Patient Handling & Back-care
description
Transcript of Patient Handling & Back-care
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Patient Handling &
Back-carePresented by:
P WIOSH Trainer
BackCare999
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Learning
Tell me and I will forget
Show me and I may remember
Involve me and I will understand
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Course objectives
By the end of the course, participants will:
Be able to demonstrate a working knowledge of
key people handling.
Have a basic knowledge of human anatomy.
Understand principle-led moving and handling
best practice.
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Manual handling operations
“any transporting or supporting of a load by hand or bodily force
Includes:Lifting, putting down, pushing, pulling, carrying or
moving thereofUsing mechanical aids, e.g. trolleys
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Photos removed to reduce size – boxes in a factory setting
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Driving forces
Addressing manual handling issues can lead to benefits:Legal compliance: criminal lawSocial: fewer sick days and less absenteeismMoral: should not be injured for workMarket: bad H&S = bad publicityFinancial: accidents cost money - civil liability
Personal: avoid pain, loss, ongoing problem
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Backs! 2012 campaign
5 million lost working days p.a. due to back painBack pain is the nation's leading cause of disability
with 1.1 million people disabled by it.
www.hse.gov.uk/betterbacks/index.htm
Wider context – 2008/9:180 fatalities at work130,000 other major injuries
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Manual handling quiz
What proportion of reported workplace accidents result from manual handling?
2008/9 reported injuries
Other 13%
Falls 8%
Struck by 15%
Slips trips 26%
Handling 38%
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Manual handling quiz
Which of the following types of workplace has the highest proportion of accidents resulting from manual handling?
a. Health care
b. Retail
c. Construction
d. Agriculture
% Injuries caused by manual handling
0% 10% 20% 30% 40% 50% 60%
Agriculture
Chemicals
Retail
Textiles
Furniture
Construction
Health care
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Sites of >3 day injury caused by handlingBack 47% etcGraphic removed to reduce size
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Types of injury from manual handling
FracturesDamage to muscles, ligaments and tendonsSpinal disc injuriesTrapped nervesAbrasions and cutsBurnsWork related upper limb disordersHerniasDeath
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Work related upper limb disorders
WRULD or repetitive strain injuries (RSI)• Tennis elbow• Carpal tunnel syndrome• Frozen shoulder
Caused by:• Repetitive activities • Carrying out an activity for a long period of time
without adequate rest intervals • Poor posture / non-neutral joint positions
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Cause of injury
Traumatic stress
Cumulative stress
Degenerative change
Psychological causes
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Vulnerable groups
OldYoungObeseUntrainedThose with existing injuryTiredPregnant women
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3 most important things
FamilyHomeRelationshipsWealth / ability to earnLeisure / sportsHealth
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Practice lift
Demonstrate a typical liftDemonstrate a good liftWhat are the changes?
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Skeleton photo removed to reduce size
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Vertebrae & discs
NucleusCartilage
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Discs Photos removed to reduce size
www.spineuniverse.com/displayarticle.php/article1431.html
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Prolapsed disc
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Stresses without a load
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The lever principle
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Centre of gravityGraphic removed to reduce size
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Centre of gravityGraphic removed to reduce size
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Centre of gravityGraphics removed to reduce size
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Centre of gravity Photos removed to reduce size
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Principles of efficient handling
Dynamic stable baseNeutral position of bodyShort levers – centre of gravity closeCorrect secure hand holdGood commands and communication
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MusclesRelaxed musclesBody in neutral positionStatic muscle fatigueUse of major muscle groups
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Team handlingWhat are the problems?
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Team handlingPlanning of liftCommunication
• How to grasp• When to lift• What level to carry• Which route• Set down points on route?
Co-ordinationDisparity of individuals: size, speed, strengthAwkward areas
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Team handling
1 person = 100%
2 people = 66% of individual capacity
3 people = 50% of individual capacity
1 = 60
2 = 80
3 = 90
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Team handling
Consider other options• Avoid• Mechanise• Use manual handling aids
Run through sequence of events verballyWalk the routeOne person take charge of giving instructionsStick to established teams if possible
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Problem loads
Inanimate objectsUnexpected issues
• Light• Heavy• Centre of gravity
Intrinsically harmful• Sharp edges• Acids
Unpredictable behaviour• Partly fixed load• Liquids – centre of
gravity• Poor sealing of container
PeopleUnexpected issues
• Light, heavy, C of G• Weak side / strong side• Collapsing
Intrinsically harmful• Teeth & nails• Hygiene
Unpredictable behaviour• Change of mind• Struggling• Aggression
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F L U E N C Y
A mnemonic
Feet
Load
Unlock
Even
Natural
Control
Your back
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Photos removed to reduce size man handling extinguishers
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Pushing and pulling
Pushing generally preferable:Operator slip or trip – no load impactLess risk of pulling load onto feet & anklesNo twisting to see where you are goingBetter position for arm jointsCan often use both handsCage less likely to tip if fixed wheels leading
But:Visibility may be hinderedhttp://www.hse.gov.uk/research/rrpdf/rr009.pdf
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Pushing and pulling considerations Wheels:
• Initial direction & obstructions• Size• Fixed or rotating
Load:• Stability / safety• Visibility
Route• Obstructions• Slopes
Hands• Between waist and shoulder height• Neutral position• Avoiding impacts
Legs: “A” frame to overcome inertia Travel
• Slow speed• Avoid starting & stopping
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Pushing a wheelchair
Pre-use checksWheelsFoot restsClothing of clientBrakesClient understands what is happening
UseDynamic stable baseShort levers
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Health and Safety at Work etc. Act 1974
Section 2(1) general duty "to ensure, so far as is reasonably practicable, the
health, safety and welfare at work of all his employees"
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Health and Safety at Work etc. Act 1974
s3: duty to others who may be affected; contractors, visitors, neighbours & public
s7: employees duties:• Take reasonable care of themselves and others • Co-operate with employer • s8: Not intentionally or recklessly interfere with or
misuse anything provided for health and safety
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Management of H&S at Work Regs 1999
Every employer shall make a suitable and sufficient assessment of the risks to health and safety of employees & non-employees.
Must implement suitable preventative and protective measures.
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Management of H&S at Work Regs 1999
Regulation 4: hierarchy of control measures:
• E – Eliminate• R – Reduce• I – Isolate• C – Control• S – Signage• P - PPE
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Provision & Use of Work Equipment Regulations 1998 (PUWER)
Work equipment must be:SuitableAdequately maintainedInspected if necessary at regular intervals by a
competent personAdequate information & training must be providedRisks adequately controlled, e.g. guarding
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Lifting Operations and LiftingEquipment Regulations 1998 (LOLER)
Lifting equipment:Any equipment used at work for lifting or
lowering loads including attachments used for anchoring, fixing or supporting it
Loads can include a person
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Lifting Operations and LiftingEquipment Regulations 1998 (LOLER)
What documentation / marking?Safe working load marking (SWL)Thorough examination
• Every 6 months for lifting people• Otherwise 12 months
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Lifting Operations and LiftingEquipment Regulations 1998 (LOLER)
Lifting operations must be:Properly planned by a competent personAppropriately supervisedCarried out in a safe manner
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Human Rights Act 1988
Blanket “no lifting” policy unlawful
Regulations to not prescribe no risk regime
Some manual handling inescapable at work
Employees must accept greater risk if lifting people rather than objects
All risk assessments based on individual needs and circumstances
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Manual Handling Operations Regulations 1992
Identify manual handling tasks with significant potential for injury • Can task be avoided?• Can it be mechanised?
If not, conduct risk assessment to reduce risk to lowest level reasonably practicable• Identify remedial actions• Prioritise these actions• Assign responsibility and target date
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Manual Handling Operations Regulations 1992
Employers responsibilityConduct risk assessmentsReduce risk of injury as far as to lowest level
reasonably practicable
Employees responsibility• To use safe systems and procedures coming from the
risk assessment
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Control measures
Eliminate the need for taskAutomateManual handling aidsPeople measures
• Safe handling techniques• Team handling• Personal protective equipment
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Risk assessment
A logical and consistent way of assessing a situation and finding ways of making it safer
Logical: justify outcomes to regulatorLead to action plan and improvementConducted by a competent personRegularly reviewed
• After an accident• If workplace or practices change
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Risk assessment
Hazard• Something with the potential to cause harm
Risk• Likelihood of the harm occurring and its severity
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Risk assessment – 5 steps
Identify the hazardsIdentify who may be harmed and howEvaluate the risk & decide on actionsImplement and documentReview
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What factors contribute to manual handling risk?
TaskLoadWorking environmentIndividual capability
OrTaskIndividual CapabilityLoadEnvironment
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Is it necessary / urgent / how often? Can the client help or does it involve taking the full
body weight? What is the distance to be travelled? Is there height difference? Will it involve stooping, twisting or turning? Are other handlers necessary? Is the client accessible? What is the safest and most effective way of
completing the task? 61
The Task
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Size of carer Have they been trained? Previous injuries / lack of fitness / pregnancy Inflexibility of attitude / techniques. Am I being asked
to do something unsafe? Unsuitable clothing / shoes Are they used to the environment Time available Are they able to work as part of a team
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Individual Capability
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Physical condition: - Size, weight and shape Pain Mobility of limbs Skin condition Conscious / unconscious Can they balance / weight
bear? Attachments e.g. catheters
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Load
Psychological State: - Understanding Anxiety / Fear Uncooperative Unpredictable
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Awkward tight spaces
Floor surfaces uneven, slippery or wet
Temperature / lighting / noise
Obstacles e.g. steps
Adjustable furniture e.g. profiling bed
Privacy
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Environment
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Controversial techniques
Drag lift
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Controversial techniques
The Australian lift Orthodox lift
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Controversial techniques
Through-arm lift with two handlers
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Controversial techniques
Arm and leg lug / hammock transfer
Bear hug / pivot transfer
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