Pinciples of Safe Manual Handling and Lifting in the Care Home

Manual Handling Principles and Practice

To provide learners with the underpinning knowledge and skills required, to undertake the manual handling of objects and people, safely within the workplace.Legislation demands that anyone who is required to handle loads of any kind during their working day are appropriately trained in the theory and techniques of Manual Handling.It is important therefore, that you understand the legal requirements relevant to this.

Legislation is an Act of Parliament

Act of Parliament

Health and Safety at Work Act 1974(Great Britain)

Health and Safety at Work Act 1978(Northern Ireland)

Human Rights Act 1998(2000)

Disability Discrimination Act 1995(2005)

Mental Capacity Act 2005(2007)

Corporate Manslaughter and Homicide Act 2007(2008)

Regulations

Management of Health &Safety at Work Regulations 1992 (1999)

Manual Handling Operations Regulations 1992  (2002)

Provision and Use of Work Equipment   Regulations 1998   (P.U.W.E.R)

Lifting Operations and Lifting Equipment Regulations 1998 (L.O.L.E.R)

The reporting of injuries, diseases and dangerous occurrences regulations 1995 (R.I.D.D.O.R)

Employees Duties

Places a duty on the employee to co-operate with the employer with regard to the use of equipment and devices and report without delay any work situation which might present  a serious and imminent danger

You are personally accountable for your own actions /omissions regardless of advice or instruction from another individual

You are responsible for clear concise documentation

REMEMBER IF YOU DOCUMENT YOU WILL BE SUPPORTED IF YOU DON’T YOU WON’T

What is the COST of carelessness

Health and Safety Executive

Improvement Notices

Prohibition Notices

Commissioning Bodies

Social Services

Fire Service

Company Insurers

Where an employer is found negligent the line manager or equivalent may also be liable and punished accordingly

If a person is accused of negligence for failure to comply with Health and Safety legislation she / he must prove that it was not reasonably practicable to do so

Risk Assessment

Under the Manual handling operations regulations RISK ASSESSMENTS MUST be completed.

There are 2 types

INFORMAL

FORMAL

The purpose of Risk Assessment is to identify hazardous situations that may cause strains and injury

Hazard

Something that has the potential to cause harm

Risk

The likelihood of harm occurring

What are you looking for?

Hazardous situations may involve

Holding awkward postures for a long time

Repetitive awkward or heavy activities

Working at speed beyond capability

Insufficient rest periods between tasks

Working in poor lighting, draughty, cold or hot environment

Pushing pulling or lifting heavy loads

What has to be assessed?

Remember T.I.L.E

T - Task

I  - Individual

L - Load

E – Environment

Tasks

You need to consider

Where the load is

The distance moving the load

Whether the load is above head height or on the ground

If it involves twisting or stooping

Is it repetitive

Individual

Need to consider

strength, height, weight

State of health and fitness

Age

Clothing

Gender

Dexterity

Experience

Motivation and attitude

Knowledge and skill

Load

Need to consider

Size and weight

Shape

If the handler’s vision is blocked

Whether it’s easy to grasp

If it’s alive

Whether it is harmful e.g. hot or sharp

Will it move or shift during handling

Environment

Need to consider

How much space is available

Uneven, slippery floor

Variations in levels e.g. stairs

Unsuitable lighting

Untidy or cluttered area

Unsuitable temperature or weather

Suitability of equipment available

Five steps to Risk Assessment

Decide if there is a problem

Who might be harmed and how

Are existing precautions adequate

Record your findings

Review and revise your assessment

Who should carry out the Risk Assessment?

Trained manual handling risk assessor

Manager

Line Manager

Responsible person at that time

Good risk assessment will result in

Less work related injury

Increased efficiency

increased staff morale

REMEMBER

All manual handling activities must be risk assessed and controls put in place to reduce the risk of injury so far as reasonably practicable

Ergonomics

Ergonomics is the science of fitting the job to the worker.The greater the mismatch between the physical capacity of the worker and the requirements of the job the greater the risk of injury

Physical / Psychological Aspects

Body shape and size

Posture

Mental Abilities

Personality

Knowledge and Experience

Ergonomic Evaluation consists of

Assessment

Planning

Implementation

Good ergonomics makes good sense and leads to a more effective, less stressful work which is beneficial to everyone!

Aspects to consider

The job being done and the demands on the worker

The equipment to be used is it appropriate to the task and the environment,assessing people, their jobs, equipment, working environment and the interaction between them which gives us the ability to design safe, effective and productive work systems

Statistics

Many Manual Handling injuries are cumulative rather than being truly attributable to any single handling incident.The injured do not always make a full recovery the result can be physical impairment or even permanent disability

When are you most susceptible to injury?

At the beginning or early into a shift

Lunch time

At the end of the day

Annual cost to industry from disability due to low back pain problems is estimated at around 6 billion. Back pain is the second most common reason for absenteeism,30% of all workplace injury claims are back related

Spine

The human spine is made up of 33 small bones, called vertebrae. These bones are stacked on top of each other to form a column. Between each vertebra is a cushion known as an intervertebral disc.

The vertebrae are held together by ligaments, and muscles are attached to the vertebrae by bands of tissue called tendons. Openings in each vertebrae line up to form a hollow canal.

The spinal cord runs through this canal from the base of the brain however it does not continue all the way down this canal it stops at L2 (lumbar vertebrae) where it branches out  Nerves from the spinal cord branch out and leave the spine through spaces in the vertebrae. The spine is strong and flexible with a natural “ S” shaped curve.

The spine has 4 defined curves which are

Cervical Vertebrae-support the head and neck

Thoracic Vertebrae-anchor the ribs

Lumbar Vertebrae-support the major part of the body’s weight and provide a stable centre of gravity during movement

Sacrococcygeal- supports part of the body’s weight and provides a stable centre of gravity during movement

Spine has 3 main functions

To protect the spinal cord

To allow movement

To support the upper body

Intervertebral  Disc

An intervertebral disc is described as a lattice network of fibres, onion like in appearance with a jelly like substance within. The disc receives it’s nutrition from the vertebral end plates which can be found above and below each disc. The disc receives it’s nutrition by a process known as diffusion

The main function of the disc is shock absorption

Repeated stresses can cause minute tears and bulging of the disc which in turn invades the spinal space . This is known as a prolapsed or herniated disc or commonly known as a “slipped disc”

Muscles

The human body consists of 650 individual muscles, which are attached to the skeleton by strong fibrous tissue known as tendons. Messages from the brain cause muscles to contract and relax.

Muscles provide power and control so that we can move this is achieved primarily by muscle groups and not by individual muscles.

To perform safe moving and handling we use 4 sets of muscles

Hip Flexor Muscles

Begin at the front of the spine, travel through the pelvis, attach to the front of the leg joining the back to the legs

Function

Used for running and walking

Side and Hip Muscles

Join the hips to the ribs, travel from the back to the front of the body

Function

Provide strength, support and movement

Back Muscles

Travel down both sides of the spinal column the largest being the Latissimus Dorsi

Function

Used for movement and weight bearing

Stomach Muscles

Travel from the ribcage to the pelvis

Function

Used for strength and support for the abdominal cavity and provide protection for the lower back. Good condition of the abdominal muscles is vital to back care

Soft Tissue Injuries

Strain

Strain is an injury to a muscle or tendon caused by twisting or pulling while improperly moving or lifting heavy objects causing overstressing of the muscles

Soft tissue injuries

Sprain

Sprain is an injury to one or more ligaments which can be as a result of a fall, sudden twist or blow to the body that forces a joint out of its normal position resulting in overstretching or tearing of the ligament

Principles of safe Handling

F = Feet

L = Load

U = Unlock (loosen up)

E = Even elbows (90 deg.)

N = Natural Spine ‘S’ shape

C = Communication/ Command

Y = Your back, Your responsibility

Good Handling Techniques

Assess the load

Position the feet

Head up

Lift with legs

Keep load close to waist

Put down then adjust

Team Lifting

Planning the lift and having a good hold are particularly important in team lifting.

Apply the principles for  two-handed symmetrical lifting.

Where the nature of the load precludes the use of this technique then the guidance
appropriate to the nature of  the load should be applied.

Indicators of Abuse

Caused by moving and handling

Bruising to wrist and arms

Scratches/Cuts

Friction Burns

Fractures

Soft Tissue injuries

Fear/Aggression/non-compliance

The following illustrations are common sights that can regularly be seen in the workplace, highlighting bad and unacceptable practice deemed as controversial with no benefit to the Service User or the handler

Action may be taken under disciplinary policies where there is evidence that employees are carrying out any of the following controversial manoeuvres without due cause (emergency situations needing immediate action to avoid serious harm to the service user’s health)

Australian Lift

According to the Royal College of Nursing, cited by Back Care(1999) this lift is responsible for more injuries to nurses than any other the handlers posture is compromised and they are lifting the most of the Service Users weight. Additionally, the Service User has no therapeutic or rehabilitative benefit.

Pivot Lift

An extremely dangerous form of moving and handling with the possibility of disc damage extremely high . There is a very high risk of injury to both the handler and the Service User

Cradle Lift

Involves excessive stooping

Requires the lifter to flex and bend sideways

Excessive pressure placed on the intervertebral discs of the lifter

Drag Lift Underarm Hook

Dangers to Handlers

Posture Stooped & Twisted

Top Heavy

Insecurity of Hold

Dangers to Client

Injury to shoulder joint

Friction to skin, feet & ankles

Compromises chest expansion

Proven to be dangerous to both the Service User and the handler. The handler is stooped and twisted they are top heavy and have an insecure hold. The Service User is caused unnecessary pain, friction to the skin on their feet and ankles, injury to shoulder joints and expansion of their chest is compromised

Lever Principle

For every 10 kilos of weight, 10 times as much pressure is placed on the lower back if incorrectly lifted.

Manual Handling Equipment

The following clearly states the procedures that must be adhered to prior to using any piece of equipment

Hoists

This mechanical aid must be used by 2 members of staff who must be present at all times. Assisted bath hoists must be used by 2 members of staff who must be present at all times

Scales that attach to the spreader bar must be removed.  A service user must not be transferred with scales attached

When in use the brakes must be off to allow the hoist to find its centre of gravity, however if using the hoist on a slope or to raise the Service User from the floor the brakes must be on for the first couple of inches of the manoeuvre.

It is not permitted to transport the Service User through a doorway or along a corridor on this equipment

Stand Aid

This mechanical aid must be used by 2 members of staff who must be present at all times. When in use the general rule is that the brakes should be applied however some appliances may differ

Refer to the manufacturers handbook

You are not permitted to transport the Service User through a doorway using this equipment

Hoist / Stand Aid Checklist

The following checks must be carried out by 2 members of care staff prior to each use

Ensure the equipment is clean and fit for purpose

Familiarise yourself with the equipment

Explain the procedure to the Service User

Check the safe working load ensuring that it is adequate to take the weight of the Service User

Check the LOLER sticker to ensure that the equipment is within its required service date if not seek advice from the Nurse in Charge / Manual Handling Facilitator

Check the battery has been charged

Check the emergency stop button (not all mechanical aids have this facility)

Check handset is functioning and not damaged

Check the legs on the equipment open and close freely

Remember

Do not use this equipment if you have not been trained to do so by a Manual Handling Facilitator

Slings

The following checks must be carried out by 2 members of staff prior to each use

Correct sling for purpose

Correct size for the Service User

Identification label is intact and the Safe Working Load is clearly visible

Evidence that the sling has been serviced as per LOLER regulations

All stitching is intact if Not Do Not Use The Sling

All straps are intact not frayed or damaged

Velcro fastening is free from threads and deemed fit for purpose

There are no flaws such as small holes in the body of the sling

Sling is clean and free from body odours

Both members of staff must be present at all times

Both members of staff must ensure that the straps have been secured to the hoist by tugging on each individual strap prior to raising the hoist

Damaged or flawed equipment must be taken out of use immediately and reported to the Nurse in Charge/Manual Handling Facilitator

Slide Sheets

Recommended slide sheets for use are

Quintal Variglide

Locomotor

Quintal User Specific (infection control)

Bariatric(specific to that Service User)

Ensure slide sheet is clean

Ensure that there are no small tears, flaws  or discolouration if so do not use

Ensure slide sheet is fit for purpose

Never discard the slide sheet on the floor

Wheelchair Safety

Remember you are the line manager for the task and responsible for the safety of the Service User

A full risk assessment has been completed

The footplates are in situ (unless the risk assessment states otherwise)

If lap straps are attached they should not be removed

The brakes are in working order

The tyres are inflated

Bariatric

Definition

 “the branch of medicine or surgery that deals with the causes, prevention and treatment of obesity

On average someone over the weight of 25 stone

This would also depend on their Body Mass Index (is a measure of body fat based on height and weight)

Statistics

30,000 deaths are caused by obesity

NHS spends £300 million a year

Three quarters of Brits are overweight

Majority of obese people are under 45

The management of extremely heavy Service Users in the past 10years has become a core topic at many conferences relating to manual handling

All obese Service Users should be accorded their Human Rights and organisations should have systems in place that do not impinge on these rights.

In Conclusion

Musculoskeletal Disorders are the most common occupational illness in Britain and injury can occur while doing any activity that involves some movement of the body from heavy lifting to typing

Always remember the Safe Principles of Manual Handling.