The Newcastle upon Tyne Hospitals NHS Foundation Trust Policy for the Transportation and Storage of Medical Gases Version : 1.1 Effective From: 7 January 2016 Expiry Date: 7 January 2019 Date Ratified: 24 September 2015 Ratified By: Trust Health and Safety Committee 1 Introduction The Newcastle upon Tyne Hospitals NHS Foundation Trust recognises that it has a responsibility to provide a safe environment for all patients, staff and visitors. It is important to remember that piped medical gasses should always be the preferred option of supplying medical gasses to patients and cylinder gasses should only be used when this is not possible. After interrogating accident data within the Trust associated with Medical Gas cylinders, it has been identified that specific guidance is needed to ensure the safe storage and transportation of Medical Gas Cylinders on wards, departments and throughout the Trust. 2 Scope This Policy document is provided to ensure that all staff involved in the handling, transportation and storage of medical gases understand their individual responsibilities and the methods employed by the Trust to ensure safe practice. 3 Aims Failure to adhere to safe practice when transporting or storing medical gas cylinders can lead to serious injury or Fatalities. 4 Duties Roles & Responsibilities Chief Executive - The Chief Executive has overall responsibility to the Trust Board for ensuring that appropriate and effective health and safety management systems are in place. Directorate Managers - The day-to-day activities of the Directorate/Department are conducted in as safe and suitable manner. Medical Gas Committee Responsible for ensuring and monitoring compliance with the policy. Author - The author retains ownership through development, consultation, approval and ratification processes. 1 of 9
5 Strategy 5.1 Storage of Medical Gas Cylinders on Wards and Departments It is imperative to safety that Medical Gas Cylinders are stored correctly on Wards or in Departments to ensure that cylinders do not pose a risk to staff, patients or visitors. If cylinders are not stored in a correct manner they can pose a risk by falling onto people causing injury or as a significant tripping hazard Cylinders should be stored in a designated area and must be secured in place It is recommended that there is a designated area located as near to the exit/entry to the department as possible for easy access, but consideration must be given to ensure that safe access and egress is maintained Cylinders should never be left lying on floors unsecured or in areas where they can present a tripping hazard Cylinders must never be propped against walls as they can fall and injure passers by Cylinders must never be left on top of tables, chairs, beds or anywhere they can fall from height and injure people Cylinders must be placed in an appropriately designed holder. Cylinders should not be placed on patients beds, they must `be placed in specifically designed holders where they can be kept away from direct contact with combustible materials. Please be advised that the Trust does not have a suitable vehicle or drivers qualified in the (Transportation of Hazardous substances) to transport medical gasses between sites. If a patient requires medical gasses that are not available through a piped system, the relevant gas or gases must be ordered from the supplier via the Trust Pharmacy Department in advance of the patient attending. 2 of 9
WALL BRACKET - CYLINDER Cylinders stored on Wards or Departments should be stored in these purpose built storage facilities. Cylinders should be stood in the upright position and secured in place with the chains provided. Any missing chains or damage to the storage facility must be reported to the Estates department for replacement or repair. HOLDER/WALL BRACKET - CYLINDER This product is for securing 2 cylinders securely and safely. It should be positioned to the wall at approximately half of the cylinder height. The cylinder size is indicated on each bracket. This product can be obtained from Bristol Maid Hospital Metalcraft Limited. CYLINDER HOLDER This product allows for safe storage of D and E size cylinders at a bedside and features a carry handle and an extended hanging hook suitable for beds with 25mm thick side/end members, with a small gap between base and frame. The holder can be bolted to the bed for added security. WALL PLATE FOR CYLINDER HOLDER This product is a stainless steel wall plate to support and provide a permanent place for 1 cylinder holder. The cylinder holders slot into the flange at the top of the wall plate as shown. 3 of 9
5.2 Transportation of Medical Gas Cylinders - Clinical CLINICAL TROLLEY - CYLINDER, 'F/G' Cylinder trolley to hold popular 'F' or 'G' cylinders. Cylinder is retained by means of two drop over chains. Wheels are inoperative when trolley is in the upright position and stationary TROLLEY - CYLINDER, 'J' This trolley has been strengthened to transport a large 'J' cylinder. Wheels are inoperative when trolley is stationary and in the upright position. Cylinder is retained by 2 drop over chains. 4 of 9
5.3 Transportation of Medical Gas Cylinders - Portering PORTERING TROLLEY - CYLINDER, 'F/G', STABILISERS Trolley fitted with 2 extra castors allowing transportation of cylinder stabilised, thus reducing likelihood of tipping. TROLLEY - CYLINDER, DOUBLE 'F/G', STABILISERS Increased width trolley with rear stabilisers to support two F or G cylinders. Cylinders are supported by drop over chain linkages TROLLEY, CYLINDER - 12 'D' or 'E' Special trolley with 12 sections suitable for 'D' or 'E' cylinders, with non-slip rubber base board and push handle one end. Suitable for transporting and delivering or for areas requiring more than the average medical gas storage. TROLLEY - CYLINDER, 'J', STABILISED For transportation of a large 'J' cylinder, with 2 extra castors allowing transport of cylinder stabilised, reducing likelihood of tipping. 5 of 9
5.4 Transportation of Patients on Medical Gas Therapy G/200/RS PORTERING, REAR STEER, INTER-NESTING CHAIR This is the G/200/RS Portering, rear steer, inter-nesting chair. This chair is purchased from Bristol Maid, Hospital Metal Craft and is the preferred chair for the transportation of patients and medical gasses. As can be seen in this photograph the cylinder sits in the cylinder holder, which is secured to the back plate of the chair. This ensures that the cylinder is away from the patient and is secured in a safe position and does not present a hazard to passers by. The cylinder holder can be removed from the chair and safely be secured to a wallmounted plate once you have reached the patients destination. (See wall mounted plate pictured above). Or transferred to an upright cylinder holder. HOSPITAL WHEELCHAIR This is a standard hospital wheelchair used throughout the trust. This chair must not be used to transport patients and medical gasses unless a third person can accompany the patient to carry the medical gas cylinder in a mobile oxygen trolley. THEATRE TROLLEY All patient trolleys used within the trust are equipped with specific medical gas cylinder storage areas as shown. These storage areas must always be used when transporting patients and medical gas cylinders. Medical gas cylinders must never by transported on top of the trolley beside the patient. 6 of 9
INFANT COT When transporting a patient in a paediatric cot the cylinder holder must be attached to the rail at the foot of the cot as shown. WARD BED When transporting patients in hospital beds the cylinder holder should be attached at the head or the foot of the bed as shown. WARD BED The cylinder holder must not be attached to the cot-side of the bed as this would present a hazard to passers by and could also cause the cot-side to collapse. 7 of 9
5.5 Guidance on Handling of Medical Gas Cylinders A full risk assessment must be completed for any task involving the transportation of medical gasses. All staff must be properly trained in manual handling and in the transportation of medical gasses. Always use the correct trolley for the size of the cylinder to be transported. Cylinder trolleys, transporters and holders should be regularly checked for defects by the user. All defects must be reported to the Estates Department for repair. Always ensure that the cylinder is secured in place when transporting. Only ever milk churn cylinders to manoeuvre cylinders over short distances e.g. trolley to bed. Never leave cylinders free standing, always ensure they are secured in an appropriate holder. Never roll cylinders along the ground as this can cause the valve to open accidentally which could cause an explosion or a fire and will also damage the cylinder paintwork and label. Never attempt to catch a falling cylinder. Only size D and E size cylinders should be used whilst transporting patients on oxygen therapy. Ensure cylinders are stored in a clean well ventilated room, free from dust and grease. Always use an appropriate cylinder carrier during transportation. These are available for beds and chairs. Never put a cylinder between a patient s legs. Never cover a cylinder with a blanket (the bedding will become saturated and pose an extreme fire hazard.) Avoid all grease and oil when handling or having medical gases administered (whether via a cylinder or via a pipeline). Do not use hand cream before handling a medical gas. Patients should not use oil / grease based lip lubrication whilst being treated with medical gases (i.e. Vaseline, Lipsyl, Chapstick, lip balms etc) Further information can be obtained from a Trust Health and Safety Advisor if required re cylinders carriers, and Pharmacy Medicines Information for issues related to gas administration. Large quantities of medical gasses stored internally should be stored on an external wall. 8 of 9
6 Training Training on the Handling, Transportation and Storage of Medical Gas Cylinders will be provided to all staff involved in their use. This training will be provided via E- Learning. 7 Equality & 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 any grounds. This document has been appropriately assessed. 8 Monitoring Compliance of this policy will be monitored by the Medical Gas Committee who will monitor the policy by undertaking a review of medical gas incidents which have taken place in the interim period between meetings. Standard / process / issue Compliance with Trust procedural document Transportation and Storage of Medical Gases. Monitoring and audit Method By Committee Frequency Reviewing Clinical Medical Gas Quarterly medical gas Governance Committee incidents & Risk reported via Datix on a Quarterly basis 9 Consultation & Review This policy has been reviewed in consultation with the Medical Gases Committee and the Trust Health & Safety Committee. 10 References The British Compressed Gas Association Technical Information Sheet TIS 12 regarding handling gas cylinders safely. 9 of 9
The Newcastle upon Tyne Hospitals NHS Foundation Trust Equality Analysis Form A This form must be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval. PART 1 1. Assessment Date: 04/11/2015 2. Name of policy / strategy / service: Policy for the transportation and storage of medical gases 3. Name and designation of Author: Ian Gaffney Health and Safety Advisor 4. Names & designations of those involved in the impact analysis screening process: Ian Gaffney Health and Safety Advisor 5. Is this a: Policy x Strategy Service Is this: New Revised x Who is affected Employees x Service Users Wider Community 6. What are the main aims, objectives of the policy, strategy, or service and the intended outcomes? (These can be cut and pasted from your policy) To ensure that medical gases used in the Trust are transported and stored safely. 7. Does this policy, strategy, or service have any equality implications? Yes x If, state reasons and the information used to make this decision, please refer to paragraph 2.3 of the Equality Analysis Guidance before providing reasons: To help demonstrate Trust is committed to providing an environment that is healthy and safe for all staff, patients and visitors. The Health & Safety at Work Act 1974 requires all employers who employ more than five employees to produce and maintain a safety policy and to bring it to the attention of all its employees. In addition the Management of Health and Safety at Work Regulations (1999) requires that all employers will have in place an effective strategy for the management of health and safety within its organisation. This policy sets out the Trust approach, arrangements and responsibilities for meeting the requirements
Health and Safety legislation. Review of policy document against evidence criteria acknowledges a number of measures in place relating to the health and safety of staff and others. Policy arrangements are in place mainly for staff activities and related risks but recognising the duty of care under health and safety legislation to patients, service users, visitors and contractors.
8. Summary of evidence related to protected characteristics Protected Characteristic Race / Ethnic origin (including gypsies and travellers) Sex (male/ female) Evidence, i.e. What evidence do you have that the Trust is meeting the needs of people in various protected Groups Health and Safety Management encompasses a duty of care recognised by the Trust to Employees and others. Pregnant Workers Policy and associated risk assessment recognises the specific risk areas for those new and expectant mothers Does evidence/engagement highlight areas of direct or indirect discrimination? If yes describe steps to be taken to address (by whom, completion date and review date) Does the evidence highlight any areas to advance opportunities or foster good relations. If yes what steps will be taken? (by whom, completion date and review date) One to One specific risk assessment undertaken already. Religion and Belief Chaplaincy support role in notification and follow up to incidents of serious violence and aggression against staff. Chaplaincy support to Stress Group. Sexual orientation including lesbian, gay and bisexual people Age Incidents where particular individuals or groups are targeted are escalated to senior management for investigation. So that assessors are aware of the drivers for this measure and is not a local Trust imposed restriction. Disability learning difficulties, physical disability, sensory impairment and mental health. Consider the needs of carers in this section Gender Re-assignment Marriage and Civil Partnership Maternity / Pregnancy. Access and Egress are common factors when undertaking risk assessment. To ensure that local risk assessor training highlights DDA requirements. Involve disabled persons in consultation over access issues where appropriate. So that assessors are more aware of this issue and can provide sound recommendations in assessments if required. Improved access to services for disabled and older persons. Incidents where particular individuals or groups are targeted are escalated to senior management for investigation. Staff complete E&D Training as part of mandatory training. Health and Safety legislation places some restrictions on the risks that new and expectant mothers may be exposed to. To ensure that the reasons for this including legislative requirement are explained when conducting pregnancy related risk assessment. So that assessors are aware of
the drivers for this measure and is not a local Trust imposed restriction. 9. Are there any gaps in the evidence outlined above? If yes how will these be rectified? 10. Engagement has taken place with people who have protected characteristics and will continue through the Equality Delivery System and the Equality Diversity and Human Rights Group. Please note you may require further engagement in respect of any significant changes to policies, new developments and or changes to service delivery. In such circumstances please contact the Equality and Diversity Lead or the Involvement and Equalities Officer. Do you require further engagement? Yes x 11. Could the policy, strategy or service have a negative impact on human rights? (E.g. the right to respect for private and family life, the right to a fair hearing and the right to education? PART 2 Name: Ian Gaffney Date of completion: 04/11/2015 (If any reader of this procedural document identifies a potential discriminatory impact that has not been identified, please refer to the Policy Author identified above, together with any suggestions for action required to avoid/reduce the impact.)