 6 2 Lying to sitting on the edge of the bed Ask the patient to do as much as possible for themselves but where necessary and appropriate use one or two carers to assist The patient rolls on to their side and swings their legs over the side of the bed The patient can then push up using their arms into a sitting position Where assistance is required roll the patient as in the standard procedure but with both of the patients legs raised bent The patient slides their feet over the side of the bed the carer places one hand under the patients shoulder between shoulder and bed and one hand on the patient s hip thigh The patient is moved into a sitting position by the carer transferring weight from leg to leg in the direction of the foot of the bed At the same time the carer transfers their body weight through patient s hip thigh This manoeuvre will swing the patient s legs around and down their upper body following into a sitting position The emphasis on the weight transfer should mean that almost all the force exerted goes onto through the patient s hip thigh and therefore minimal effort is required from the carers hand under the patient s shoulder i e The carer is NOT lifting the patient up by their shoul
2. Musculoskeletal Disorders Musculoskeletal disorders MSDs are problems affecting the muscles tendons ligaments nerves or other soft tissues and joints The back neck and upper limbs are particularly at risk West London Mental Health NHS Trust Page 6 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 5 1 5 2 5 3 ii vi 5 4 Duties Chief Executive The Chief Executive is responsible for ensuring that the Trust has policies in place and complies with its legal and regulatory obligations Accountable Director The accountable director is responsible for the development of relevant policies and to ensure they comply with relevant standards and criteria where applicable They must also contain all the relevant details and processes as per Policy P3 They are also responsible for trust wide implementation and compliance with the policy Managers Managers are responsible for organising their service s activities in such a way that so far as is reasonably practicable they avoid the need for manual handling activities If manual handling cannot be avoided then carrying out a suitable and sufficient risk assessment of the manual handling activity for the purposes of identifying what needs to be done to control the risks arising effectively This includes recording the significant findings of the risk assessment and reviewing the assessment both periodically and when it i
3. Even operations lying within the boundary mapped out by the guidelines should be avoided or made less demanding wherever it is reasonably practicable to do so 2 Lifting and Lowering Women Shoulder height Shoulder height i Elbow height Ebow height Knuckle height Knuckle height Mid lower leg height Mid tower leg height Figure 1 Lifting and lowering Observe the Lifting and Lowering work activity being assessed and compare it to the diagram First decide which box or boxes the lifter s hands pass through when moving the West London Mental Health NHS Trust Page 17 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 load Then assess the maximum weight being handled If it is less than the figure given in the box the operation is within the guidelines If the lifter s hands enter more than one box during the operation then the smallest weight figure applies An intermediate weight can be chosen if the hands are close to a boundary between boxes The guideline figures for lifting and lowering assume a the load is easy to grasp with both hands b the operation takes place in reasonable working conditions and c the handler is in a stable body position If these assumptions are not valid it will be necessary to make a full assessment as in Appendix 2 The basic guideline figures for lifting and lowering in Figure 1 above are for relatively infre
4. a relatively infrequent up to approximately 30 operations per hour or one lift every two minutes and b there are no other posture problems then the guideline figures in Figure 1 above can still be used but with a suitable reduction according to the amount the handler twists to the side during the operation As a rough guide If handler twists through Guideline figures see from front Figure 1 should be reduced by 45 10 90 20 Table 2 Reduction factors for twisting and turning Where the handling involves turning ie moving in another direction as the lift is in progress and twisting then a detailed assessment should normally be made West London Mental Health NHS Trust Page 19 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 4 Guidelines for carrying The same guideline figures above used for lifting and lowering see Figure 1 above can be applied to carrying operations where the load is a held against the body and b carried no further than about 10 m without resting Where the load can be carried securely on the shoulder without first having to be lifted as for example when unloading sacks from a lorry the guideline figures can be applied to carrying distances in excess of 10 m A more detailed assessment should be made for all carrying operations if a the load is carried over a longer distance without resting or b the h
5. the patient may grab hold of the carer s hand arm shoulder neck and cause an injury If the patient is unable to get off the floor make them comfortable with pillows and blankets When the patient is able to be moved safely clear the area West London Mental Health NHS Trust Page 48 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 If necessary slide the patient into a space that allows for easier access for the hoist A minimum of three carers will be required to perform this task Place a pillow under the patient s head and an evacuation sheet blanket or bed sheet under the patient s body by rolling using the standard procedure See section 6 1 One carer protects the patient s head two carers pull the blanket at the patient s feet if the feet are nearest to the exit This should be done with the carers standing with their knees bent and their backs straight not twisted If the patient s head is nearest the exit the blanket is pulled out head end first Once the patient is appropriately positioned use a hoist to return the patient to their bed chair Insert the hoist sling by rolling the patient using the standard procedure See section 6 1 Position the hoist The patient s legs may have to be raised to enable the sling to be secured to the hoist Raise the patient from the floor ensuring that they are in a sitting position Do not attempt to take the weight of
6. 4 2 7 4 3 7 4 4 7 4 5 8 1 8 2 Manual Handling Aids and Equipment The correct equipment should be used to assist in moving and handling activities and to perform lifting operations When selecting equipment you should consult widely and take advice in particular from the equipment supplier on its suitability for the manual handling activity or lifting operation The managers and supervisors of equipment users must give those users suitable and sufficient information instruction and training on how to use the equipment safely and by doing so ensure they are competent to use the equipment safely Information instruction and training can usually be obtained from the equipment supplier That equipment must be adequately maintained its maintenance documented in accordance with the supplier and manufacturer s instructions to ensure it remains safe and without risks to health All services should maintain an up to date list of all such equipment i e an asset register for the purposes of facilitating this maintenance Any equipment associated risks should be escalated and included in the relevant workplace risk register Training All staff will receive training in moving and handling in accordance with the Trust s Mandatory Training policy M12 In particular they will receive I manual handling information during their Induction programme which is designed to inform them of the existence of this policy and som
7. 6 This should be amended as the patient s condition changes From this assessment the correct transfer technique and the most appropriate equipment is used 1 5 Patients who can stand but have difficulty turning or taking steps There are three methods that may be considered depending on the assessment of the patient 1 Patients who use a transfer board should be assessed by a therapist Place the chair at 60 to the bed Place one end of a transfer board under the patient s thigh nearest the chair and the other end position onto the chair The patient should reach across to the far arm of the chair and slide their bottom along the board until safely positioned in the chair These patients should have good sitting balance and upper body strength 2 A turntable may be used for patients who can stand and have a good balance but are unable to take steps 3 Stand Aid or Hoist 1 6 Patients who are unable to weight bear These patients must not be moved manually There are only two methods to be considered The use of a hoist stand aid The use of a transfer board if assessed as safe to do so 1 7 Toileting a patient It is a very high risk activity to support a patient whilst attempting to attend to their hygiene and or rearranging their clothing Carers must not hold a patient up whilst performing this activity To reduce the risk Always refer to the patient s Moving and Handling Risk Assessment If assessed as n
8. 8 Insufficient recovery time Give individuals control of start stop process 9 Work rate imposed by Rest time process Breaks to complete other tasks to reduce fatique Avoid lifts from floor level Swivel action seats that are secured on floor that can be adjusted to suit height of task 10 Handling whilst seated Ensure loads do not weigh over 3kg for a women and 5kg for a man West London Mental Health NHS Trust Page 32 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 Is the LOAD Control measures to be implemented 11 Heavy Ensure loads do not weigh over 16kg for women and 25kg for men at knuckle height Ensure loads do not weigh over 10kg for women and 15kg for men at elbow height Maximum weight limitations will be needed to be reduced by 30 where operation is repeated once twice a minute or by 50 where operation is repeated five to eight times a minute and by 80 for operations repeated more than twelve times a minute 12 Bulky unweildy Repackage item consider possible use of handles Divide load into more manageable pieces Consider team handling 13 Difficult to grasp Same controls as above 14 Unstable or and unpredictable Move in a safe environment good conditions not snowy windy etc Use slings or other aids for more effective control Ensure containers holding li
9. s shoulder and hip level and performs a weight transfer manoeuvre by stepping backwards on the command GO with the other two carers moving as above If a fourth carer is available they stand at the receiving side of the bed and when the patient is in mid position they can grasp the sheet at the patients shoulder and hip level and weight transfer backwards completing the manoeuvre If the transfer board is not immediately and easily removable move the bed away from trolley roll the patient off the transfer board in the standard manner and the other carers pull out the transfer board 10 0 30 Tilt Preston K W 1988 If a patient needs to be turned regularly for relief of pressure areas 30 tilting should be used by the following Three soft pillows are needed to support the trunk and lower limbs plus a minimum of two are required for the head and neck Place the patient centrally in the bed in the recumbent or semi recumbent position West London Mental Health NHS Trust Page 54 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 The assisting carer tilts the patient away from them using the standard procedure for rolling the roll only requires to be approximately 30 The first pillow is placed length ways at an angle of approximately 45 with a comer of the pillow positioned carefully to fill the small of the back Do not over do this a pillow depth of 1 5 2 is
10. the Patient is in Bed Ask the patient to do as much as possible to help e g use a monkey pole or ask the patient to bridge i e The patient lies on their back both knees flexed feet flat on bed forearms and hands flat on bed palms down The patient pushes down on their hands and feet to raise their hips A patient can be rolled on to a bedpan Hand blocks If this is not possible the hoist must be used Do not attempt to lift the patient onto the bedpan 9 0 Bed to Bed Bed to Trolley Trolley to Bed Assess the patient and if fully co operative and fully conscious encourage them to transfer independently If not use the following procedure West London Mental Health NHS Trust Page 53 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 Obtain a transfer board Minimum of three carers Remove the head of the bed The patient should be off centre in the bed towards the side that they are going to transfer from Place the transfer board under the patient by rolling using the standard procedure i e push do not pull the patient into the recovery position If the patient is lying on a narrow surface it may not be safe to use the standard procedure In this case carers should use the Alternative Procedure Place the transfer board under the patient and bed sheet draw sheet Leave enough of the transfer board exposed so that a safe and effective bridge is made b
11. under the patient Repeat manoeuvre from other side of bed to unroll the rest of the slide sheet 8 3 To position a Slide Sheet under a Patient with Three Carers One standing at the head end of the bed facing the foot end with the backrest off This carer grasps the upper part of the slide sheet or the top slide sheet if using two large open types at either side of the patients head just above their shoulders The carer supports the patient s head Ensure that any stack in the slide sheet is taken up One on each side of the West London Mental Health NHS Trust Page 52 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 patient facing each other These carers grasp the upper part of the slide sheet or the top slide sheet if using two large open types at points level with the patients shoulders and hips Ensure that any slack in the slide sheet is taken up All carers hold the slide sheet dose to the patient s body unless doing so means that any carer compromises their posture by over stretching In which case grasp the slide sheet in a position most comfortable for the carer The carer at the head end places one foot behind the other adopting a wide base ready to perform a backwards weight transfer manoeuvre in the direction of the move The carers at each side of the patient bend their knees and adopt a wide base ready to perform a sideways weight transfer manoeuvre in the
12. usually adequate Gently allow the patient to roll back onto the pillow Check that the patients shoulders and thoracic spine are supported The patients leg on the same side as the inserted pillow is supported next using a pillow under its entire length the pillow being moulded around the limb with the patients heel extending over the end to prevent heel pressure The third pillow is inserted at an angle to support the other leg from the back of the knee to the ankle leaving the heel unsupported Acarer can check that there is a clearance between the patient s sacrum and the mattress by checking with their flattened hand it should be easy to put a hand in the slight gap created Support for the feet may be necessary to prevent foot drop 11 0 HOISTING PRINCIPLES i Unless otherwise dictated by the patient s risk assessment care plan use a minimum of two carers when hoisting ii Storage not in use Ensure the brakes are on when the hoist is not in use Ensure electric hoists are left on charge when not in use iii Safe Working Load SWL This should be clearly marked on every hoist If in doubt check with the manufacturer Never use a hoist to lift a patient wno exceeds the safe working load iv Service checks Hoists and slings should be inspected twice a year v Moving a hoist Always push where possible and keep close to your body Mobile hoists are designed to transfer patients they are not designed to
13. worker to the job Load a discrete movable object Moving Manual handling the transporting or supporting of a load by human effort It includes the lifting putting down pushing pulling carrying or moving there of by hand or bodily force Musculoskeletal Disorders Musculoskeletal disorders MSDs are problems affecting the muscles tendons ligaments nerves or other soft tissues and joints The back neck and upper limbs are particularly at risk West London Mental Health NHS Trust Page 14 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 MSD Musculoskeletal disorders CSU Clinical Service Unit NHSLA National Health Service Litigation Authority NHS National Health Service DoH Department of Health RCN Royal College of Nurses 14 Appendices Appendix 1 Risk Assessment filter Appendix2 Manual Handling Risk Assessment blank form Appendix 3 Manual Handling typical control measures for use with Appendix 2 Appendix 4 Safe Moving and Handling Guidance on lifting without mechanical aids Appendix 5 Content of Manual Handling training for inanimate and non violent animate loads Appendix 6 Patient Handling Assessment Appendix 7 Patient Assessments Appendix 8 Techniques for moving and handling of patients West London Mental Health NHS Trust Page 15 of 56 Policy M5 First date of issue February 2007 This is current ver
14. 1st review Name Signature Job Title Date 2nd review Name Signature Job Title Date West London Mental Health NHS Trust Page 41 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 Patient s Name Appendix 6 cont PATIENT HANDLING CARE TASKS PLAN PROFILE Assessment stage Initial 1st Review 2nd Review Reason for review Care task No of staff required Insert the method and or equipment to be used If a hoist is used enter the sling size amp measurement below Insert the method and or equipment to be used Insert the method and or equipment to be used Movement in Bed Into or out of bed Sitting up in bed Moving up the bed Turning in bed For Changing Washing Repositioning Sitting to standing Chair to chair commode Toileting Washing Bathing Mobilising Walking Emergency evacuation If a sling hoist is to be used enter here measurements of i for Liko Slings hip to hip ii for Arjo slings coccyx to top of head Handling plan completed by Initial review Name Signature Job title Date 1st review Name Signature Job title Date 2nd review Name Signature Job title Date West London Mental Health NHS Trust Policy M5 First date of issue February 2007 Page 42 of 56 Thi
15. Policy M5 First date of issue February 2007 Page 22 of 56 This is current version M5 07 June 15 Appendix 2 Premise details Name of assessor Date of assessment Lente Manual Handling Tasks Tasks Who might be Significant risk of injury harmed yes no more than dokas HOS pg porters Yes 2 e g moving office furniture e g porters Yes 3 etc etc 4 5 6 West London Mental Health NHS Trust Page 23 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 1 2 3 1 Holding the load away 4 from the trunk 5 6 1 2 3 2 Twisting stopping 4 5 6 1 2 Pe 3 3 Lifting or reaching 4 above shoulder level 5 6 1 2 3 4 Carrying long 4 distances 5 6 1 2 3 5 Strenuous pushing or 4 pulling 5 6 West London Mental Health NHS Trust Page 24 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 6 Unpredictable movements 7 Repetitive handling aJ eee eee ee ee ee eee 2 pT 3g To o T T CO 8 Insufficient recovery time 4 J PT s To o T T T e T ed To o To T o o o 9 Work rate imposed by process 10 Handling whilst seated West London Mental Health NHS Trust Page 25 of 56 Policy M5 F
16. Trust Page 55 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 and in particular the following Keep the load close Maintain good posture Push rather than pull Use your leg muscles to do the work Avoid twisting Do not lift Plan ahead Avoid unsuitable environments Wheelchairs should be treated as any other piece of moving and handling equipment staff should consider the following points before using one to move a patient Is the wheelchair suitable for the patient Is the wheelchair well maintained Does it need two people to push it Additional factors should be considered if the wheelchair is to be used outside of the clinical environment e g visits to the shopping facilities the Health Centre etc a risk assessment should be made to determine whether or not any of the following would pose a potential risk Has the vehicle been fitted with a suitable wheelchair access security system How far is the car park from your destination Are the weather conditions going to make it difficult to manoeuvre the wheelchair Will kerbs be a problem Is there suitable access Is it wide enough Is there a threshold doorsill Are there any obstacles to negotiate Are there suitable toileting facilities Are there ramps if so are they steep or slippery Will there be crowds Will it be noisy Will the lighting be adequate It is the responsibili
17. West London NHS Mental Health NHS Trust Promoting hope and wellbeing together Policy M5 Safer Moving and Handling Policy Version M5 07 Ratified by Trust Management Team Date ratified 3 June 2015 Title of Author Deputy Director of Nursing Forensic services Title of responsible Director Director of Nursing and Patient Experience Governance Committee Clinical Effectiveness amp Compliance Date issued 4 June 2015 Review date April 2018 Target audience All staff Trust wide Disclosure Status B Can be disclosed to patients and the public EIA Sustainability M5 EIA final 141124 BL M5 271114 doc Policy P3 Sustainable Other Related Procedure or Documents West London Mental Health NHS Trust Policy M5 First date of issue February 2007 Page 1 of 56 This is current version M5 07 June 15 Equality amp Diversity statement The Trust strives to ensure its policies are accessible appropriate and inclusive for all Therefore all relevant policies will be required to undergo an Equality Impact Assessment and will only be approved once this process has been completed Sustainable Development Statement The Trust aims to ensure its policies consider and minimise the sustainable development impacts of its activities All relevant policies are therefore required to undergo a Sustainable Development Impa
18. able intervals rovide appropriate signage to convey message Provide appropriate staff training 26 Be aware of the emergency procedures No child young workers under school leaving age shall be ernployed to do this work Young persons not to carry out any significant tasks unless it s part of their training they are supervised by a competent person and the risk has been reduced to a reasonable level Provide suitable training Parents quardians to be informed of the risks Provide specific required equipment 27 Young persons 18 years and under West London Mental Health NHS Trust Page 36 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 Keep records from worker s doctors of pregnanc Have on going discussions with the worker about their limitations and abilities throughout pregnanc Adapt the task to avoid standing for long periods at a time Review task in the last three months of pregnancy gradually removing the need for manual handling Liaise with the Occupational Health Service or the worker s doctor if more information is required 23 Pregnant Monitor health problems assessing their impact on the worker s ability to perform manual handling Consult the Occupational Health Unit Discuss the limitations and abilities of the worker with the person in question Stop the worker from completing the task Adapt the task to suit the needs of the handler Monitor the abili
19. ands are below knuckle height or above elbow height due to static loading on arm muscles 5 Guidelines for pushing and pulling For pushing and pulling operations whether the load is slid rolled or supported on wheels the guideline figures in the table below see Table 3 assume the force is applied with the hands between knuckle and shoulder height It is also assumed that the distance involved is no more than about 20 m If these assumptions are not met a more detailed risk assessment is required Load weight v Gender Men Women Guideline for stopping or starting a load Guideline for keeping the load in motion 20kg 15kg 10kg 7kg Table 3 Guideline figures for pushing and pulling a load As a rough guide the amount of force that needs to be applied to move a load over a flat level surface using a well maintained handling aid is at least 2 of the load weight For example if the load weight is 400 kg then the force needed to move the load is 8 kg The force needed will be larger perhaps a lot larger if conditions are not perfect e g wheels not in the right position or a device that is poorly maintained Moving an object over soft or uneven surfaces also requires higher forces On an uneven surface the force needed to start the load moving could increase to 10 of the load weight although this might be offset to some extent by using larger wheels Pushing and pulling West London Mental Hea
20. ary 2007 This is current version M5 07 June 15 Professional guidelines and code of practice NMC COT CSP Unison COR etc Safer Handling of People in the Community 1999 BackCare Revitalising Healthcare 2000 HSC Manual Handling Assessments in Hospitals and the Community 2003 RCN Guide MSIP A Practical Guide to Resident Handling 2004 Leicester City NHS Guidance for the Moving and Handling of Patients 2010 The following publications can be downloaded free of charge from the Health amp Safety Executive website see www hse gov uk Handling Home care HSG225 ISBN 9780717622283 Manual Handling Operations Regulations 1992 as amended Guidance on the regulations ISBN 071762823X Getting to grips with manual handling A pain in your workplace Ergonomic problems and solutions HSG121 HSE Books 1994 ISBN 0 7176 0668 6 Manual handling in the health services Third edition HSE Books 2004ISBN 0 7176 1248 1 12 Supporting documents trust documents This policy should be read in conjunction with the following Trust policies Care Programme Approach C2 Health and Safety H3 Incident Reporting and Management 18 Risk Management strategy and policy R1 Violence Reduction and Management V2 Managing health and attendance S8 13 Glossary of terms acronyms Ergonomics the science of matching a job to a worker based on the worker s physical abilities and psychological requirements rather than matching the
21. ated transfer from bed to chair chair to bed Transfer from chair to chair commode Transferring to toilet with minimal assistance Transferring to toilet using commode Lateral transfer board full length Straight and curved transfer boards Glide sheets Turntable Handling belt Stand and turn disc West London Mental Health NHS Trust Policy M5 First date of issue February 2007 Page 43 of 56 This is current version M5 07 June 15 4 Hoisting Fitting a sling with patient in bed Fitting a sling in bed using glide sheet Fitting a sling with patient in chair Fitting a sling in chair with glide sheets Hoisting from bed to chair Hoisting from chair to bed Hoisting patient from floor Use of stand aid hoist Transferring to toilet using stand aid hoist Transferring to toilet using sling lifting hoist Sling lifting hoist capable of lifting from the floor Stand aid hoist Slings various sizes West London Mental Health NHS Trust Policy M5 First date of issue February 2007 Page 44 of 56 This is current version M5 07 June 15 Appendix 8 TECHNIQUES FOR MOVING AND HANDLING OF PATIENTS 1 0 Commands Used When Moving and Handling Loads The command to be used when manoeuvring a patient is Ready Steady where the word Go is used in this procedure the operator should use an action word e g sit roll slide Using an action word helps the pa
22. ays weight transfer manoeuvre from leg to leg in the direction of the move their body weight going through the patient via their forearm thus assisting the patient to stand Alternatively the carer stands close to the side of the patient facing the same way as the patient The carer places their outside foot level with the patient s feet and the other comfortably behind adopting a wide base Placing their hands on the patient as above on the command GO the carer performs a forward weight transfer manoeuvre from leg to leg assisting the patient to stand If two carers are required one stands on each side of the patient and proceeds as above West London Mental Health NHS Trust Page 46 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 Where a handling belt is assessed as appropriate the same procedure can be followed holding onto the handles of the belt instead of holding the patient directly The carers must not use the handling belt to lift patients If the patient is not able to raise his bottom off the chair then a standing aid or hoist must be used A patient must not be supported in standing if they are unable to take any weight through their legs 1 4 Bed to Chair Chair to Commode Toilet to Wheelchair It is essential that an assessment of the patient s own capabilities is carried out and recorded on the individual patient Moving and Handling Risk Assessment form see Appendix
23. chair and so make the full move that much easier 1 3 Sitting to Standing A patient should be assessed for their ability to stand with or without assistance and an appropriate height chair should be provided Where appropriate the patients walking aid should be placed within easy reach of the operator To encourage independent standing ask the patient to Move their bottom forward in the chair Place their feet apart one foot slightly in front of the other Place their hands on the arms of the chair Ask the patient to look forward Ask the patient to lean forward so that their head is over their toes Arocking motion at this stage may help some patients rocking forwards in time with the commands Ready Steady The patient is instructed to push with their hands and stand up on the command Stand If the patient uses a walking aid the carer gives it to them after the patient has stood up 1 3 1 Where assistance is required The carer should stand on one side of the patient facing the patient side on The carer adopts a wide base placing one foot level with the patients feet The carer places one arm around the patient s waist or the flat of their hand in the small of the patients back and the other hand resting on the patients shoulder To do this the carer must bend their knees not their back _ The same procedure as above can then be followed On the command GO the carer performs a sidew
24. ct Assessment to ensure that the financial environmental and social implications have been considered Policies will only be approved once this process has been completed West London Mental Health NHS Trust Page 2of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 M5 Safer Moving amp Handling Version Control Sheet Version M5 01 M5 01 M5 02 M5 03 M5 04 M5 05 M5 06 M5 07 Date Title of Author Status Oct 07 Dir N amp F To ED 12 10 07 Dir N amp F consultation 06 02 08 Dir N amp F Revised policy in circulation 12 12 08 Head of Revised for Standards amp NHSLA Compliance Feb 10 Head of Health Policy reviewed and Safety 27 08 10 Head of Health Revised Policy and Safety Issued January Head of Risk Revised policy 2013 Health and Safety February Interim Deputy Reviewed policy 2015 Director of Nursing Comment Substantial revision to Policy Consultation period ending Minor amendments Significant revision Minor amendments to meet requirements in Policy P3 and to be NHSLA compliant Presented to Policy Review Group 17 August 2010 Approved Amended to meet requirements of latest version of Policy P3 and the 2012 13 NHSLA risk management standards For approval at January 2013 TMT Approved This policy is due for review in January 2015 It has been amended to ensure it reflects the latest version of reference materials and add
25. ctivity to be assessed is low risk the filter should quickly and easily confirm or deny this If using the filter shows the risk is within the guidelines you do not normally have to do any other form of risk assessment unless you have individual employees who may be at significant risk for example pregnant workers young workers those with a significant health problem or a recent manual handling injury However these filter guidelines only apply when the load is easy to grasp and held ina good working environment West London Mental Health NHS Trust Page 16 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 ii The filter is likely to be useful if a there is a strong chance the work activities to be assessed involve significant risks from manual handling or b The activities are complex In either of these cases using the filter may not save any time or effort so it may be better to opt immediately for the more detailed risk assessment see Appendix 2 iii The use of the filter will only be worthwhile if it is possible to quickly say within ten minutes assess whether the guidelines in it are exceeded Application of the guidelines will provide a reasonable level of protection to around 95 of working men and women However the guidelines should not be regarded as safe weight limits for lifting There is no threshold below which manual handling operations may be regarded as safe
26. der Always hoist if the patient is unable to assist 6 3 Lying to sitting in bed For the following manoeuvres the patient must have sitting balance If not then they must either be hoisted and or cared for in a profiling bed If the patient cannot sit up unassisted they may be able to use a Jacob s ladder or bed lever to assist them If not advise them to West London Mental Health NHS Trust Page 50 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 roll onto one side and then push themselves up into a sitting position If the patient is unable to do any of the above then use the following method Adjust the height of the bed so that the carers can comfortably adopt an upright kneeling position either side of patient facing the head of the bed their inside knees on the bed at the patients hip level The patients arms should be folded and their chin on their chest The carers outside hands go under the patients shoulder Prior to the manoeuvre advise the patient to breathe out on the command GO this will help to prevent them stiffening resisting the manoeuvre On the command GO the patient is moved into a sitting position by the carers sitting on their heels in a weight transfer manoeuvre If this has to be a regular occurrence for whatever reason then consider nursing the patient on a sheet and use this to sit the patient forward The carers take up position as abo
27. direction of the move avoiding twisting _ On the command GO slide the patient up the bed in short stages weight transferring from leg to leg in the direction of the manoeuvre Remove the slide sheet as above i e roll the patient from side to side An alternative method is to grasp the lower surface of the slide sheet s at the patient s ankles or knees and gently but firmly pull backwards towards the patient s head until the slide sheet s are removed Where a patient presents carers with infection control issues disposable single patient use slide sheets may be used if there are not enough normal slide sheets available to cover for the consequential laundry of infected equipment 8 4 To position a Slide Sheet under a Patient with two or four carers One carer on each side of the bed two carers on each side of the bed if four staff are available and now follow as above except that there is no carer at the head of the bed 8 5 Bed Bathing Sheet Changing Always get the patient to do as much as possible for themselves Aminimum of two carers are required if the patient is not able to assist in movement Ensure that the bed is at least at waist height When turning the patient use the standard procedure i e push do not pull the patient into the recovery position If this is either impractical or unsafe use the Alternative Procedures see Section 6 Avoid bending and twisting 8 6 Inserting a Bed Pan whilst
28. dling assessment and implemented the findings Only if it is safe to do so should you attempt to handle the load manually without aids Prepare the area and the load as usual see appendix 1 then prepare yourself Remove rings and watches prior to commencing any manual handling Ensure gloves are worn when handling sharp or slippery objects Keep your feet apart with one foot slightly in front of the other to provide better balance If the load is on the floor place your feet on either side of the load bend your knees and keep your back naturally erect i e spine in line N Grip the load with the whole of both hands ensuring you have a secure hold Then carry out the move N Hold the load as close to your body as possible bend your arms and keep them near to your body Only move the load when you are ready and have control Head to start the movement Look straight ahead Straighten your knees as you lift thereby using your leg muscles to aid the lift Keep your back naturally erect spine in line Rest the load on a firm object if it is necessary to change your grip whilst carrying the load When lifting or moving a load with another person Where possible choose someone of similar height and weight to yourself Make sure they understand what is going to happen and what is expected of them Identify who will lead the move Agree in advance and subsequently use clear commands using ready steady follo
29. e of its contents Il manual handling information during their local induction and Ill refresher training in accordance with the Trust s mandatory training matrix Any requests for specialist advice and any associated training should be made through the Learning and Development Centre see section 4 8 above Specialist advice can also be sought directly from appropriate national professional bodies such as the Royal College of Nursing RCN Monitoring Several performance measures will be used to monitor compliance with this policy The key measures are i managers carrying out manual handling risk assessments when they are needed and subsequently reviewing the assessment where is reason to believe circumstances have changed or in any event annually West London Mental Health NHS Trust Page 12 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 9 2 9 2 1 10 11 ii the implementation of action plans arising from manual handling risk assessment iii the recording reporting and investigation of all incidents involving manual handling and iv quarterly managers reviewing the ward service manual handling incidents identifying and analysing any trends and producing appropriate action plans to minimise the risk of recurrence As stated in the Trust Health and Safety policy directors will have their own arrangements in place to both monitor and ensure compl
30. e than one third of all over three day injuries reported each year to the enforcing authorities i e the Health amp Safety Executive and local authority Environmental Health officers Moving and handling injuries can cause back pain and a variety of musculoskeletal disorders MSD s along with fractures and strains Currently MSD are the biggest cause of sickness absence in the NHS reportedly accounting for 40 of all sickness absence Other factors such as stress can increase the likelihood of these types of injuries occurring Often MSDs are a result of a cumulative effect as opposed to one particular incident or accident This policy supplements the Trust s Health and Safety policy H3 Scope This policy applies to all West London Mental Health NHS Trust employees Contractors Trust partners and others performing work either with or on behalf of the Trust should take into account the requirements of this policy when performing that work and either observe its requirements or have in place equally effective arrangements Definitions Ergonomics the science of matching a job to a worker based on the worker s physical abilities and psychological requirements rather than matching the worker to the job Load a discrete movable object Moving Manual handling The transporting or supporting of a load by human effort It includes the lifting putting down pushing pulling carrying or moving by hand or bodily force
31. ecessary two carers may be required one to assist the patient to stand and another to attend to the patients hygiene and rearrange their clothing Make appropriate use of available aids to assist the patient to safely stand e g toilet rails zimmer frame stick Where a patient is unable to stand safely use a stand aid or a hoist West London Mental Health NHS Trust Page 47 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 2 0 Procedure for Walking with a Patient The patient s ability to walk must be assessed The patient must be able to weight bear bilaterally and take steps without manual assistance The patient may wear a transfer belt and use an appropriate aid where necessary e g walking frame stick If using a handling belt hold one handle on the side of the patient If using a hand hold for reassurance the patients arm s should be straight hand pressing down on to the carers flattened hand Thumbs should not be interlocked this enables carers to release their grip quickly and safely if the patient should fall Face the direction you are going and ensure a clear path Do not attempt to hold a patient up if they begin to fall 3 0 Procedures for the Manual Handling of Falling Fallen Patients The patient should be risk assessed and recommendations guidance for carers should be followed If a patient does fall there is a significant risk of injury to the carer I
32. essments 43 Appendix 8 Techniques for moving and handling of patients 45 West London Mental Health NHS Trust Page 4of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 1 Flowchart The requirements of the manual handling regulations are shown in the flowchart below Do the Regulations apply i e does the work involve a manual handling operation any moving and handling activity Is there a risk of injury Yes possibly Is it reasonably practicable to avoid moving the load Ys No Is it reasonably practicable to automate or mechanise the operation No Does some risk of manual o gt handling injury remain Carry out assessment Ta Yes possibly Determine measures to reduce risk of injury to the lowest level reasonably practicable Implement the measures Is the risk of injury sufficiently reduced End of initial exercise Review if conditions change West London Mental Health NHS Trust Page 5of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 2 1 2 2 2 3 2 4 3 1 3 2 Introduction This policy describes the arrangements in place which ensure the risk of injury to Trust patients employees contractors and service users etc arising from moving and handling also Known as manual handling activities are adequately managed and minimised Moving and handling accidents account for mor
33. etween the bed and the trolley Position the trolley parallel and as close as possible to the bed Ensure that the trolley and bed brakes are on If using three carers ensure that the far cot side on the trolley is raised for the patient s safety In order to minimise carer effort gravity and the patient s weight can be utilised by raising the bed approximately 2 higher than the trolley The manoeuvre will therefore involve pushing the patient downhill to approximately waist height The carers stand at the head feet and near side of the patient The carer at the side places their hands on the patient s hip and shoulder The carer stands with one foot behind the other ready to perform a forward weight transfer manoeuvre which will push the patient in the direction of the transfer on the command GO The carer at the head end takes up all the slack in the sheet supporting the patient s head and pillow The carer at the foot end supports the patient s feet in the same manner The carers at the head and feet ends stand with their feet apart adopting a wide base On the command GO they transfer weight from one leg to the other in the direction of the move avoiding twisting On the command GO move the patient mid way The pushing carer then walks round to the other receiving side and helps to manoeuvre the patient the remaining distance by moving the patient towards them The carer grasps the draw sheet at the patient
34. f the patient becomes unsteady and is close to a chair bed then the carer should guide them into the chair or onto the bed The carer should not Tower the patient as this will involve taking their weight If the patient is in close physical contact at the moment of collapse the following steps are recommended Release your hold on the patient Do not attempt to hold the patient up When the patient is on the floor the carer can then put them into the recovery position check for injury summon help etc If the patient is out of the carers reach it is unrealistic to try to rush to rescue them The carer will not be close enough to get into position in time In this situation there is no safe way of dealing with a falling patient other than to allow them to fall Where possible carers should endeavour to remove items of furniture etc that may harm the patients fall In the early stages of walking with a patient or if the risk assessment indicates a patient has a history of falls two or three carers should walk with the patient one of them following the patient pushing a wheelchair 4 0 Procedure for Getting a Patient off the Floor Always use a hoist if the patient is unable to get up independently by Assess the patient for any injuries and get medical assistance where necessary Ascertain whether the patient can get off the floor independently and or with verbal guidance Do not offer the patient any physical assistance
35. g equipment or hazardous environmental conditions 5 5 Risk Health and Safety Service The Risk Health and Safety Service is responsible in particular for i the provision of specialist advice on the safer moving and handling of inanimate loads ii undertaking manual handling inspections and audits in the course of which sampling both the extent to which services are carrying out manual handling risk assessments and the quality of those risk assessment and iii providing assistance to the Occupational Health Service and managers to rehabilitate employees who have sustained an injury arising from a moving and handling activity 5 6 Clinical Service Unit Risk Health and Safety Advisers The Clinical Service Unit CSU Risk Health and Safety Advisers are responsible in particular for i providing specialist advice to their CSU staff on the safer moving and handling of inanimate and if possible animate loads ii undertaking manual handling inspections and audits in the course of which sampling both the extent to which services are carrying out manual handling risk assessments and the quality of those risk assessment and iii assisting the Occupational Health Service and managers rehabilitate CSU employees who have sustained an injury arising from a moving and handling activity 5 7 Occupational Health Service The Occupational Health Service is responsible in particular for i upon request carrying out the pre emplo
36. g of bed linen whilst the patient is in the bed If the patient is able to co operate and move themselves ask them to do so If not Raise the bed to at least waist height Turn the patients head in the direction of the turn i e away from the carer Asecond carer must be on the other side of the bed to ensure the patients safety Cross the patient s arms Raise bend the patients leg nearest to the carer so that their foot is as near to their bottom West London Mental Health NHS Trust Page 49 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 as possible If this is not possible cross their ankles The carer gently pushes against the patient s shoulder and hip so the patient will easily turn over onto their side assuming the recovery position The receiving carer maintains the patient s position and safety by resting their hands on the patient s shoulder and the uppermost side of the knee Alternative Procedure For rolling patients onto their side where the patient is either On a trolley On a treatment couch i e narrow surfaces On the floor On a divan bed The carer follows the above Standard Procedure but pulls the patient over and toward them This is because the carer does not have to compromise their posture by leaning across to reach the patient due to the narrow surface and to push roll the patient on a narrow surface constitutes an unnecessary risk
37. gn and date the form below and no further action is required If yes then please complete both the form below and the one overleaf Assessment stage Initial 1st Review 2nd Review Comments e g is special eqpt required Reason for review Is there a behavioural pattern Yes no Yes no Yes no that may affect the handling delete one delete one delete one Is the patient able willing to Yes no Yes no Yes no cooperate Can the patient understand simple instructions communicate Can the Patient maintain a Yes no Yes no Yes no sitting position Is the Patient able to weight Yes no Yes no Yes no bear during transfers stand YERIMO Yes no Yes no walking Can the patient independently Turn in bed Yes no Yes no Yes no Move up the bed Yes no Yes no Yes no Get in out of bed Yes no Yes no Yes no Get in out of chair toilet commode Yes no Yes no Yes no Get in out of bath shower Yes no Yes no Yes no see overleaf Is the patient able to use both upper limbs to push pull grip Yes no Yes no Yes no with both hands If using only one specify which side Any history of dizziness or falls Yes no Yes no Yes no Any handling constraints e g pain skin condition sensory Yes no Yes no Yes no impairments etc please specify in the comments box Handling assessment completed by Initial review Name Signature Job Title Date
38. h face to face workshop is recorded on registers in the Exchange based system and into ESR 6 2 Recorded by namer title Learning amp Development staff 6 3 When recorded date By the end of the each face to face workshop All E learning Induction completions are reported mid month and end of month and input into Exchange and ESR 7 Procedures 7 1 Risk Assessment 7 1 1 A suitable and sufficient risk assessment is required when hazardous manual handling is unavoidable The assessment should identify where the risk lies and identify an appropriate range of ideas and actions for reducing the potential for injury 7 1 2 Therefore as stated above managers must identify the significant manual handling operations undertaken by their staff i e those manual handling activities and West London Mental Health NHS Trust Page 9 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 operations which pose a significant risk of injury see appendix 1 for a framework to use when deciding whether an activity poses a significant risk of injury Any significant manual handling operations should be risk assessed by a competent person the risk assessment should be performed using a Tor the manual handling of inanimate loads the form at appendix 2 and b Tor animate loads i e people the forms at appendix 2 and 3 The risk assessment will involve the following process i avoiding hazardous manual handli
39. his is current version M5 07 June 15 1 person 2 people 3 people Men 25kg 55lbs 33 3kg 73lbs 37 5kg 82Ibs Women 16kg 35lbs 21 3kg 47Ibs 24kg 53lbs Table 5 Guideline figures for combined lifting capacities of 2 to 3 people 7 Recording findings and reaching a decision Table 5 below can be used to record the results of your use of the filter For each task use the filter to assess each of the activities involved some tasks may only involve one activity e g lifting and lowering while others may involve several Identify whether each activity being performed comes within the guidelines and if there are other considerations to take into account it may be helpful to make a note of these Then make a final judgement of whether the task needs a full risk assessment Remember you should be able to apply the guidelines and make a judgement quickly if not then a full risk assessment will be required see Appendix 2 Activity For each activity does the task fall outside the guidelines Y N Are there any other considerations which indicate a problem Y N Indicate what the problem is if possible Is a more detailed assessment required Y N Lifting and lowering Carrying Pushing and pulling Handling whilst seated Table 5 Record of Application of guidelines West London Mental Health NHS Trust
40. his manoeuvre is easier than manoeuvring the hoist with patient in situ To make more space around the bed Draw curtains screens around other patients Move tables chairs lockers out of the way Move the bed into a central more spacious area 8 0 Moving up the Bed 8 1 The Patient who cannot Sit Up In order to minimise risk to the lowest reasonable level such patients should be nursed in an electric profiling bed Prior to doing any manoeuvre prepare the bed area i e brakes on create as much space as possible Always use the hoist if there are no suitable alternatives When a patient is not able to sit unsupported or is in a semi recumbent position a slide sheet can be used to slide the patient higher up the bed 8 2 To position a Slide Sheet under a Patient with 2 Carers Raise the bed to at least waist height Turn the patients head in the direction of the turn i e away from the carer Asecond carer must be on the other side of the bed to ensure the patients safety and to foster their confidence Roll the patient onto their side using the standard procedure see section 6 1 Ensure the slide sheet is facing the correct way and is slippery in the desired direction Position the half rolled slide sheet as far as it will go under the rolled patient Alternatively the slide sheet can be placed under the bed sheet If using large open slide sheets place two sheets on top of one another directly
41. iance with the requirements of the health and safety policy and any related policies such as this safer moving and handling policy In the course of their audits and inspections the CSU Risk Health and Safety Advisers and the Clinical Audit Service will assess the extent to which manual handling risk assessments for respectively loads and patients are being carried out and the quality of those risk assessments The results of those inspections and audits will be fed back to the service ward manager concerned for them to take appropriate improvement action if for example assessments are not being carried out and or their quality is poor Also those results are reported to the directorate senior management team included in the periodic reports it receives on health and safety and compliance with the care programme approach policy which deals with patient care plans for the director and their senior management team to take if necessary appropriate corrective action Fraud statement Not applicable Guidance This policy should be read in conjunction with the following Legislation Health and Safety at Work etc Act 1974 Manual handling operations Regulations 1992 SI 1992 2793 Guidance from other organisations Back in Work 2004 DoH Backs 2005 HSE The Guide to The Handling of People 6 Edition 2011 BackCare RCN NBE West London Mental Health NHS Trust Page 13 of 56 Policy M5 First date of issue Febru
42. ilities and needs The care plan should include instructions on the appropriate moving and handling techniques equipment to be used e g Hoists sliding sheets or other specialist equipment and the number of nurses necessary to undertake the task safely For further information on care plans and their implementation and monitoring you should refer to the Care Programme Approach policy C2 and senior management should be familiar with the main issues surrounding assessments but a specific person e g Back Care Adviser should be appointed to co ordinate the assessments The co ordinator should have received training in patient handling assessments Applying these principles allows a member of staff who has received suitable training instruction and information and who is using the correct equipment to give some assistance and support to a patient when facilitating transfers from sitting to standing walking or performing horizontal moves see appendices 7 and 8 When handling patients who either are reluctant to move or who present a serious risk of injury from potential violence this activity can be carried out only by staff who have received adequate information instruction and training in accordance with the Violence Reduction and Management policy and Mandatory Training policy West London Mental Health NHS Trust Page 11 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 7 4 7 4 1 7
43. iolent animate loads The Manual Handling Training will include information on the following as appropriate e Spinal mechanics and function e Importance of back care and posture risk factors of back pain e Current relevant legislation and professional guidelines where relevant e Assessment of risks Tasks including unexpected Loads both inanimate and human Environment and importance of good housekeeping The limits of individual capacity their own and that of others Equipment e Local policies e Importance of ergonomic approach e Principles of normal human movement and promotion of client independence where relevant e Safe management of inanimate loads e Handling strategies for clients with impaired mobility where relevant e Dealing with unpredictable occurrences e Use of equipment e Problem solving NB The content of training for staff who deal with clients patients who themselves pose a serious risk of injury arising from potential or actual violence physical aggression can be found in the Violence Reduction and Management policy V2 West London Mental Health NHS Trust Page 40 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 Appendix 6 PATIENT HANDLING ASSESSMENT Name Ward Dept Age Gender _ M F Weight Height approx Have you identified a handling risk need YES NO e g the patient has temporary or permanent mobility problems If no please si
44. irst date of issue February 2007 This is current version M5 07 June 15 11 Heavy 12 Bulky unweildy 13 Difficult to grasp a To o T T T T T y 2 pT 3g a es ee e e LL eee ee ee eee eee eee 2 Se a ee ee ee H 14 Unstable or and unpredictable 15 Sharp or otherwise potentially damaging West London Mental Health NHS Trust Page 26 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 16 Slippery surfaces eg fluid presence O O1 amp 0 My 17 Variation in floor level or work surfaces 00 amp Oo Mh 18 Hot humid conditions O O11 amp 0 M 19 Strong air movements 00 amp Oo M West London Mental Health NHS Trust Policy M5 First date of issue February 2007 Page 27 of 56 This is current version M5 07 June 15 20 Constraints on posture 21 Poor lighting 22 Unusual strength 23 Special training information West London Mental Health NHS Trust Page 28 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 24 Clothing create a hazard 25 Personal protective clothing c
45. itional relevant published guidance at section 11 Trustwide consultation ending 13 05 15 West London Mental Health NHS Trust Policy M5 First date of issue February 2007 Page 3 of 56 This is current version M5 07 June 15 Content Page No 1 Flowchart 5 2 Introduction includes purpose 6 3 Scope 6 4 Definitions 6 5 Duties 7 5 1 Chief Executive 5 2 Accountable Director 5 3 Managers 5 4 Employees 5 5 Risk Health and Safety Service 5 6 Clinical Service Unit Risk Health and Safety Advisers 5 7 Occupation Health Service 5 8 Clinical Audit 5 9 Capital Estates amp Facilities Department 5 10 Learning amp Development Service 6 Systems and Recording 9 7 7 1 Risk Assessment 7 2 Moving and handling loads 9 7 3 Safer Patient Handling 7 4 Manual Handling aids 8 Training 12 9 Monitoring 12 10 Fraud Statement not applicable 13 11 References 13 12 Supporting documents 14 12 Glossary of Terms Acronyms 14 Appendices 15 Appendix 1 Risk Assessment filter 16 Appendix 2 Manual Handling Risk Assessment blank form 23 Appendix 3 Manual Handling typical control measures for 31 use with Appendix 2 Appendix 4 Safe Moving and Handling Guidance on lifting 38 14 without mechanical aids Appendix 5 Content of Manual Handling training for 40 inanimate and non violent animate loads Appendix 6 Patient Handling Assessment 41 Appendix 7 Patient Ass
46. lth NHS Trust Page 20 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 forces will also be increased if workers have to negotiate a slope or ramp see paragraph 164 in the main document Even where the guideline figures in table 3 above are met a detailed risk assessment will be necessary if risk factors such as uneven floors confined spaces or trapping hazards are present There is no specific maximum distance over which the load can be pushed or pulled as long as there are adequate opportunities for rest or recovery If you are unsure then carry out a detailed risk assessment 6 Guidelines for handling while seated Women Figure 3 Handling while seated The basic guideline figures for handling operations carried out whilst seated are shown above in Figure 3 and in the table below Men Women 5kg 3kg Table 4 Guideline figures for handling whilst seated These guidelines apply only when the hands are within the box zone indicated If handling beyond the box zone is unavoidable a more detailed assessment should be made 6 Number of lifters versus their Combined Capacities The table below provides guideline figures on the combined lifting capacity of several people If there is any doubt about the combined capacity a more detailed assessment should be made West London Mental Health NHS Trust Page 21 of 56 Policy M5 First date of issue February 2007 T
47. ng operations where possible by elimination or automation mechanisation of the operation ii where avoidance of hazardous manual handling is not possible carrying out a full assessment taking into account the following five factors T task E individuals capacity capability or L L load E environment T E equipment E and any other factors e g equipment protective clothing and uniform and iii devising and implementing appropriate steps an action plan to reduce the risk of injury to the lowest level reasonably practicable using an ergonomic approach Those ergonomic measures are likely to include changing the layout of the workplace job rotation providing equipment e g trolleys hoists etc and in acute mental health avoiding as far as reasonably practicable the need for physical interventions The risk assessment should be reviewed either if new information comes to light if there is a change in the manual handling operation or if a reportable injury near miss incident has occurred 7 2 Moving and handling loads 7 2 1 First ask yourself the question Is it really necessary for me to manually handle this load 7 2 2 Musculo skeletal pain can be avoided if loads are moved safely Therefore the lifting lowering pushing pulling carrying or supporting of a load which is likely to cause an injury should be avoided Where possible appropriate equipment must be used e g West L
48. o not reach over 7kg for a woman and 10kg for a man at shoulder height If handler holds loads at a distance from the body at shoulder height the weight should not 3 Lifting or reaching above exceed3 kg for a woman and 5kg for a man shoulder level i e provided nsure route is clear of obstructions nsure handler can rest every 10 metres if needed Reduce weight of load frequency of task mm Z D iz SU 2 E2 2 w W E wo a SU a O 4 Carrying long distances D O 7 D D 2 w 0 S a pb D 3 D D 3 3 Qa Ensure the force of having to stop or start a load does not exceed 16kg for women or 25kg for si sama al ing pulling Ensure the force of keeping the load in motion does not exceed 7kg for women or 10kg for men A spring loaded weight can be used to assess this i West London Mental Health NHS Trust Page 31 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 Secure the load Reduce the weight of load frequency of task Stabilise the centre of gravity to avoid top heavy loads Fill containers properly with fluid rather than half filled 6 Unpredictable movements Reduce the frequency of the task weight of load etc ob rotation Limit repetitiveness Regular breaks from the activit 7 Repetitive handling Ensure rest is relative to the intensity of the work Provide suitable rest facilities Programme rests into the work schedule
49. ondon Mental Health NHS Trust Page 10 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 7 2 3 7 3 7 3 1 7 3 2 7 3 3 7 3 4 trolley sack barrow hoist etc It is not possible to give specific safe weight limits for a person since the lifting and handling ability of individuals varies greatly but guidelines do exist see appendix 1 Safer Patient Handling Patient handling is a common activity in the NHS The following patient handling principles should be observed i ii ii manual lifting of patients i e taking all or most of the patient s weight should not be undertaken but for exceptional or life threatening situations Where the need arises to give assistance to a patient then a full patient handling risk assessment see appendix 6 must be carried out In a life threatening or emergency situation the principles described in appendix 8 should be followed patients should be encouraged and facilitated to assist in their own transfer arising from a suitable and sufficient risk assessment which will include an action plan see 5 1 above the appropriate handling aid equipment e g hoists sliding aids or other specialist lifting equipment should be made available and used to reduce the risk of injury both to staff and to the patient iv the risk assessment should be incorporated into the patient s care plan stating clearly the patient s movement ab
50. osition Once the patient is sat up one carer supports the patient whilst the other raises the backrest of the trolley If the patient is unable to assist consider the use of a hoist 7 0 Devices to Prevent Patients Slipping Down the Bed Nurse the patient in an electric profiling bed 7 1 Manoeuvres up the Bed A patient should not be routinely moved up the bed It should only be done if there is a West London Mental Health NHS Trust Page 51 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 medical reason for doing so or at the patient s specific request These manoeuvres should only be carried out if assessed to be safe to do so If in doubt don t do it The patient should move themselves with or without the help of a slide sheet and or hand blocks If the patient is able to walk then stand the patient out of bed and walk them back to the top of the bed If the patient can stand but has difficulty taking steps or is attached to equipment of any kind stand them up and move the bed down until the correct position is reached Where assessed to be appropriate carry out a recognized manoeuvre with a slide sheet Use a hoist to lift the patient clear of the bed Move the bed down using two carers until the patient is over the head end of the bed it may be necessary to move the hoist backwards to do this and then lower the patient back into the bed Push the bed back up against the wall T
51. patients bottom at the level of the seat cushion Using their inside hands they take hold of the patients legs securing a hold at the back of the calves behind the patients knees From this position the carers perform a backwards weight transfer manoeuvre on the West London Mental Health NHS Trust Page 45 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 command GO they sit back from a high kneeling position onto their heels keeping their outside arms as straight as possible and maintaining a good posture This manoeuvre will slide the patient forwards their bottom moving clear of the chair cushion The two carers can now release the patient the momentum caused by the manoeuvre combined with gravity and the patients weight will cause the patient to slide out of the chair and onto the floor To protect the patients head a third carer places a pillow behind the patient s head as the patient is sliding out The pillow may be kept in place by the two kneeling carers until the patient is on the floor The patient is now in a position to be resuscitated This manoeuvre can be made a little easier if the carers initially sweep the patient s feet forwards This can be done by standing either side of the patient and placing a foot behind the patient s ankles On the command GO the carers sweep the patient s feet forwards which will move the patients bottom forward in the
52. quent operations up to approximately 30 operations per hour or one lift every two minutes The guideline figures will have to be reduced if the operation is repeated more often As a rough guide Where operations are Figures should be reduced repeated by Once or twice per minute Five to eight times per 50 minute minute Table 1 Reduction factors for repeated operations i e repeated either more that 30 times per hour or more than one lift every 2 minutes Even if the above conditions are satisfied a more detailed risk assessment should be made where a the worker does not control the pace of work b pauses for rest are inadequate or there is no change of activity which provides an opportunity to use different muscles or c the handler must support the load for any length of time 3 Twisting West London Mental Health NHS Trust Page 18 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 G Ou DAS K D Ct 90 twest 45 twist Figure 2 Assessing twist In many cases manual handling operations will involve some twisting ie moving the upper body while keeping the feet static see Figure 2 above The combination of twisting and lifting and twisting stooping and lifting are particularly stressful on the back Therefore where the handling involves twisting and turning then a detailed assessment should normally be made However if the operation is
53. quids are well filled to minimise liquid movement Secure loads more effectively eg to more stable brackets Provide personal protective clothing 15 Sharp or otherwise potentially damaging Contain package the load to avoid direct contact Provide appropriate guarding around the load to prevent sharp injuries Heavy duty gloves or other appropriate gloves may be needed West London Mental Health NHS Trust Page 33 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 Competent drainage system Use of slip resistant surfacing Robust system for cleaning of spillages Appropriate footwear to be worn 16 Slippery surfaces eg fluid presence ask to be carried out on single level Use mechanical assistance to move load between levels Gentle slopes provided between two levels Work from ladders is avoided where possible Suitable footwear provided 17 Variation in floor level or work surfaces Relocate work to better conditions Use of PPE gloves hats etc Use of fans heaters to control environment 18 Hot humid conditions Use thermometers to monitor temperatures Steady secure bulky and unwieldy loads Use of different route 19 Strong air movernents Control of air movements West London Mental Health NHS Trust Page 34of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 Move obstructions befo
54. re handling Use a different route where there are no constraints Re arrange gangways and other working areas so adequate space can be given Ensure sufficient clear floor space and headroom 20 Constraints on posture ntroduce more natural light Provide artificial light 21 Poor lighting Provide emergency lighting Identify those who are susceptible and reduce the need to use extra strength when conducting the activity Use mechanical assistance 22 Unusual strength Make these tasks one off short duration jobs for those that are capable of handling the load Make the load lighter reduce frequency etc Provide manual handling training Provide training on use of equipment Monitor handlers technique Repeat training at suitable intervals Mark load with weight and any other relevant information 23 Special training information West London Mental Health NHS Trust Page 35 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 Provide suitable clothing Provide clothing that does not prevent dexterity or inhibit free movement 24 Clothing create a hazard Conceal fasteners pockets or any other features on which loads may snag Provide suitable PPE for the task eg PPE that neither restricts movement nor had features 25 Personal protective Store and maintain properly clothing creates a hazard Ensure adequate emergency procedures exist Review documentation at suit
55. reates a hazard 26 Be aware of the emergency procedures 27 Young persons 18 years and under West London Mental Health NHS Trust Page 29 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 28 Pregnant 29 Health problems 30 An injury 31 Disabled 32 Other hazards please state Date all action points are to be Person responsible for monitoring implementation and Name and signature of manager confirming Date iat ner id implemented by progress of action points all control measures have been implemented par a fewa West London Mental Health NHS Trust Page 30 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 Appendix 3 for use with Appendix 2 rovide mechanical assistance educe the weight of the load the frequency and the distance of the task ald the load closer to the bod 7 1 Holding the load away fram the trunk rovide mechanical assistance Ks KOES O 2 a D G wo Cc SU D D o a eb D SU UO Cc D z D SU W D wo 2 SU a D The maximum weight limitation must be reduced by 10 where the handler twists through 45 2 Twisting stopping degrees or by 20 where twisting through 90degrees Reduce weight of load frequency of the load Relocate items Relocate heavier items where it s possible to lift from waist height Ensure weights d
56. s is current version M5 07 June 15 Appendix 7 PATIENT ASSESSMENTS suggested equipment Where necessary risk assessments should be carried out to facilitate the safer moving of the patient using the following manoeuvres described below Including where appropriate the use of relevant handling aids ensuring the health and safety of both staff and patient Maneouvre Suggested equipment 1 Sitting Standing and Walking Moving patient forward backwards in a chair Sitting to standing from a chair Standing to sitting in a chair Sitting to standing from edge of bed Standing to sitting on edge of bed Assisted walking The falling patient Raising the fallen patient Slide sheets including one way glide sheets Handling sling Handling belt 2 Bed Mobility Turning in bed Getting in and out of bed 30 degree tilt 180 degree turn Fitting and removing slide sheets Sliding the supine patient up down the bed Sliding the seated patient up down the bed Sitting a patient from lying Sitting a patient up and onto edge of bed Correct posture whilst feeding patient Correct posture whilst examining treating a patient Flat and or tubular slide sheets Handling sling Turntable Bed ladder Hand blocks Leg raiser 3 Lateral Transfers Lateral supine transfer from bed to trolley trolley to bed Standing transfer from bed to chair chair to bed Se
57. s no longer valid either removing or reducing the risk of injury to the lowest reasonably practicable level by implementing the control measures identified by the risk assessment in any action plan e g providing information about the load marking on a load its weight performing a Patient Handling Assessment providing easily accessible handling aids and mechanical equipment such as special beds hoists sliding sheets trolleys etc ensuring their staff have received suitable and sufficient information instruction and training in order to perform their manual handling activities safely ensuring any equipment provided for use in handling activities and lifting operations is safe and without risks to health and is maintained in good working order and ensuring the current details of any equipment provided for use in handling activities and lifting operations are entered on the Trust s asset register as appropriate Employees Employees are responsible for informing their manager about any physical impairment or condition they have which may affect their ability to undertake any moving and handling activity and West London Mental Health NHS Trust Page 7 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 reporting immediately to their manager any hazards that may affect adversely any manual handling activities performed by either themselves patients service users etc e g defective liftin
58. sion M5 07 June 15 Appendix 1 RISK ASSESSMENT FILTER to determine whether a more detailed risk assessment is required Reproduced from the HSE Publication L23 Manual Handling Guidance on the Regulations 1 Introduction This filter s use is intended to set out an approximate boundary within which the load is unlikely to create a risk of injury sufficient to warrant a detailed assessment This filter is relevant to the following manual handling activities lifting and lowering carrying for short distances pushing and pulling and handling while seated a b c d wo a a To use the filter you will need to refer to the relevant section below on the manual handling activity and consider the guideline figures After consideration of the guideline figures you will need to carry out a more detailed assessment see Appendix 2 if a using the filter shows the activity exceeds the guideline figures b he activities do not come within the guidelines e g if lifting and lowering unavoidably takes place beyond the box zones in Figure 23 c there are other considerations to take into account d the assumptions made in the filter are not applicable for example if when carrying the load it is not held against the body or e for each task the assessment cannot be done quickly say within 10 minutes Some words of caution i The filter is most likely to be useful if you think that the a
59. the patient s head rely upon a high backed sling Do not attempt to manually lift anyone off the floor Always use a hoist 5 0 Cardiac Arrest Patient Collapses to the Floor The patient should not be manually lifted from the floor The patient should only be moved if not moving them would put the patient and or healthcare staff at risk of further harm If the patient recovers they should be hoisted into bed However using a conventional sling to do this will put pressure on the patient s abdomen and put the patient at risk of re arresting therefore a stretcher type sling should be used If a stretcher sling is not available the patient may be placed in a conventional sling so long as it is possible to ensure that they are hoisted in the supine position If this is not possible the patient should be made as comfortable as possible and not moved until the Paramedics arrive with a stretcher 6 0 Procedures for Moving and Handling of a Patient on a Bed 6 1 Rolling Turning A Patient This procedure can be used for all of the following manoeuvres Rolling Turning a patient 30 Tilt Insertion removal of a slide sheet under a patient Insertion removal of a hoist sling under a patient on a bed Insertion removal of a hoist sling under a patient on the floor Insertion removal of a transfer board under a patient Bed bathing a patient Application of or changing the dressings of a patient whilst in bed Changin
60. tient understand and also avoids any confusion 1 1 Procedures for Seated Patients 1 1 1 Sitting Back In a Chair Ensure the patient is sitting in the correct size of chair The patient should be able to have their bottom at the back of the seat and still be able to have their feet flat on the floor with their knees at hip height If this is not possible i e for very short patients the patient should be given a footrest to rest their feet on 1 1 2 Consider ways to prevent slipping One way slide sheet Where appropriate use a moulded or angled chair 1 1 3 Ways to sit back in the chair Encourage the patient to move themselves back in the chair The patient stands and steps back before sitting down The patient stands up the carer pushes the chair if the chair is easily moveable to the back of the patients legs or the carer carers stand the patient and a third carer pushes the chair to the back of the patients legs If the patient is unable to move themselves staff should reposition them using a standard or hoist 1 2 Cardiac Arrest in a Chair IF A PATIENT HAS A CARDIAC ARREST WHILST SITTING IN A CHAIR DO NOT ATTEMPT TO LIFT THE PATIENT BACK INTO BED Call for assistance a minimum of two carers are required SLIDE THE PATIENT ONTO THE FLOOR Any manoeuvre involving a patient who has arrested is a high risk one Two carers kneel in front of the patient The carers place their outside hands behind the
61. transport patients vi Use of hoist legs Use handset controls to alter position of legs if the hoist is electric Avoid kicking the hoists legs into position if the hoist is manual Alter the hoists leg angles appropriately when positioning patient in a bed chair etc vii Use of spreader bar Do not push or pull excessively Protect the patient s head from potential injury viii Use of brakes Brakes should be OFF except when in storage being used on an incline or when adjusting a hoisted patient s clothing i e prior to toileting ix Explanation to user Communicate with your patient and where possible obtain their consent and cooperation x Slings Use the appropriate sling for the hoist Irrespective of manufacturer ensure that the hoist sling interface is compatible Use appropriate size sling for the patient For general purpose slings this means that the sling should fit from the top of the patient s head to the base of their spine xi Manual override All electric hoists have a manual override which can be operated in the event of a power failure Carers should familiarize themselves with the override system on their hoists For comprehensive guidance to the safe use of hoists refer to the manufacturer s instructions for care and use of their hoists 12 0 Use of Wheelchairs to Move Patients When using a wheelchair to move a patient staff should follow the principles of safe handling West London Mental Health NHS
62. ty of the individual member of staff to decline to undertake a task if they consider it to be unsafe for either themselves or to the patient this principle is enshrined in the duty of care to oneself and to others West London Mental Health NHS Trust Page 56 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15
63. ty of the worker Provide more mechanical assistance 29 Health problems Same controls as above 30 An injury Consult with the individual in question about limitations and abilities of the worker Adapt the task to suit the needs of the individual so they are not disadvantaged more so than 31 Disabled able bodied people Consultation with the Occupational Health Service 32 Other hazards please state Date all action points are to be Name and signature of manager confirming all control measures have been implemented implemented by West London Mental Health NHS Trust Page 37 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 Appendix 4 Safe Moving and Handling Guidance on lifting without mechanical aids First always ask yourself the question Is it really necessary for me to manually handle this load Musculo skeletal pain can be avoided if loads are moved safely Therefore the lifting lowering pushing pulling carrying or supporting of a load which is likely to cause an injury should be avoided Where possible appropriate equipment must be used e g trolley sack barrow hoist etc It is not possible to give specific safe weight limits for a person since the lifting and handling ability of individuals varies greatly but guidelines do exist see appendix 1 Before attempting to handle a significant load manually you must have carried out a manual han
64. ve Using their inside arms they grasp and take up any slack in the sheet positioning their hands dose to the patients shoulders Keeping their arms straight the carers perform the same weight transfer manoeuvre to sit the patient up Ensure that the sheet is in good condition i e not torn Once the patient is sat up one carer can support the patient To reduce the risk to its lowest level patients who require assistance to sit up should be nursed on a profiling bed 6 4 Lying to sitting on a trolley This manoeuvre may also be used for a patient in bed where both carers can easily access the patient If the patient has sitting balance but is unable to sit themselves up use the following method Ensure that the patient is on a draw sheet and that it is under their shoulders As there is little or no room for the carers to place their knees on the trolley safely this manoeuvre is carried out with the carers standing Adjust the height of the trolley to waist height one carer standing each side of the patient facing the patients face Using their inside arms they grasp and take up any slack in the draw sheet positioning their hands close to the patient s shoulders The carers adopt a wide base placing their inside foot at about a pace s distance behind their outside foot On the command GO the carers keeping their arms straight step back onto their inside foot performing a weight transfer manoeuvre in the standing p
65. wed by a word describing what you are about to do e g ready steady lift ready steady push etc See appendix 1 for weight guidelines for Multiple Person Lift In summary West London Mental Health NHS Trust Page 38 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 Keep close to the load Relax knees Offset feet Avoid stooping Use an open palm hold Lead with the head Move feet Avoid twisting Vary positions frequently 6900 2 OV gt G0 Under no circumstances should staff use the following high risk unsafe patient handling techniques DRAG LIFT underarm drag lift a nurse places a hand or an arm under the patient s axilla ORTHODOX LIFT two nurses stand either side of the bed and lift a patient on their clasped wrists under the patient s back and thighs LIFTING WITH THE PATIENTS ARMS AROUND THE NURSES NECK FRONT TRANSFERS WITH A NURSE nurse in front of the patient when lifting a patient from sitting to standing Pivot Transfer Bear hug Elbow lift TWO SLING LIFT AUSTRALIAN LIFT SHOULDER LIFT THROUGH ARM COMBINED LIFT MOVING A PATIENT ACROSS THE BED BY LIFTING LIFTING A PERSON FROM THE FLOOR LIFTING A PERSON INTO OUT OF BATH West London Mental Health NHS Trust Page 39 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 Appendix 5 Content of manual handling training for inanimate and non v
66. yment assessment of the suitability of any applicant for employment with the Trust in which manual handling is an integral significant part and ii providing advice on the rehabilitation of an employee who is returning to work from an absence due to a injury sustained during a manual handling activity 5 8 Clinical Audit The Clinical Audit Service is responsible for auditing the existence and quality of risk assessments that have been carried out for the moving and handling of service users see appendix 7 Such risk assessments will be incorporated in a patient s Care Plan West London Mental Health NHS Trust Page 8 of 56 Policy M5 First date of issue February 2007 This is current version M5 07 June 15 5 8 1 The service will undertake inspections and audits across the Trust in the course of which sampling both the extent to which services are carrying out patient handling risk assessments and the quality of those risk assessments 5 9 Capital Estates amp Facilities Department The Capital Estates amp Facilities Department is responsible in particular for ensuring any equipment used for handling activities or lifting operations is adequately maintained and remains safe to use 5 10 Learning amp Development Service The Learning amp Development Service is responsible for arranging the provision of specialist advice on the handling of animate loads 6 Systems and recording 6 1 Where Recorded All Induction attendance for eac

Policy: M5 - West London Mental Health Trust

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