Manual Handling - Theory Manual Handling can be defined as any transporting, supporting of a load, lifting, pushing, putting down, pulling, carrying or moving of any load. The load includes a person, it also includes holding awkward and static postures. (Manual Handling Operations Regulations Guidance on Regulations 1992;HSE 2004 ISBN 071762883 X) Costs of Injuries Caused by Poor Manual Handling Handling Operations were 38% of all workplace injuries resulting in over 3 days absence in 2001/2002 should be reported as a R.I.D.D.O.R. (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations). Of these 47% involved the back or the spine. 10.5% of all manual handling injuries resulted in major injury. Nationally, manual handling accounts for 52% of all 3 day or more injuries in the Health Service. (HSE Guidance on Regulations, 2004) Legislation Health and Safety at Work Act 1974 SECTION 2 EMPLOYERS RESPONSIBILITY to ensure so far as reasonably practicable, the health, safety and welfare at work of their employees. SECTION 7 EMPLOYEES RESPONSIBILITY the employees under a corresponding duty to take reasonable care for their own health and safety and those who maybe affected by their acts or omissions and to co-operate with the employer in performing its duties under the act. Manual Handling Operations Regulations 1992, 2004 AVOID hazardous manual handling so far as reasonably practical. ASSESS manual handling tasks which cannot be avoided. REDUCE the risk of injury so far as is reasonably practical. Manual Handling Operations Regulation 1992, 2002 Where it is reasonable to do so, remove the need for manual handling by employees where there is a risk of them being injured. Where it is not reasonable to do so, make assessments of all such manual handling operations carried out by employees in order to reduce the risk of injury to the lowest level reasonably achievable.
Principles of Safe Handling Avoid doing the task if possible Assess Reduce the risk Reassess Maintain S curve Bend the knees and hips Keep the load close Stable base Good grip Head up Elbows bent Look where you are going Ensure a clear path way Correct foot wear Communicate with patient and other colleagues involved in the move Check the environment Attend training Risk Assessments Risk assessments underpin all safer handling. Safer handling starts and ends with risk assessment. INDIVIDUAL specific to the patient GENERIC regularly performed activities PERSONAL undocumented assessment prior to any activity ie am I trained, am I fit, do I need assistance, is the environment safe? Remember the acronym T.I.L.E when performing Risk Assessments. Task how am I going to carry out the manual handling activity? Individual who is going to carry out the activity? Load what am I moving? Environment where am I doing this activity and where has it got to be moved to?
Task Why move the patient? Can the move be avoided? How often am I going to have to undertake this task? Should I use equipment? Does the task involve holding the load away from the trunk, any sudden movements, twisting the trunk, poor posture, excessive distances when lifting, lowering or carrying, pushing or pulling of the load? Individual Is the handler competent in moving and handling techniques and also in the use of the equipment available within the area? How many staff available to help? How many staff are needed for the move? What are their individual physical characteristics? Consider other factors. Load How mobile is the patient? How much can the patient help? Could the patient be taught to move themselves without help? Is the patient difficult to handle in relation to size? Can they weight bear? Have they got good balance? Can they walk unaided? Can they stand? Are they confused, conscious, forgetful, uncooperative, aggressive, and unable to communicate? Does the patient pose any other risks such as pain or rigidity? Consider the characteristics of patient weight, height, amputee or a paraplegic. Environment Are there any limitations in the space? Can the environment be improved? Is the use of equipment appropriate? Is the floor slippery or even? Are there extremes of conditions? Are they any obstacles? Is there the need for equipment to be involved in the transfer? Good Posture Good posture is vital when undertaking any handling activity and is a major part of safer handling. Also it is highly relevant in other activities for example when working at computer wotkstations. Keep spine in its natural position which is a S shape. Avoid prolonged forward flexion or twisting. Avoid maintaining one position for long periods of time.
Risk Factors For Back Injury Excess load Distance Holding loads away from area of trunk at arms length high or low Twisting Movements including bending and stooping Repetitive movements Insufficient rest between moves What can you do? Communicate Plan moves Use equipment Appropriate techniques when moving patients Communicate Always communicate with all of those involved in the move using the UHL recognised command Ready Steady Go When in theatre the move is to be lead by whoever is controlling the airway. Ensure everyone understands the intended move and their role within the move. Do not insist upon using moves creating hazards to others. Plan Moves The intended most must be the most appropriate for the scenario. Everyone understands the intended move and is familiar with it. Appropriate is available for use. Use Equipment Use appropriate equipment to reduce the effort you have to apply. Ensure the equipment is safe to use. Get advice if in doubt. Keep equipment at a good height. Use Appropriate Techniques Any manual handling technique used are to reduce the effort and the risk of injury involved in the move, poor or bad performed manual handling techniques can have catastrophic effects. A single poor technique or poor posture during a single move is probably not going to cause a major injury. Large numbers of back injuries and problems are caused by repeated use of poor techniques or poor posture.
The Bariatric Patient UHL is seeing more very obese patients being admitted to the trust: April October 2005 saw 14 very obese patients admitted April October 2006 saw 38 April October 2007 saw 44 April October 2008 saw 66 In patient days have also increased: April October 2005 465 April October 2006 619 April October 2007 739 April October 2008 897 The largest patient admitted so far weighed 300kg (48 stone) as an emergency admission. (UHL Manual Handling Service) Handling the Bariatric Patient Weight of the patient is required to assess suitable equipment More staff will be needed to move the very obese patients and standard manual handling techniques may not work with very large patients. Other equipment may be needed for the very wide patients. These are available within UHL. When moving these patients around the bed, slide sheets or similar will be needed, in addition to extra staff. The very obese patient presents a greater manual handling risk than the average patient. Who to Contact for Advice Manual Handling Cascade Trainers in your Directorate Manual Handling Service via switchboard Nick Howlett (Service Lead) Paul Ayrton Andy Lewitt Ruth Smith.