Manual Handling Policy - NHS Gateshead · Appendix 3 Controversial/Unsafe Practices Handout ........

RM06 Manual Handling Policy v9 1

Policy No: RM06

Version: 9.0

Name of Policy: Manual Handling Policy

Effective From: 31/05/2016

Date Ratified 12/05/2016

Ratified Health and Safety Committee

Review Date 01/05/2018

Sponsor Director of Strategy and Transformation

Expiry Date 11/05/2019

Withdrawn Date

Unless this copy has been taken directly from the Trust Intranet site (Pandora) there is no assurance that

this is the most up to date version

This policy supersedes all previous issues.


Version control

Version Release Author/

Reviewer

Ratified

by/Authorised

by

Date Changes

(Please identify page no.)

1.0

2.0

October 2002 Marian

Morrison

Risk

Management

Committee

October

2002

3.0

July 2005 Marian

Morrison

Risk

Management

Committee

May 2005

4.0

5.0 Sept 2006 Marian

Morrison

Risk

Management

Committee

Health and

Safety

Committee

Sept 2006

6.0 Sept 2009 Aileen

Hunter &

Deborah

Southworth

Health and

Safety Sub

Committee

Format and monitoring changes 1-

18

Additional Appendices: Training

Matrix and Risk Assessment Forms

updated

7.0 02/08/2012 Deborah

Southworth

Health and

Safety

Committee

10/07/2012 Review and Format as per OP27

Policy

Pg 5-30

Main changes to Risk Assessment

section and Training. Monitoring

and Appendices reviewed

8.0 19/06/2014 Deborah

Southworth

Health and

Safety

Committee


Policy.

Pages 1,4,5,7,9,11,12,13,14,

15,22,23,25,28

Main changes to Risk Assessment

section 6.1, minor changes to

wording, Updated references.

Monitoring and Appendices

reviewed

9.0 31/05/2016

Deborah

Southworth

Health and

Safety

Committee


Policy

Pages 1, 2, 3, 4, 6, 10,16, 20,23,24

Monitoring reviewed

Updated references


Contents

Page No

1. Introduction ......................................................................................................................... 4

2. Policy Scope .......................................................................................................................... 4

3. Aim of Policy ......................................................................................................................... 5

4. Duties (Roles and responsibilities) ........................................................................................ 5

4.1 Trust Board ......................................................................................................... 5

4.2 Chief Executive ................................................................................................... 5

4.3 Executive Directors ............................................................................................. 5

4.4 Divisional Directors, Divisional Managers and Heads of Service ....................... 5

4.5 Modern Matrons ................................................................................................ 6

4.6 Ward/departmental Managers .......................................................................... 6

4.7 Employee Responsibilities ................................................................................. 7

4.8 Occupational Health Department ...................................................................... 8

4.9 Clinical Ergonomics ............................................................................................. 9

4.10 QEF Estates Department .................................................................................... 10

4.11 Health and Safety Advisor .................................................................................. 10

4.12 Procurement Dept .............................................................................................. 10

4.13 Tissue Viability Specialist Nurses ........................................................................ 11

5. Definitions ............................................................................................................................ 11

6. Main Body of Policy

6.1 Risk Assessment ................................................................................................. 11

6.1.1 Generic risk assessment ...................................................................... 13

6.1.2 Inanimate Objects................................................................................ 14

6.1.3 Patient Risk Assessment ..................................................................... 14

6.1.4 Rehabilitation Handling ....................................................................... 16

6.1.5 Specialist Services ................................................................................ 16

6.2 Equipment .......................................................................................................... 17

6.3 Bariatric Patients ................................................................................................ 17

7. Training ............................................................................................................................ 17

7.1 Training ............................................................................................................... 17

7.2 Record Keeping................................................................................................... 19

8. Equality and Diversity ........................................................................................................... 20

9. Monitoring Compliance with the Policy ............................................................................... 20

10. Consultation and review ...................................................................................................... 22

11. Implementation of policy (including raising awareness) ...................................................... 22

12. References ............................................................................................................................ 23

13. Associated documentation (policies) .................................................................................... 24

Appendices

Appendix 1 Manual Handling of Loads Risk Assessment Form .......................................................... 26-27

Appendix 2 Patient Manual Handling Assessment Form ................................................................... 28-29

Appendix 3 Controversial/Unsafe Practices Handout ........................................................................ 30-41


Gateshead Health NHS Foundation Trust

Manual Handling Policy

1 Introduction

Musculoskeletal disorders continue to be the most common type of work- related illness reported

by general practitioners. Work related musculoskeletal disorders (WRMSDs) can affect muscles,

joints and tendons in all parts of the body and the majority of work-related musculoskeletal

disorders develop over time. An estimated of 9.5 million working days were lost due to work

related musculoskeletal disorders, an average of 17 days lost for each case. (HSE Statistics

2014/2015).

On 1st

January 1993 the European Directive 90/269/EEC Manual Handling Operations Regulations

1992 (as amended 2002) under the Health and Safety At Work Act 1974, came into force. The

guidance on regulations L23 was reviewed in 2004, with the release of the 3rd

Edition to support the

continued risk reduction of handling activities.

The regulations require the employer to adopt an ergonomic approach to the removal or reduction

of risk from manual handling injuries, also to ensure safe systems of work within a safe working

environment. The ergonomic approach requires manual handling to be seen in the context of a

wide range of factors, which includes the nature of the task, the load, the working environment,

and the individual’s capability.

Gateshead Health Foundation Trust has prepared this policy in order to meet its statutory

obligations and with the aim of reducing the risk, to the lowest level possible, to staff from

potential manual handling incidents.

Although ideally the need for manual handling of loads (as outlined in the HSE Guidance document

L23 on the Manual handling Operations Regulations) should be avoided, it is recognized that due to

the nature of the work undertaken by the Trust, staff may have no alternative but to move loads

manually.

As stated in the policy, managers and staff should follow measures to manage the risk in order to

minimize the risk of injury to themselves and others so far as reasonably practicable.

The Trust will ensure that the necessary arrangements are in place to facilitate the implementation

of this policy, by ensuring they have in place appropriate professionally competent persons with

those duties specified in their job brief.

The Trust will continue to work towards a “safer lifting policy” and as part of this process will

ensure a current policy of minimal lifting.

2 Policy scope

This policy is Trust wide and applies to all members of staff employed/working within Gateshead

Health NHS Foundation Trust involved in the manual handling of people and loads.

The policy applies to all staff, locums, students, bank staff, and voluntary workers involved in the

manual handling of people and loads.

The regulations make the self-employed responsible for their own health and safety during

handling. They should take the same steps to safeguard themselves as would be expected of an

employer in protecting their employees in similar circumstances.


The standard of this policy should be the minimum standard expected of other employers when we

contract with them for work to be done.

3 Aim of policy

The aim of this policy is to:

• Implement a consistent, safe, and effective approach for managing manual handling risks

(in line with the Risk Management Policies).

• Assist all employees of the Trust to adopt a positive approach to safer manual handling in

order to minimise the risks of musculoskeletal injury and achieve a reduction in the number

of injuries and disablements caused by manual handling operations.

• Assist the Trust in implementing the manual handling requirements of Health and Safety

legislation in particular the Manual Handling Operations Regulations 1992 (as amended)

and relevant associated regulations, arrangements and national guidance.

• Outline the responsibilities of all staff and the organization with regard to their role in

developing and implementing this Policy.

4 Duties (Roles and responsibilities)

4.1 Trust Board

The Trust Board is responsible for implementing a robust system of corporate governance

and risk management within the organisation.

The Director of Strategy and Transformation sponsors this policy and is responsible for its

implementation.

4.2 Chief Executive

The Chief Executive has overall responsibility for the implementation of this Policy.

However day-to-day responsibility for the operational implementation of the policy has

been devolved to a local level as described hereafter.

4.3 Executive Directors

Are responsible for ensuring that appropriate health and safety management systems are in

place within their own area, so that this policy is adhered to, enabling the Trust to meet its

duty under current legislation.

4.4 Divisional Directors, Divisional Managers, and Heads of Service

Are responsible for:

4.4.1 The implementation of the policy and for ensuring that adequate resources are

available for staff to fulfil their duties and responsibilities, in reducing the risk

associated with handling tasks.

4.4.2 Implementing the Manual Handling Operations Regulations and the Trust Manual

Handling Policy within their work area.


4.4.3 Promoting and supporting the Manual Handling Risk Assessment process within

their area of responsibility.

4.4.4 Ensuring attendance of all relevant staff at the Trusts Moving and Handling Training

Programme in accordance with the training matrix in the Trust Mandatory Training

Needs Analysis, this can be found on the Trust Intranet.

4.4.5 Seeking advice from the Clinical Ergonomics team, Control of Infection, Tissue

Viability, Medical Devices and/or the QEF Estates Department, before purchasing

manual handling equipment and accessories.

4.5 Modern Matrons


4.5.1 Supporting Divisional and Ward managers in ensuring staff attend training,

appropriate and timely records are kept, and risk assessments are carried out.

4.5.2 Implementing the Manual Handling Regulations and the Trusts Manual Handling

Policy within their area and developing and implementing safe systems of work.

4.6 Ward / Departmental Managers

Local Managers must be aware of the Manual Handling operations undertaken in their

area.

Local Managers are responsible for:

4.6.1 Implementing the Manual Handling Regulations and the Trust’s Manual Handling

Policy within their area and developing and implementing safe systems of work.

4.6.2 Avoiding the need for their staff to undertake manual handling tasks, which involve

a risk of injury so far as is reasonably practicable.

4.6.3 Carrying out an appropriate risk assessment of any manual handling task, which

cannot be avoided but where there is a significant likelihood that an injury may

occur. The appointment of Manual Handling Risk Assessors who have undertaken

appropriate training will support this process.

4.6.4 Making a clear record of the assessment using the Trust paperwork, communicating

its findings to all staff involved and including significant risks in the local risk

register.

4.6.5 Ensuring all (generic) manual handling related action plans are addressed with

relevant staff at ward/departmental level, prior to forwarding the action plan to the

relevant Divisional Manager, and where further advice is required, to the Clinical

Ergonomics and/or Health and Safety department.

4.6.6 Introducing appropriate measures to avoid reduce or manage the risks by

redesigning the task or the use of mechanical aids.


4.6.7 Identifying the training needs of staff and ensuring staff attend the appropriate

training in manual handling as outlined in the training matrix guidance in the Trust

Mandatory Training Needs Analysis, which can be found on the Trust Intranet.

4.6.8 Ensuring that manual handling requirements are appropriately identified during the

recruitment process, in job descriptions and/or risk assessments.

4.6.9 Making reasonable allowances for any known health and ability problems, which

might impact on an individual’s ability to carry out manual handling tasks safely.

4.6.10 Referring a member of staff to Occupational Health if there is a good reason to

suspect that an individual’s state of health might significantly increase the risk of

injury from manual handling operations.

4.6.11 Documenting, monitoring and reviewing manual handling assessments to reflect

any change in working conditions, personnel involved or significant change in the

manual handling operations effecting the nature of the task or the load. Risk

Assessments should be reviewed annually or if circumstances changes.

4.6.12 Maintaining records of any accident, ill health, and/or training related to manual

handling operations.

4.6.13 Ensuring all manual handling accidents, incidents and near misses are reported and

investigated via the Trust’s Incident Reporting Tool DATIX, to establish if there has

been any breach of policy. It is important that findings from such investigation are

shared with the local team.

4.6.14 Ensuring a manual handling risk assessment is completed in a timely manner

following the return to work of any member of staff suffering from musculoskeletal

problems.

4.6.15 Ensuring that manual handling practices used are ‘best practice’ and that

controversial methods are not routine practice within their area.

4.6.16 Ensuring suitable and sufficient manual handling equipment is available to reduce

risk and that equipment is easily accessible, properly maintained, cleaned, and used

correctly, seeking appropriate specialist advice prior to purchasing any equipment.

4.6.17 Ensuring adequate staffing levels for safe working practice.

4.6.18 Carry out an appropriate risk assessment in relation to pregnant workers to reduce

the risk of injury to the individual and others at work.

4.7 Employee Responsibilities

The employee must:

4.7.1 Take reasonable care of their own health and safety and that of others who may be

affected by their activities when involved in manual handling operations.

4.7.2 Co-operate with their manager in the making of assessments of hazardous manual

handling tasks and applying the principles promoted at Trust training.


4.7.3 Read and comply with the Trust’s Manual Handling Policy and seek advice if

anything in the policy is not understood.

4.7.4 Inform their manager of pregnancy, medication, or musculoskeletal conditions,

which may affect their ability to handle loads safely.

4.7.5 Present themselves in a suitable mental and physical condition to undertake the

work they are contracted to do.

4.7.6 Observe safe systems of work and use of equipment provided to reduce risk,

reporting any defects in mechanical aids to their manager. The equipment should

be labelled and the faulty equipment withdrawn from use.

4.7.7 Identify and report any change in the nature of the task, work area, personnel

involved, or load, which may necessitate a review of the risk assessment.

4.7.8 Report all accidents and near misses arising from manual handling procedures in

accordance with Trust Policy.

4.7.9 Seek advice from the manager or appropriate advisor of any situation where they

are unsure of the correct procedure to adopt or when they are unsure how to use

any manual handling equipment in their work area.

4.7.10 Wear suitable clothing and footwear to facilitate free movement and allow a stable

posture.

4.7.11 Participate in training as outlined in the Trust Mandatory Training Needs Analysis

and apply the principles of efficient movement, risk assessment and ergonomics to

handling tasks in their workplace.

4.7.12 To use the people handling methods that are currently considered to be best

practice as routine (as demonstrated and practiced in training sessions) and avoids

using controversial methods.

Reference: Guide to the Handling of People 5th

Ed 2005 and 6th

Ed 2011

4.7.13 Carry out a full and comprehensive risk assessment of the task/situation in cases

where “best practice” is not possible, contacting the Clinical Ergonomics Team for

advice as necessary.

4.8 Occupational Health Department Responsibilities.

The Occupational Health Department will:

4.8.1 Ensure that appropriate pre-employment health screening is carried out, which

takes into account any manual handling operations necessary, as identified in the

prospective employees job description. Managers will be advised as to the outcome

of

such screening.

4.8.2 Review any musculoskeletal problems arising out of or in connection with work and

where necessary the nurse advisor will seek advice from the Clinical Ergonomics

Advisor, Physiotherapist or Occupational Health Physician as appropriate.


4.8.3 Provide assistance with assessments of work tasks as identified in the job

description.

4.8.4 Make arrangements for assessing the staff member’s ability to return to work and

to full duties when there has been a period of absence from work. When

appropriate, a referral will be made to the Clinical Ergonomics team.

Refer to Trust Occupational Health Policy PP45

4.9 Clinical Ergonomics

The Clinical Ergonomics Service will:

4.9.1 Act as the specialist advisors in manual handling on behalf of the Trust. This service

is available Monday – Friday and is based within Occupational Health. Out of hours,

staff should contact the 1200 bleep holder or their manager for further advice.

4.9.2 Design, develop, and deliver manual handling educational/training programmes for

all Trust employees. This also involves the evaluation and monitoring of the training

course content.

4.9.3 Provide specialist advice to all managers on measures and equipment to help

minimize moving and handling risks within their area of responsibility.

4.9.4 Ensure that staff are notified of their training course details

4.9.5 Record all training on the Trust OLM records database.

4.9.6 Inform staff who fail to attend or who do not complete training. Refer to Trust

Mandatory Training Policy PP25.

4.9.7 Carry out an annual audit of compliance on the manual handling risk assessment

process in conjunction with the Health and Safety department. An overview will be

taken by the department, problem areas and issues identified, and

recommendations made. An Annual Report and any required actions will be

presented to the Health and Safety Committee.

4.9.8 Work with the Health and Safety Department to review and report annually on

manual handling Datix information.

4.9.9 Work with and provide advice to the Occupational Health nursing team in assessing

and making arrangements for staff returning to work or being re-deployed when

appropriate, particularly in cases covered by the Equality Act 2010.

4.9.10 Lead on the format and verification of all necessary documentation for patient

handling and inanimate load handling. Awareness training and training on the use

of the documents will be undertaken on the Introduction to Moving and Handling,

Manual Handling Risk Assessor, Practical Skills sessions and refresher sessions as

appropriate.

4.9.11 Produce a Manual Handling Annual Report for consideration by the Health and

Safety Committee.


It will include:

- compliance with this policy,

- updated training statistics,

- specific handling related data from incidents reported,

- handling linked claims data,

- information specifically linked to the interpretation of trust risks.

- appropriate Action Plan

4.10 QEF Estates Department


4.10.1 Maintaining equipment and certification to reduce risks (PUWER and LOLER 1998).

4.10.2 Working with Clinical Ergonomics Team, Medical Devices, Procurement and Trust

managers regarding the purchase and location of equipment such as bariatric

equipment, mobile and overhead tracking hoists.

4.10.3 Giving specialist advice regarding equipment faults via the Trust call logging system.

4.10.4 When undertaking either a new build or refurbishment, consideration is given to

the issue of manual handling. Designs and plans should take account of ergonomics

in intended designs, to minimise the risks caused by manual handing and poor

postures. Advice from Clinical Ergonomics, and other relevant departments, should

be sought where appropriate.

4.11 Health and Safety Advisor

The Health and Safety Advisor will work in conjunction with the Clinical Ergonomics

Department to provide additional competent advice in relation to the implementation and

application of this policy including: -

• supporting managers to undertake manual handling risk assessments

• providing support and advice to manual handling risk assessors when requested.

• the investigation of manual handling incidents

4.12 Procurement Department

The Procurement Department will ensure that:

4.12.1 Any equipment purchased is of a suitable standard

4.12.2 The relevant professionals and departments are consulted prior to the purchase of

equipment, if appropriate.

4.12.3 Appropriate information accompanies equipment supplied e.g., manufacturer’s

instructions

4.12.4 The relevant departments are informed e.g., QEF Estates and medical devices

department of new equipment purchased so that appropriate service and re-

certification schedules are drawn up


4.13 Tissue Viability Specialist Nurses


4.13.1 Advising on specialist beds and pressure relieving equipment and may be contacted

by switchboard.

4.13.2 Advising on tissue viability and pressure care issues, which may impact on moving

and handling.

5 Definitions

The following definitions apply to this policy document:

• Manual Handling refers to the transportation or supporting of a load/person by hand or

bodily force including lifting, lowering, pushing, pulling carrying and moving. (MHOR 1992

as amended). Manual Handling includes both transporting of a load and supporting a load

in a static posture

• In the context of this policy a Load is defined as an inanimate object such as equipment or a

box, or a person e.g. patient, which needs to be supported, transferred or moved. The level

of risk is balanced against any potential movement or any piece of equipment that is moved

• An injury is any harm to the body arising as a result of carrying out a manual handling task.

• Risk Assessment: The process whereby hazards and risks are evaluated alongside controls

designed to reduce the risk to ensure that risks are eliminated or reduced as far as is

reasonably practicable. This may be generic, completed for an area or department, or

individual completed as an assessment of any manual handling risks in providing care or

rehabilitation for a patient/client.

• Reasonably Practicable: The process of balancing time, cost, and effort against the

reduction in risk achieved. The level of risk is balanced against any potential resource input

that is required to remove or reduce the risk.

• Ergonomics: - Designing the task, workplace, and equipment to fit the individual and

reduce the risk of strain and injuries.

• Oracle Learning Management System (OLM): This is the training section of the NHS

Electronic Staff Records Database (ESR)

• Mandatory Training Needs Analysis (TNA): This document describes all the mandatory

training provided within the Trust including manual handling training.

6.0 Risk Assessment

6.1 Risk Assessment

The Management of Health & Safety at Work Regulations 1999 require an employer to

carry out a ‘suitable and sufficient’ assessment of the risks to the health and safety of their

employees and to anyone else who may be affected by their activity, so that the necessary

preventative and protective measures can be identified.


The process of risk assessment begins with the identification of hazards and risks. Further

guidance on the consistent and comprehensive identification of health and safety hazards

can be found in the Health and Safety section of the Trust Intranet.

A ‘suitable and sufficient’ risk assessment should:

• identify the significant risks arising out of the work;

• identify and prioritise the measures required to comply with any relevant statutory

provisions;

• remain appropriate to the nature of the work and valid over a reasonable period of

time.

In order to be suitable and sufficient, the risk assessment should be carried out by an

individual (or team), who understands the processes/work concerned, and can identify all

relevant risks. It must cover both employees and non-employees affected by the

undertaking, and take account of those more vulnerable due to inexperience, disability, or

age e.g. Young persons.

Risk Assessors will conduct workplace risk assessments as required, including manual

handling assessments.

Risk assessments should be undertaken as required, and all risk assessments must be

reviewed no less than every two years or more frequently especially where:

- new technology has been identified

- actions have been taken as a result of risk assessment

- they have become invalid or can be significantly improved

- there has been a substantial change in the work

- manual handling incident has been reported

- information about the risk changes

Risk assessments should be recorded on the trust’s documentation and should be passed to

the manager for review.

A copy of each risk assessment should be stored locally in a ‘risk assessment file’. Managers

should ensure that all staff are aware of the risk assessments and that they are readily

available to all staff. All new staff should be directed to the department/ward risk

assessment file.

Where risk assessment identifies an issue for which the area/department does not have the

resources to eliminate or control the risk, this must be escalated to the divisional

director/divisional manager/assistant divisional manager. The health and safety advisor

should be notified (Ext 3758) and these risks should be entered onto the risk register for

appropriate escalation and management as outlined in the Trust Health and Safety Policy

RM02.

Guidance for risk assessors and risk assessment templates are available in the Health &

Safety section on the trust’s Intranet site.

A risk assessment is required to be carried out for all handling tasks, both patient and non-

patient which have been identified as being necessary, but where there is a significant risk

of an injury occurring. (MHOR 1992 as amended).

The risk assessment should be carried out BEFORE the task is undertaken.


All paperwork must be dated and signed and should include any associated paperwork on

action plans or risk reduction solutions. This is evidence that the process is seen as a cycle

of continuous management of risks and improvement.

Risk assessments can cover a number of situations in the workplace as follows:

- generic situations

- movement of inanimate objects

- patient movement

- rehabilitation

- specialist services.

Guidance for each of these is covered below in more detail.

6.1.1 Generic Risk Assessment

The stages of the Generic Risk Assessment are outlined in the Trust Risk Assessment

Guidance, which can be found on the Trust Intranet site and Trust Health and Safety

Policy RM02.

The same manual handling risk may be apparent in more than one ward or

department, therefore, where possible, a generic risk assessment can be adopted

which has been checked, adjusted to reflect any local details or changes where

necessary and confirmed as applicable to that area. The risk assessment should be

dated and signed and should be reviewed according to the normal process.

A set of generic risk assessments, including those related to manual handling, have

been developed that will cover the main areas of risks. Work will continue to

ensure that the number of generic risk assessments available is extended until as

many generic risk assessments as necessary are in place. Generic risk assessments

are assessments produced only for a given job/task or activity.

A generic assessment is undertaken when the activity involved extends to several

departments within the organisation and where a core set of precautions should be

taken to prevent injury or harm.

Generic risk assessments must be edited to ensure that all the risks and controls

relevant to the area are included and any details that are not relevant are removed,

with a risk rating inserted, completed, signed, and dated so as to ensure that the

assessment is suitable and sufficient.

Each task is given a risk rating. Tasks/activities with a risk rating of 8 or more, will

require a detailed manual handling risk assessment. In the case of manual handling

tasks, a specific manual handling risk assessment form must be completed on the

appropriate form. (Appendix 1)

Copies of generic risk assessments are available to download from the Health and

Safety Section on the Trust Intranet A copy of each generic risk assessment should

be filed in the Directorate/Dept, health, and safety policy folder, a copy placed in

the relevant area where the task or activity is undertaken (as per Trust Guidance).


6.1.2 Inanimate Objects

Where there is a significant risk of injury a risk assessment MUST be carried out

before the job is undertaken.

The assessment should be carried out by a nominated risk assessor, who has under

gone the necessary training.

The assessment should be in suitable and sufficient detail to consider and record all

reasonably foreseeable risks, and other factors, including the use of appropriate

equipment, that relate to complete handling task.

The assessment will identify short term and/or long-term risk reduction methods

and specify the safest method of carrying out the task within what is reasonably

practicable, taking into account those staff who are at particular risk.

The assessment will be reviewed at least annually as part of a management

process, or more frequently should there be any significant changes in the handling

task or when an incident occurs. (Management of Health and Safety at Work

Regulations 1999)

The assessment and its outcome must be shared with the team carrying out the

tasks. The assessment should be completed on the correct paperwork.

The HSE MAC assessment tool is used by some departments e.g., in operational

services where this tool may be considered to be the most appropriate method of

assessment.

(Ref: http://www.hse.gov.uk/msd/mac/index.htm and booklet and score sheets

accessed via http://www.hse.gov.uk/pubns/indg383.pdf).

6.1.3 Patient Risk Assessments

The Trusts approach to people handling aims to promote the safety of staff while

protecting the human rights of patients.

The Trust will ensure that manual handling risks, whether clinical or non –clinical

are reduced, so far as is reasonably practicable. This will be achieved by balancing

the safety and human rights of employees and the assessed care needs and human

rights of patients.

Patient risk assessments should be discussed and completed in consultation with

patients and relatives where possible.

Staff must take into account the cultural and beliefs of the patient when carrying

out manual handling to ensure that no distress is caused and to ensure promotion

of independence and privacy of patients in our care.

Pre-operative and In-patients Risk Assessments

A specific manual handling risk assessment must be completed as appropriate using

Trust documentation.


Individual patient risk assessments will be undertaken using appropriate Trust

documentation, e.g., Pre-Operative and In-Patient Adult Risk Assessment Tool

booklet.

The assessment should be completed, as appropriate, for all in patients and should

be linked to the Mobility/Moving and Handling Care Standard documentation.

(Reference to Trust Care Standards documents, which are on the Trust Intranet

Site)

The risk assessment should be completed appropriately to form an action plan

detailing the handling risk level, number of staff and any equipment required to

carry out the task safely.

The patient risk assessment MUST be reviewed weekly or as the patient’s condition

changes, e.g. when there is reason to believe the assessment is no longer valid

because the patient’s condition and ability has changed, circumstances of the task

have changed, or there have been significant changes in the environment or the

task. In accordance with the Regulations, a review must also take place if an

accident or incident occurs.

The assessment must consider the patient, and their condition and all other clinical

circumstances, which are likely to impact on the handling tasks prior to a final safer

system of handling being chosen.

All patient risk assessments should be signed (or countersigned) and dated by a

qualified health care professional.

Other Patient Risk Assessments

There are some clinical areas within the Trust where the Pre-Operative and In-

Patient Adult Risk Assessment Tool booklet is not appropriate.

In these areas, a single individual patient risk assessment form is available for use

e.g., Physiotherapy, Day units, some community based acute services (Appendix 2).

In some areas, modifications to the single patient risk assessment form have been

made to suit individual departmental needs and requirements e.g., Paediatric

Physiotherapy. However, any modifications to this form must be discussed with the

Clinical Ergonomics Department to ensure that the form contains the required

patient risk assessment information.

The assessment must consider the patient, and their condition and all other clinical

circumstances, which are likely to impact on the handling tasks prior to a final safer

system of handling being chosen.

The single patient risk assessment should be completed appropriately to form an

action plan detailing the handling risk level, number of staff and any equipment

required to carry out the task safely.

The risk assessment must be kept under constant review and changes made when

appropriate e.g. when there is reason to believe the assessment is no longer valid

because the patient’s condition and ability has changed, circumstances of the task

have changed or there have been significant changes in the environment or the

task.


In accordance with the Regulations, a review must also take place if an accident or

incident occurs

All patient risk assessments should be signed (or countersigned) and dated by a

qualified health care professional.

6.1.4 Rehabilitation

Rehabilitation handling is aimed at promoting or maintaining function and

independence, in accordance with individual treatment goals (Guide to the

Handling of People V5 2005 and V6 2011).

A risk assessment must be carried out as part of the overall assessment and

treatment plan by the relevant Therapy team.

Handling methods must be realistic for all those carrying out the tasks. Less skilled

people should not be expected to compromise their safety or that of their patients

by working outside of their capabilities in carrying out handling tasks.

In accordance with the risk assessment, equipment should be used to complement

handling methods.

Therapists should not be using controversial handling methods as routine practice.

Therapists may have to work from a position in front of the patient, and their

greater skill and knowledge may make this less of a risk than for those who are

unskilled. However the risk assessment must consider any additional risks.

Therapists must, when delegating therapeutic handling to staff, ensure the health

and safety and competencies of those involved.

Patient handling assessments must be constantly monitored and adjusted, where

required, to indicate assessment decisions, which is the responsibility of the

assessing clinician.

6.1.5 Specialist Services

In areas where there is a rapid through put of patients it may not be practicable to

carry out a risk assessment on each patient. In these circumstances a generic risk

assessment of handling situations, where there is likely to be a significant risk of

injury must be carried out (MHOR as amended).

If at a procedure/surgical pre-assessment meeting, a patient is identified as having

a specialist handling need, then a full risk assessment must be completed in line

with Section 6.1.3

Areas where generic risk assessments may be required include:

- Breast Screening

- Endoscopy & Colposcopy

- A & E including Plaster Room

- Out Patient Clinics

- ENT

- Theatres

- Screening Services e.g., AAA screening, ECT

- Woman’s Health


- Mortuary

- POD Surgery Centre

- Radiology & Medical Physics

- Maternity

- Day units e.g., Chemo day unit, Woodside, Ellison unit, Chronic Pain service,

Jubilee Day Unit

This list is not exhaustive. If in doubt, then the Clinical Ergonomics team should be

contacted for advice.

6.2 Equipment.

Equipment shall be provided to assist in the avoidance or reduction of the risk from the

handling event.

Equipment should be used in accordance with manufacturer’s instructions

Staff should be trained in the safe use of any equipment used to reduce such risks or for

musculoskeletal injury risk reduction. Clinical/departmental managers must establish

minimum competencies for using equipment and ensure that their staff are trained

accordingly. Records of all training and attainments of competencies must be taken and

maintained by line managers (Refer to Trust Medical Devices Policies)

Advice should be sought regarding equipment suitability from appropriate trust advisors,

e.g. Clinical Ergonomics, Hotel Services, Infection Control, Tissue Viability, Health and Safety

Advisor, Medical Devices or QEF Estates Departments.

Equipment should be cleaned and decontaminated between uses with different patients as

per Manufacturer’s instructions and Trust Infection Control Policies.

For purchase of equipment refer to Policy for the Procurement Management and Use of

Medical Devices RM30

6.3 Bariatric Patients

Moving and handling very heavy, dependent patients involves a foreseeable risk. In such

cases the guidelines and procedures for caring for these patients should be followed. There

will be occasions when tasks require adjustments to the process due to changing needs or

poor initial assessment.

The Guidelines for the Management of the Bariatric Patient can be found on the Trust

intranet site.

7 Training

7.1 Training

As manual handling training is mandatory within the Trust, the requirements are detailed

within the Trust Mandatory Training Needs Analysis which can be found within the OD&

Training section on the Trust Intranet Site.

As laid down in the Regulations, the Trust will:


7.1.1.1 All newly appointed staff to the Trust will receive Manual Handling Training on the

Corporate Induction training, in line with the Trust Induction Policy. This

incorporates full manual handling training appropriate to their individual work role

requirements on commencement of their employment, in line with Trust

Mandatory Training Needs Analysis and Induction Policy PP30.

7.1.1.2 To ensure all new staff attend the appropriate training session(s), the

Organisational Development & Training (OD&Training) Department co-ordinate the

Induction Training and supply the names of all new starters to the Trust to the

Clinical Ergonomics Team

7.1.1.3 All staff should attend manual handling training as required by the Trust as

indicated in the Trust Mandatory Training Needs Analysis.

The manual handling training programmes include all or some of the following elements

depending upon the type of course and training needs:

• Legislation, local policies and procedures

• Understanding of the basic principles of biomechanics including mechanics and

function of spinal structures

• Recognise the difference between safe and unsafe/controversial practices and their

relationship to Musculoskeletal Injuries.

• Importance of back care and posture including the risk factors of back pain and

musculoskeletal injuries

• Importance of an ergonomic approach to risk assessment and management and the

role of the individual

• Work place specific handling methods to include inanimate loads and people

handling.

• Promotion of person independence, where appropriate.

• Work place specific handling equipment

• The principle of general fitness for handling.

• Opportunity to practice safer handling methods.

Course handouts and further information on manual handling can be located on the Trust

Intranet site.

Controversial /unsafe Patient handling practices handout can be found in Appendix 3.

7.1.2 Provide training programmes for appropriate groups of staff before any manual

handling tasks are undertaken. The level of training each staff group requires is

identified in the Trust’s Mandatory Training Needs Analysis.

7.1.3 Provide training for groups of staff at all levels, which include skills involved in

making ergonomic assessments and a problem solving approach to manual

handling operations.

7.1.4 Monitor and review-training programmes to meet the needs of specific

occupational groups and develop good practice based on assessment of current

training status and the skills required to supervise and monitor established safe

practice.

7.1.5 Staff should attend courses relevant to their job role (reference to TNA). If a

manager considers this to be unnecessary, then a risk assessment must be carried


out indicating how any risks will be managed in the workplace. Copies of the

assessment should be sent to Clinical Ergonomics and the relevant Divisional

Manager.

7.1.6 Training will be provided on the principles of efficient human movement, and their

application to manual handling tasks and on equipment available at the training

session. Training will also include skills involved in making an ergonomic assessment

and a problem solving approach to manual handling tasks.

7.1.7 The Clinical Ergonomics team will monitor and review all training programmes to

ensure that the content is current, meets recognized standards, reflects the needs

of the Trust, and addresses issues reported in DATIX as appropriate.

7.1.8 Attendance on training will be monitored by Clinical Ergonomics who will report on

attendances. Managers will be made aware of non-attendance and be responsible

for ensuring that training is completed.

7.1.9 The frequency of Refresher training is specified in the Trust’s Mandatory Training

Needs Analysis.

7.1.10 Refresher training for staff returning after absence may be recommended by

Occupational Health, where appropriate, as part of their return to work

programme.

7.1.11 Where possible the Trust will adhere to the “trainer to delegate ratios” as

recommended by the National Back Exchange: HSE 2007. The recommended

number currently stands at 6 – 8 delegates per trainer.

7.1.12 Customized awareness/refresher training will be provided for all staff where a

unique manual handling task has been identified or a piece of equipment e.g. hoist,

is used infrequently.

7.1.13 All staff completing the appropriate training programme will receive a Certificate of

Attendance to include in the personal/professional development record.

7.2 Record Keeping

Training

7.2.1 Records of attendance and non-attendance at Manual Handling Training will be

recorded on the Oracle Learning Management (OLM).

7.2.2 It is the responsibility of the OD&Training Department to record all Induction and

Mandatory training onto OLM, in line with Mandatory Training Policy PP25 and

Induction Policy PP30.

7.2.3 A core course elements document is completed following the main training courses

i.e., Induction, Introduction to moving and handling and practical skills courses and

is a record of course content, practical elements covered and level of participation

during the sessions. For other courses, course documentation is also completed

outlining the session content.


7.2.4 For the full outline of the process for the Management of Non-Attendance for

Mandatory and Statutory Training for directly managed staff, which includes

manual handling, refer to Mandatory Training Policy PP25.

7.2.5 Any areas where there is persistent non-attendance, consultation will take place to

ascertain the reasons with the relevant line manager.

7.2.6 Manual Handling is classed as Mandatory Training and failure to comply may result

in further action being taken. Refer to Mandatory Training Policy PP25

Risk Assessments

7.2.7 Any risk assessment completed must be accurately recorded using the relevant

Trust documentation

7.2.8 Copies of all non clinical risk assessments must be available for inspection in line

with health and safety policies by the relevant manager.

7.2.9 The Clinical Ergonomics team, with the Health and Safety Advisor, will monitor and

review all manual handling risk assessments to identify trends/risks for further

action or follow up, and in addition will develop and monitor the implementation of

an appropriate action plans, where required.

8 Equality and diversity

The Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide

services to the public and the way we treat our staff, reflects their individual needs and does not

discriminate against individuals or groups on the grounds of any protected characteristic (Equality

Act 2010).

An equality analysis has been undertaken for this policy, in accordance with the Equality Act (2010)

This policy when implemented should reflect anti-discriminatory practice. Any services,

interventions or actions must take into account any needs arising from race, gender, age, religion

and belief, language, communication, sensory impairment, disability and sexuality.

9 Monitoring compliance with the policy

Standard/process/

issue

Monitoring and audit

Method By Committee Frequency

Process for recording

Manual Handling Training

information.

All manual handling

training records put

onto OLM database

Clinical

Ergonomics/

OD&Training

dept

Health and

Safety

Committee

(HSC)

For each

course

Process for following up

those who do not

complete training

Non-compliance -

course registers given

to OD&Training.

Monitoring process

ref:

Mandatory training

Policy and Induction

Policy.

Clinical

Ergonomics

/

OD&Training.

Health and

safety

Committee

HR

Committee

For each

course

updates to

committee

as required


Standard/process/

issue



Monitoring of the above

Manual Handling

Training Report

Clinical Ergo Health and

Safety

Committee

Annually

Standard/process/

issue



Moving and Handling managing the risk associated with moving and handling

Moving and handling

patient risk assessments

Ward Audits of

patient risk

assessments

Clinical Ergonomics

Health and

Safety

Committee

Annually

Generic Moving and

Handling clinical and non

clinical risk assessments

Department

and Ward

audits

Clinical

Ergonomics/

Health and

Safety

Health and

Safety

Committee

Every two

years or sooner

if assessed

necessary

How action plans are

developed and followed

up as a result of risk

assessments

Audit Clinical

Ergonomics/

Health and

Safety/Managers

Health and

Safety

Committee

As above

Monitoring of the above

Annual report

Clinical

Ergonomics/

Health and Safety

Health and

Safety

Committee

Annually

Compliance with the

policy

Annual report Clinical

Ergonomics/

Health and Safety

Health and

Safety

Committee

Annually

Incidents Incident

statistics

Managers/ Health

& Safety team

Health and

Safety

Committee

Annually

The Clinical Ergonomics Team, in conjunction with Health and Safety, will carry out an annual audit

on compliance of the manual handling risk assessment process. The findings will be analysed and

included in a report, together with recommendations and supporting action plan where

appropriate. This will be presented to the Health and Safety Committee.

Manual Handling incidents recorded on Datix will be reviewed annually by clinical ergonomics and

health and safety. Where trends are identified within the year or where there is a significant

increase in accidents or incidents, these will be reported to the Health and Safety Committee.

Managers will be provided with a list of staff who have attended manual handling training and a

list of non-attendees. This list will be issued as requested, for them to take the appropriate action

in accordance with their responsibilities as specified in Section 4 of this policy.


For Mandatory training and Corporate Induction training, the OD and Training Department will

monitor and report on attendance and non-attendances as per the relevant Trust Polices.

To ensure that all relevant issues are addressed an appropriate action plan will be drawn up

annually, identifying areas for improvement/change, with leads and timescales clearly specified.

Any action plan and updates will be discussed at the Health & Safety (General aspects of Manual

Handling including training) and implementation monitored by the Clinical Ergonomics Team.

Regular monitoring and audit of health and safety is essential to ensure that the arrangements in

place for managing health and safety are effective and compliant with relevant statutory

provisions. The Trust will use a variety of mechanisms to monitor and audit the health & safety

arrangements.

A Manual Handling Annual Report will be produced by the Clinical Ergonomics Service on each

financial year (April – March), which will be reviewed, by the Health and Safety Committee.

10 Consultation and review

This policy has been reviewed and updated and has been circulated for comment and consultation

to the following: Clinical Ergonomics and Occupational Health department, Risk Management;

Health and Safety Advisor, Internal Audit and Counter Fraud Service and the Equality and Diversity

Co-ordinator, staff side health and safety reps, Safer Working Group, Heads of Departments,

Medical Devices; Compliance and Assurance, Tissue Viability Specialists; OD&Training, in line with

OP27 Trust Policy for the development, management and authorisation of policies and procedures.

The policy has been reviewed and approved by the Health and Safety Committee and will be

regularly reviewed according to OP27 Policy or more frequently depending on updates in health

and safety legislation, guidance or requirements or significant changes in work practices.

11 Implementation of policy (including raising awareness)

This policy will be implemented in accordance with OP27 Policy for the development, management,

and authorisation of policies and procedures. It is also included in corporate and mandatory

training, and relevant staff education/training events.

This policy reflects the Trusts stance on the Management of Risk and the provision of good Health

and Safety standards. Managers must have named individuals who progress manual handling

within each Directorate or Service Area. These named individuals are responsible for ensuring the

policy is implemented, in full, in each locality of the trust. They are key in the assessment process

and the maintenance of records within their own departments.

The Trusts risk assessment process will provide the evidence for each management unit to identify

any needs, relating to manual handling compliance, e.g. need for training, equipment etc. This

should be conveyed to the Clinical Ergonomics, Health and Safety and Risk Management Teams.

The Clinical Ergonomic Service will provide assistance and guidance for managers and staff on any

assessments, they feel require specialist knowledge. The service will also provide assistance on

solutions requiring changes to work places, changes to the environment and further staff training

when managers request such support

The Trust Membership Coordinator as detailed within OP27 will circulate this policy.


12 References

College of Occupational Therapists (2006) Manual Handling (Guidance 3), London

Gateshead Health NHS Foundation Trust. Standard of Practice No. 23. Moving and Handling/

Mobility

http://staffzone/trust-documents/clinical-documents/clinical-documents-care-standards.php

Gateshead Health NHS Foundation Trust Risk Management Guidance Risk Assessment Forms and

Guidance Procedure V 3 2012

Trust Intranet site link:

http://pandora/docs/healthandsafety/risk-assessments/Pages/Home.aspx

Gateshead Health NHS Foundation Trust Intranet site: Staff zone

http://staffzone/trust-documents

Gateshead Health NHS Foundation Trust: Guidelines for the Management of the Bariatric Patient

http://staffzone/trust-documents/clinical-guidelines/clinical-guidelines-general.php

Gateshead Health NHS Foundation Trust: Training Needs Analysis

http://staffzone/ddi/departments/o-d-and-training/staff-development.php

The Management of Health & Safety at Work Regulations 1999. Statutory

Instrument 1999 No. 3242. ISBN 0 11 085625 2

The Chartered Society of Physiotherapy: Guidance on Manual Handling in Physiotherapy 4th

Ed.

London The Chartered Society of Physiotherapy 2014

Great Britain. Health and Safety at Work etc Act 1974. Elizabeth II. Chapter 37 (1974) London: The

Stationary Office

Health and Safety Executive (1992) Manual Handling. Manual Handling Operations Regulations (as

amended): Guidance on Regulations L23. Revised 3rd

ed (2004). Sudbury: The Stationary Office.

Health and Safety Executive (1998) Manual Handling Manual Handling Operations Regulations

1992 .2nd Edition. London: The Stationary Office.

Health and Safety Executive (1998). Provision and Use of Work Equipment Regulations Approved

Code of Practice and Guidance, L22 (4th

Ed.) (2014) Suffolk, HSE Books

Health and Safety Executive (1992). Workplace health, safety and welfare. Workplace (Health,

Safety and Welfare) Regulations 1992. Approved Code of Practice and Guidance, L24 ( 2nd

Ed.)

(2013) Suffolk, HSE Books

HSE: Health and Safety Statistics 2014/2015

• http://www.hse.gov.uk/statistics

• http://www.hse.gov.uk/statistics/overall/hssh1415.pdf

• http://www.hse.gov.uk/statistics/at-a-glance.pdf

• http://www.hse.gov.uk/statistics/causinj/handling-injuries.pdf

• http://www.hse.gov.uk/statistics/causdis/musculoskeletal/

• http://www.hse.gov.uk/statistics/causinj/kinds-of-accident.pdf


Health and Safety Executive (1999) The Management of Health and Safety at Work Regulations.

Sudbury: Health and Safety Executive

HSE (2007) Manual Handling training. Investigation of current practices and development of

guidelines RR583: London; The Stationary Office

HSE Mac Tool http://www.hse.gov.uk/msd/mac/index.htm and booklet and score sheets accessed

via http://www.hse.gov.uk/pubns/indg383.pdf)

Lloyd, P (Chairman of Co-ordinating Committee) (1997) The Guide to the Handling of Patients.

Revised 4th

ed (1998): Middlesex. National Back Pain Association in collaboration with the Royal

College of Nursing.

National Back Exchange. (1993) Essential Back – Up. Recommendations for setting up effective back

care programmes. Revised 2002 ed, Middlesex: Scutari Projects Ltd.

National Back Exchange (2010) Standards in Manual Handling (3rd

Ed): Towcester

RCN (2000) Introducing Safer Patient Handling Policy. Royal College of Nursing, London.

Smith, J. (ed) The Guide To The Handling of People. 5th

ed. Middlesex: Backcare in collaboration with

the Royal College of Nursing and The National Back Exchange. (HOP5)

Smith, J.(ed) The Guide to the Handling of People. 6th

edn. Middlesex: Backcare in collaboration with

the Royal College of Nursing and The National Back Exchange. (HOP6)

The Inter-professional Advisory Group. The Inter- Professional Curriculum Framework for Back Care

Advisors. Revised Edition (1997). London: College of Occupational Therapists in collaboration with

the Chartered Society of Physiotherapist, Ergonomics Society, national Back Exchange and Royal

College of Nursing.

13 Associated documentation

This document represents the Trust’s Manual Handling Policy. It is recommended, therefore, that

this document be read in conjunction with the following documents which can be found on the

Trust website:

Risk Management Policies

RM01 Risk Management Strategy

RM02 Health and Safety Policy

RM04 Incident Reporting and Investigation Policy

RM05 Reporting Defects & Failures Policy

RM07 Display Screen Equipment

RM13 Provision & Use of Work Equipment Policy

RM17 Personal Protective Equipment at Work Policy

RM19 Lifting Equipment Policy

RM30 Procurement, Management and Use of Medical Devices Policy

RM41 Young People at Work Policy

RM45 Training Policy for Medical Devices

RM50 Slips, Trips, and Falls Policy

Health and Safety Intranet on Office Sharepoint Pandora: risk assessment section within document

centre Risk Assessment Procedure V 3 2012


Infection Control Policies

IC01 Control of Infection Policy

IC03 Standard Precautions for the Prevention & Control of Infection

IC15 Cleaning and Disinfection Policy

HR Policies

PP10a Recruitment and selection policy Non medical Staff

PP11 Managing Attendance at Work Procedure

PP14 Equal Opportunities in Employment Policy

PP25 Mandatory Training Policy

PP29 Education and Training Policy

PP30 Induction Policy

PP39 Well Being at Work

PP45 Occupational Health Policy

Operational Services Policies

OP06 IT and Information Security Policy

OP27 Policy for the development, management, and authorisation of policies and

procedures.

This list is not an exhaustive list but represents key documents which outline arrangements and

processes which complement the approach outlined in this Policy


Appendix 1

MANUAL HANDLING OF LOADS: ASSESSMENT CHECKLIST

Section A - Preliminary: Ref: No ....................

Job description

Factors beyond the limits of the guidelines?

Is an assessment needed?

(i.e. is there a potential risk for injury, and are the factors beyond

the limits of the guidelines?)

YES/NO*

If ‘YES’ continue If ‘NO’ the assessment need go no further

Operations covered by this assessment

(detailed description):

Locations:

Personnel Involved:

Date of assessment:

Diagrams/Photos (other information):

Section B - See over for detailed analysis

Section C - Overall assessment of the risk of injury? LOW/MED/HIGH* (*Circle as appropriate)

Section D - Remedial action to be taken: (Use additional sheet if necessary for action plan)

Action Plan / Remedial steps that should be taken. (include date by which each action should be taken and by whom if

appropriate:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Review Date:

Date for reassessment:

Assessors name: Signature:

TAKE ACTION....AND CHECK THAT IT HAS THE DESIRED EFFECT


SECTION B: Questions to consider:

NOTE: If a question is not applicable please indicate

by using N/A next to the question e.g., twisting?

N/A

If YES, tick appropriate

Level of Risk

Problem occurring from the task

(Make rough notes in this column in preparation for the

possible remedial action taken) taken)

Possible remedial action/ action plan

(Possible changes to be made to system/ task/ load

workplace/space/environment. Communication

required LOW MED HIGH

The tasks – do they involve:

• Holding loads away from trunk?

• Twisting?

• Stooping?

• Reaching upwards?

• Large vertical movements?

• Long carrying distances?

• Strenuous pushing or pulling?

• Unpredictable movement of loads?

• Repetitive handling?

• Insufficient rest or recovery?

• A work rate imposed by process?

The loads – are they:

• Heavy?

• Bulky/unwieldy?

• Difficult to grasp?

• Unstable/unpredictable?

• Intrinsically harmful (e.g. hot/sharp)?

The working environment – are there:

• Constraints on posture?

• Poor floors?

• Variations in levels?

• Hot/Cold/Humid conditions?

• Strong air movements?

• Poor lighting conditions?

Individual capabilities – does the job:

• Require unusual capability?

• Hazard those with health problems?

• Hazard those who are pregnant?

• Call for special information/training?

Other Factors:

Manual Handling Policy v9 28

Appendix 2

PATIENT MANUAL HANDLING RISK ASSESSMENT

Patients Name and Address:

DOB:

WEIGHT: FALLS

SCORE:

Body build : Above Average, Average,

Below Average,

Height : Tall, Medium, Short,

Initial Assessment on admission By:

(Print Name)

Is Patient Independent with or without aids Yes/No

If Yes go no further

If No Full Assessment Required

HANDLING CONSTRAINTS (please circle)

Pat. Physical - Weakness, Pain, Medical problems, Skin integrity, Joint problems, Balance

Pat. Other - Comprehension, Behaviour, Co-operation , Sight, Hearing, Drug Therapy

Physical Environment - Space, Lighting, Flooring, Temperature, Furn/Fittings, Other

Any further relevant information:

TASK : mark any

areas not

appropriate with

N/A

MH

RISK

No of

staff

HOIST TRANSFER TECHNIQUES/

EQUIPMENT REQUIRED

Date/Time Initials

H M L

IN/OUT BED

TURNING IN BED

UP & DOWN BED

SIT TO STAND

WALKING

BATH OR SHOWER

TOILETING

OTHER

WARD: ………………… ROOM: ………….. DISCHARGE DATE: ………………


HOIST TYPE:

………………………..

………………………..

Safe working Load of

hoist:…………….

SLING TYPE

PLEASE TICK

SLING SIZE

Universal

Amputee

Standing

Other: Please state

Any Additional information/ Action Required ( use additional sheet if required):

SIGNATURE:…………………………………… DATE:…………………………

Print Name………………………………………... Grade…………………………………………….

1st

REVIEW/DATE COMMENTS SIGNATURE

2

nd REVIEW/DATE COMMENTS SIGNATURE

3

nd REVIEW/DATE COMMENTS SIGNATURE

NB This is a general risk assessment, In addition the following should be considered.

1) Staff should be trained for the level of risk identified

2) The capabilities of individual members of staff should be considered.

3) Prior to commencing each task staff should determine whether the assessment is valid.

4) The assessment should be based on the best practice possible


Appendix 3

CLINICAL ERGONOMICS SERVICE

MANUAL HANDLING CONTROVERSIAL PRACTICE

In 1997 the Royal College of Nursing together with the National Back Pain Association have in the 4th

Edition of the Guide to Patient Handling produced a resume of what they consider to be “banned practices”

The R.C.N. is a recognised, respected, professional body, and any text relating to manual handling that this

organization promotes cannot simply be ignored or dismissed. This would not only be unprofessional, but

from the Trust’s legal point of view, it would be unwise and unsound.

The Guide to People Handling 5th

Edition provides evidence through accepted risk assessment tools of the

risks associated with a variety of manual handling tasks including controversial practice. This evidence

considers the risks for beginners through to experienced practitioners as suggested by BENNER (1984)

However, the Guide to Patient Handling 4th

Edition and the Guide to People Handling 5th

Edition and The

guide to the Handling of People a systems approach 6th

Edition are NOT legal documents. They are pieces

of work intended to inform anyone experienced or otherwise, who may be handling people, of what is

generally considered to be practice which may increase risk and that which may reduce risk.

The Manual Handling of Loads Regulations is the legal instrument, in which it states that risks must be

reduced to the “lowest level reasonably practicable”. It is to this standard that we must work.

In order to comply with statutory obligations, the Trust has adopted a risk management approach.

This does not mean that the Trust either condones or will tolerate the habitual, prolonged or continued use

of poor practice. The Trust expects that in managing risks a suitable and sufficient risk assessment is

undertaken and that the principles of good practice are given primary consideration when deciding how the

task should be carried out. There will be times when there needs to be a balance between risk reduction,

individual care, treatment provision and perceived best practice. In these cases anything less than best

practice must be justified through risk assessment and poor practice must never be tolerated as a routine

choice of handling techniques.

Time is spent explaining these issues on the Introduction to Manual Handling day. These issues are

discussed further on the practical skills course.

Introduction

The persistent use of poor posture and practice continues to be the source of much ill health and injury

associated with manual handling. This statement is supported within the Trust by the Datix information.

The Guide to Patient Handling 4th

Edition, 5th

Edition and 6th

Edition contains a description of “unsafe

practice and controversial techniques”.

The Guide to People Handling 5th

Edition attaches evidence through approved risk assessment methods of

the risks associated with controversial practice in addition this evidence considers the risk for different

levels of skill within the staff group.

The list is as follows:


The Original Four

a. the drag lift

b. the orthodox lift

c. lift with the patients arms around the carers neck

d. lifting using poles and canvas

The ExtendedList

a. top and tail lift

b. cross arm lift

c. Australian lift

d. Elbow lift

e. Through arm lift

f. Two sling lift

g. The bear hug

h. Belt holds from the front

i. Pivot transfers

j. Front transfers with one nurse

k. Shoulder slide

l. Moving a patient across a bed

m. Flip turn

This list is not exhaustive and reference should be made to complete original text.


GATESHEAD HEALTH NHS FOUNDATION TRUST

This information from professional bodies needs to be considered in the context of Gateshead Health NHS

Foundation Trust policy, procedure and philosophy for managing risk.

The list is one of TECHNIQUES. It must be remembered that the Trust bases its practice on the application

of physical, biomechanical anatomical, physiological and developmental principles. It subscribes to the

philosophy stated in chapter 5 of the 4th

Edition that “efficient movement of the human body involves the

application of principles rather than the learning of techniques”.

This does not mean that the Trust will tolerate the habitual, prolonged and continued use of poor practice

and posture.

The Trust Requires That:

1. ALL issues associated with that handling task must be considered. This is done by the risk

assessment process.

2. A suitable and sufficient assessment of risk is carried out BEFORE the task is attempted.

3. That the manual handling risks are considered and evaluated alongside any other risks which may

exist in carrying out this task in a given situation.

4. The principles of safer, good practice are given primary consideration when deciding how to carry

out a task and are applied to all handling activities.

Has Lifting been banned

As stated the Guide to People Handling 5th

Edition in the past ‘lifting’ was condemned as ‘unsafe’ and In the

Guide to the Handling of People 6th

Edition “Techniques become controversial when they increase risk of

injury to the person or handler(s) beyond acceptable limits” however it is now argued that in certain very

limited defined situations with named people it may be assessed as necessary to perform a manual lift.

The risk assessment supporting the use of such practice must be very thorough; supported with suitable

and sufficient documentation and systems of work that as a MINIMUM standard address the following:

1. Copy of the risk assessment plus clinical reasoning which explain why this handling method is being

employed. There should be an explanation of what other best practices have been considered and why

they could not be used in this situation.

2. Procedures must be detailed in writing

3. Space, equipment and furniture details

4. Risks associated with carrying out the task e.g. lifting for both the person and ALL the handlers

involved both formal and informal.

5. The minimum number of people needed to do the job

6. Those doing the job MUST be assessed as being fit to carry out the task. Vulnerable people e.g. those

who are pregnant; those who have reduced mobility or capabilities should not be expected to participate.

Where appropriate Occupational Health / Clinical Ergonomics should be contacted for advice in accordance

with the Manual Handling Policy.


7. Handlers and supervisors must receive specific additional training for the task and there needs to

documented evidence that this has occurred.

8. Provision must be made to ensure that skill levels are maintained through regular refresher training.

This training must be documented.

9. Staffing rotas must ensure that there is adequate numbers of suitable trained staff on duty at all

times. Annual leave and sickness absence situations must be considered.

10. The manager should sign any documents to support the need for using this method.

11. Alternative arrangements must be documented to provide a fallback option for use in foreseeable

circumstances.

12. The situation MUST be kept under constant review and when possible there should be a change to

best practice and where appropriate using equipment.

Drag lift

This manoeuvre is one in which the carer places their hand or arm under the patient’s axilla.

NB some authorities are also describing the ‘drag lift’ as any manoeuvre where carer places their hand or

arm between the patient’s arm and chest wall.

Common Uses:

1. to sit a patient in bed

2. to move a patient up the bed

3. to move the patient from sitting to standing

4. to support the patient in standing

5. to move the patient from one position to another

This manoeuvre is performed with one or two carers; with equipment and without: from the front or the

back.

Dangers to Carer:

1. Posture: the carer stands in a top-heavy position.

This position is known to be dangerous because of the compression forces

created in the spine and the consequent effect on the spinal discs.

The static muscle activity associated with maintaining this position is

known to result in muscle fatigue with a consequent loss of protection.

Overtime the habitual use of this posture will result in a reduction in the

ability of these elastic tissues to stretch and recoil – like ‘knicker’ elastic.

The risk of injury is increased significantly

2. Poor Leverage: The above position provides poor leverage for handling tasks.

The patient load is handled at some distance from the carer’s body. In this

position the weight and resistance offered by patient load must be added

to the weight of the head, trunk and arms of the carer carrying out the task.

Thus the WHOLE load can be much heavier than we think.


The force that ligaments and muscles have to exert to move the load are

very large indeed; all this effort hold the position comes from small

muscles, which were not designed to bear this kind of load.

3.Lack of stability: this position causes the operator to be off balance, because the centre of

gravity moves forwards and the line of gravity falls outside the base area:

the operator doesn’t fall because the ligaments and muscles in the back

tense and work hard to provide a counter balance: there is an increased

risk of the carer falling or being pulled further out of balance by the patient.

4. Shoulder Damage: because of the posture of the carer and the effect this has on muscle

activity, to carry out an action the only muscles available are the arm

muscles – these muscles are meant for mobility not strength, so the action

is inefficient and increases the likelihood of the carer having a shoulder or

neck injury.

5. Lack of Friction: the carer cannot slide the patient in this position; therefore they tend to

take the full weight of the patient.

6. Increase in pressure because the upper arms are being relied upon to do all

Gradients of the activity brute force is applied and the action is

Associated with carried out too quickly causing pressure to rise within

Speed of movement. the spinal segment, which are damaging to the discs.

7. Lack of Control: should the patient collapse or take their feet off the floor, the carer

will take the full weight of the patient and will find it difficult to

safely lower the patient to the seat or floor.

Disadvantages to the Patient

1. Shoulder Injuries: the patient is balanced on the carers forearm and

as a result soft tissue damage may be done to the patients shoulder; the

shoulder may be dislocated: the manoeuvre is very painful.

2. Bedsores: when dragging a patient up the bed or to the back of a chair, skin may be

damaged and pressure damage may result.

3. Lack of the patient is completely dependent on the carers:

Rehabilitation they are unable to participate in the activity.

4. Increased likelihood the nurses cannot control the patient load very easily

of being dropped and so there is an increase in the likelihood of the

patient being dropped.

5. Inappropriate because of the discomfort and speed of the action

Behaviour the patient may be afraid and react in an aggressive way.


EVIDENCE REVIEW

REBA 13 VERY HIGH IMMEDIATE ACTION REQUIRED

SKILL LEVEL: NOVICE: ADVANCED BEGINNER: COMPETENT

Very high risk and high postural risk for the handler. High effort required.

Potential risk of shoulder damage for patient.

Person being handled cannot help with activity.

Lifting and Lifts

A lift may be considered to be taking all or a substantial part of the weight of the load.

Lifting a patient must be avoided whenever possible lifting should never be the first course of action

considered.

Orthodox Lift

Two carer’s stand one each side of the bed. They clasp wrists under the patient’s back and thigh and the

patient is lifted.

NB this lift may also be referred to as the cradle or traditional lift and may be carried out using patient

handling slings.

Dangers to Carers

1. Poor Posture: The static muscle activity associated with this posture leads to muscle

fatigue with a consequent loss of protection and an increased likelihood of

injury. Overtime there will be adaptive shortening in otherwise elastic

tissue, which further increases risk.

In addition compression forces increase in the spine.

2. Poor leverage: the load is held at a distance from the carer’s body thus the LEVER ARM

increases in length. As a consequence the muscles in the lower back and

around the shoulders have to work extremely hard to stabilize the area and

move the load.

3. Lack of stability: the posture causes the operator to be in an off balance position, because

the line of gravity is close to the edge of the base area. As the base area of

the operator is fixed the patient is moved out of the operator’s base area.

The operators posture moves from bad to worse as now an element of

twisting is superimposed on a top-heavy position. At the end of the

manoeuvre the operator is even more off balance.

4. Lack of use of this is a lift and therefore friction is not used.

Friction:

5. Increased pressure efficient movement cannot be used, so brute force

gradients associated takes over. The task is carried out quickly to make

with velocity use of momentum, but this causes a rise in pressure

within the spinal segment, this may damage the disc

6. Lack of control of the the patient load is moved away from the operators,

load: usually well outside their fixed base area. Thus the operators


are pulled further into a top-heavy, twisted position whilst bearing the full

weight of the load and controlling that load to set it down.

It is a tall order to ask the spine and spinal muscles to exercise this amount

of control. Injury is likely to occur

Dangers to Patient

1. Skin damage: the skin may be damaged as the carers push their arms into position. The

skin may also be damaged as a result of increased pressure from the carer’s

arms on a relatively small area of the patient’s skin. The heels may drag on

the bed.

2. Increased likelihood due to lack of control of the load on the part of the

of patient being dropped: operators.

3. Lack of rehabilitation: the patient is completely dependent on the operators.

4. Inappropriate because of the possible discomfort e.g. from the head being

behaviour unsupported and speed of the action the patient may be afraid and react in

an aggressive way.

EVIDENCE REVIEW

REBA: 10-12 HIGH TO VERY HIGH ACTION REQUIRED NOW

SKILL LEVEL: NOVICE: ADVANCED BEGINNER: COMPETENT

Very high risk activity due to posture adopted for task and effort required.

Person being handled cannot help with activity.

Australian or Shoulder Lift

Dangers for Carers

1. Poor Posture: unless the carer has reasonable tissue flexibility and is careful about getting

into a good position, then the carer tends to be on a significant twist. If the

free hand is then used to support the patient the carer’s trunk will be even

more twisted

2. Lack of Stability: the base of support is fixed, therefore as the patient load is moved up the

bed, the load is moved outside the carers base area, thus the carers line of

gravity moves close to the edge of the base are (sometimes it is moved

outside of the base area) which increases instability.

3. Poor Leverage: as the patient load is moved away from the operator, the lever arm

increases small back muscles have to work inappropriately hard to stabilize

and control both the operator and the load. Any mechanical advantage

that did exist is now lost at an important phase of the manoeuvre.

4. Shoulder damage: a substantial part of the weight is taken on one shoulder, therefore there is

likely to be a strain on the joint. The arm under the patient’s thigh is

usually at an awkward angle and as a result is likely to be damaged.

5. Lack of use of friction: this is a lift. Sliding is not used. The carer therefore

supports the full weight of the patient.

6. Increase in pressure in order to get the job over and done the carers often

within the spine: carry out the task quickly and with jerky movements.

This increases the pressure within the spinal segments.


7. Lack of Co-ordination: the carers cannot see each other, nor can they see

the patient, therefore there is an increased likelihood that the procedure

will be uncoordinated. If the two carers are of substantially different

heights than the lack of co-ordination increases further.

8. Lack of Control: the carers cannot see what the patient is doing and so risks increase. The

patient may push on a foot unexpectedly or they may move backwards.

The patient may also nip or hit the carers or may attempt to push

downwards on the carers. The carers will have no control over the load

and as a result the manoeuvre may go very wrong resulting in injury.

Disadvantages for Patient

1. Shoulder Movement: the patient must have good shoulder girdle stability

and movement, otherwise the shoulder would very easily be damaged.

2. Sitting Posture: the patient must be able to achieve and maintain a good sitting position.

The patient must therefore have good hip movement.

3. Skin Integrity: heels and bum may be dragged. If a paddle is used under the knees

delicate skin may be damaged due to excessive pressure or it may cut into

the back of the knee.

General Disadvantages

1. It is invasive with regards to personal space. This may be unacceptable to some people.

2. Some patient’s e.g. those with increased extensor tone; those who are confused and those with hip

problems may have difficulty in maintaining a good position.

3. It is unsuitable for patients with fractured ribs, bone secondaries or other chest injuries.

EVIDENCE REVIEW

REBA: 12-13 VERY HIGH CHANGE REQUIRED NOW

SKILL LEVEL: ADVANCED BEGINNER: COMPETENT

(NOVICE SHOULD NOT BE DOING THIS)

Very high risk activity due to posture and effort required.

Top and Tail Lift/ Through Arm Lift

The carer at the body end of the patient places their arms under the patient’s shoulders between the

patient’s chest wall and arms. The carer takes hold of the patient’s forearms; the carer at the foot end of

the patient takes hold of the patient’s ankles or calves.

Disadvantages for Carers

1. Poor Posture: carers cannot assume a good posture to carry out this lift. They are top-

heavy and twisted and as a result the risk of injury is increased.

2. Lack of Stability: the carer’s base area is fixed and inappropriate for the task resulting in an

initial unstable position, which increases as the action progresses.


3. Poor Leverage: associated with poor postures assumed by the carers. Poor leverage is also

associated with the patient load being handled at a distance from the

carer’s body.

4. Lack of use of friction: this is a lift and so the total weight of the patient is

being taken by the carer. Sliding principles are not used.

5. Lack of Control: there is an increased risk of the carers losing control of the load. This lack

of control is associated with poor posture and stability. The risks are

increased further if the patient is unco-operative or cannot or will not keep

skill and follow instructions.

6. Increase in spinal this technique is usually carried out in a quick

pressure associated manner, which serves to increase the pressure

with velocity: within the spinal units.

Disadvantages for the Patients

1. Shoulder Damage: it is likely that the patient will be damaged.

2. Inappropriate if the patient is caused pain it is likely that they will

Behaviour: respond in a way, which may put the carers at risk.

3. Falls: if there is insufficient control of the patient load the patient may be

dropped or fall.

4. Skin Damage: the paddle may damage delicate skin due to excessive pressure or it may

cut into the back of the knee. The patient may be dragged at the point of

lift.

Two Sling Lift

This lift is very similar to an Orthodox Lift and is just as dangerous. The presence of the slings does not

make the manoeuvre safe; it is still a total body lift.

The disadvantages for the carers are the same as those described for the Orthodox Lift.

The disadvantages for the patient are the same as those described for the Orthodox Lift. In addition if the

patient is unable to control her/his head the head may flop back and cause injury

EVIDENCE REVIEW

REBA: 10-13 HIGH – VERY HIGH CHANGE IS NEEDED NOW

SKILL LEVEL: NOVICE: ADVANCED BEGINNER:- COMPETENT

High risk activity due to posture, effort and weights handled.

Person being handled cannot assist and is likely to experience discomfort.


Elbow Lift and Pivot Transfers

These two manoeuvres are very similar and are therefore being considered together.

In both rocking is used to build up momentum the patient is half stood, turned and sat down.

NB in the ELBOW TRANSFER the patient is bundled up so that the head is under the handler’s upper arm.

The patient is brought into a stoop standing position. Unless the patient is very small they usually cannot

extend the knees.

THE RISKS ARE THEREFORE INCREASED.

Disadvantages for Carers

1. Poor Posture: carers tend not to assume a good posture. They adopt a top-heavy stance.

2. Lack of Stability: the carer’s base is fixed and as a result of the rocking, the carer constantly

moves in and out of balance. The risk of being off balance significantly

increases at the point where the patient is brought onto their feet.

3. Poor Leverage: associated with the poor postures of the carer. The patient is likely to be

handled at distance from the carer’s body.

4. Lack of use of it is a manoeuvre where the carer is very likely to

Friction: support a substantial amount of the weight of the patient load. Sliding

cannot be used.

5. Lack of Control: there is an increased risk of the carer losing control of the load as they not

only have to generate enough force to control their own movement, they

also have to be able to control the movement of the patient. Should the

patient’s knees collapse or in the case of the elbow lift, should the patient

stand up the risks are increased further.

6. Increase in spinal the speed of the manoeuvre will result in an increase

pressure associated in pressure within the spinal unit.

with velocity:

7. Lack of use of head: neither the carer or the patient can use the

developmental principles of moving the head away first at the

effort phase of the action. The spine is therefore likely to lock

in a top-heavy position.

Disadvantages for patients

1. Inappropriate the patient may respond in an inappropriate manner

Behaviour: if they feel vulnerable or afraid. This may put both them and the carers at

risk.

2. Falls: if there is insufficient control of the load they may fall. If the task is taking

place too close to a wall the patient may hit their head.

3. Inability to help: the patient is totally dependent and cannot help.

4. Instability: as a result of the base of support and speed of movement the patient load

is out of balance.


Holds from Front

These include the Bear Hug and Belt Hold

The bear hold in itself provides a poor hold with which to assist a patient load.

The use of a belt provides a better holding point BUT the carer’s control of the load is compromised

especially if the belt is not applied correctly or fastened tightly. In addition if the carer holds the straps

incorrectly, should an accident occur the carer may be hurt?

Working from the front of a patient

This is now being considered to be poor practice. In some areas it is said to be “banned practice”.

However, where the handling environment is poor and / or out of the control of the employer and in

rehabilitation settings working from the front may be the only option.

In order to MINIMIZE the risks certain aspects need to be carefully considered.

1. A RISK ASSESSMENT should always be carried out in accordance with the Manual Handling of Loads

Regulations.

2. Consideration must be given to the level of skill experience and training of the staff/carers carrying out

the task as well as the abilities of the patient load.

3. Consideration must be given to the application of physical, anatomical, physiological developmental

and biomechanical principles not just for the handler but also for the patient load and for all parts of

the task.

4. A mini appraisal of the situation should be carried out before each handling episode.

Patient

NB the patient MUST bring their back away from the chair back in order to bring the centre of gravity

into the pelvis and then be moved forwards on the chair seat.

Carer

If the patient requires assistance to move away from the chair back then the carer SHOULD NOT

assume a top-heavy forward flexed position and pull the patient forward from the shoulders. In this

position the leverage is such that the loading end in the lumbar spine and because of the length of the

lever arm the spinal muscles have to exert a force approximately five times greater than the weight of

the load in order to achieve the task. The head and he leg muscles cannot assist. It is a brute force,

unskilled movement which undoubtedly increases risk. This is the case whether a male or female

carries out the task.

Allowing a Patient to hold the Carer

It is advisable NOT to allow a patient load to hold the carer in a handling task.

In this situation if the patient begins to fall they cannot be lowered to the floor. It is highly likely that the

carer will be pulled to the floor and will be injured.

Use of Equipment

Using equipment to reduce the risks associated with handling tasks needs careful assessment and

consideration.


The equipment available in this Trust has not been “banned” from a Health and Safety point of view, but

the equipment must be chosen carefully and used correctly. It must be suitable for its chosen task; it must

not be faulty; staff must know how to use it correctly and be aware of what could happen if the equipment

is misused or if it is inappropriate for the task.

The need for equipment and the type of equipment chosen should form part of the risk assessment

process.

The same physical, biomechanical, anatomical, physiological and developmental principles should be

applied to the use of equipment as are applied to carrying out tasks without equipment.

Equipment should not be used if you do not know how to use it. This will only increase the risk for both

carer and patient.

The clinical ergonomics service will be able to provide information about equipment whose use is

considered to be less than best practice.

Conclusion

Gateshead Health Trust does not condone the routine and habitual use of poor practice. However, in

following a risk management philosophy, the Trust does understand that in some circumstances when ALL

the risks associated with providing care and treatment for a specific patient have been assessed and

considered some action which, falls short of best practice will be the only option.

In such circumstances it is expected that staff will be able to provide a reasonable argument supported by a

risk assessment for the decision made. It is also expected that the situation will be kept under constant

review and a change to best practice made as soon as reasonably practicable

Manual Handling Policy - NHS Gateshead · Appendix 3 Controversial/Unsafe Practices Handout ........

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