Appendix 2 - Additional Guidance and Information

(Adapted with gratitude from Gloucestershire Health and Care NHS Foundation Trust Moving & Handling Policy (V2)

Rehabilitation requirements

In the rehabilitation of individuals, it is advisable that a multi-disciplinary team approach is adopted; using Risk Assessment before deciding which handling aids and techniques should be used. To ensure that agreed care plans are implemented through joint working, it is essential for the various organisations to take responsibility for their own acts and omissions.

In a joint statement by the Charted Society of Physiotherapists, the College of Occupational Therapy and the Royal College of Nursing – Partnership in the Manual Handling of Patients (1997), it is stated that there may seem to be a conflict between safer handling policies and the rehabilitation or maintenance need of the patient, however both health and safety and professional procedures call for nurses and therapists to assess their patients and devise suitable management programmes, considering the safest techniques, evidence based practice, use of additional people and the use of equipment to facilitate rehabilitation whilst applying a host of risk reduction measures.  Assessment for core treatment plans are not separate from those for the reduction of manual handling risks/hazards and decisions on the methods of moving the patients together with treatment plans flow from the same decision-making process.

Therapists having identified the skills required to perform a task should ensure these skills are possessed by the appropriate staff.  The employer of these staff must be aware of, and responsible for, their health and safety.

It is recognised by the organisation that there are different levels of skills and training within various professions and that there may occasionally be individuals who will require different handling to those methods outlined in this document. This is acceptable as long as the situations have been risk assessed and that the agreed method of handling is performed by trained staff.  Documentation and agreement by managers must be completed in all these identified situations, e.g. It may be a necessary component of assessment for relevant employees who are suitably trained to supervise and prompt individuals on steps or stairs by observing them closely and assisting in accordance with the requirements of a risk assessment/management plan.

Guidance to support with reasoning regarding what equipment is suitable for use (NB: Some elements of this algorithm may not be relevant to all settings and will be dependent on the equipment they have available).

Individuals who have difficulties expressing their views. 

Where the individuals have mental capacity but have difficulty expressing their wishes, employees should make all reasonable attempts to ascertain their wishes by making use of interpreters, non-verbal communication, independent advocates and the view expressed through others.

Where individuals lack capacity staff must follow the council’s Mental Capacity Policy and procedures.

Under the terms of the Mental Capacity Act, it is possible for individuals to make an advanced directive as to their wishes and this should be honoured whenever practicable.

Emergency handling

Some situations are foreseeable and can therefore be planned for to reduce the risk of injury. Assessment of the person prior to movement is essential undertaking a multifactorial falls risk assessment e.g. If an individual has a history of falls or collapses then this must be incorporated into their manual handling risk assessment and be clearly stated in their care plan.

However, there may be some life-threatening situations where staff may not have time to get equipment or plan the move. Staff in this instance must undertake a dynamic risk assessment considering their safety and the safety of others prior to taking any further action. If a person falls and is unable to stand independently with verbal prompting (Backward chaining) and or who is complaining of pain (and is not in immediate danger), staff should make the person comfortable and seek further advice/assistance from the emergency services. They must stay with the person until necessary assistance/equipment arrives.

The falling person 

Where staff are close to a person, staff may use preventative steps to support someone who is at risk of falling. For example, if a person is wobbly staff might put a chair behind them and guide them towards it if it were safe to do so. However, staff should not take any weight or stabilise if they are putting themselves at risk. If an individual falls and it would be unsafe to guide them to a chair, staff are advised to let them fall - moving obstacles where possible, use first aid skills and protecting their head where possible. If the person is holding onto staff and pulling them down, the staff member should go to the ground safely with the individual in a controlled manner to reduce the likelihood of any injuries to either party.

If a person falls when a staff member is not within arm’s length this is perceived to be attempting to catch a falling person. Staff members should not attempt to catch a failing person, such as when a person falls outside of a staff members arm’s length, the staff members should allow them to fall to the floor removing obstacles where able to minimise risk of injury. Attempts to break the fall may pose too great a risk to the member of staff (Betts and Mowbray in Smith 2005; Sturman, 2008).

Sturman 2008 (cited in HOP 6 2011) argues that if a staff member is in contact with the individual prior to a fall (i.e. hands on) then the handler has contact and therefore would not be catching the person. In this instance a technique may be attempted depending on the handler’s level of fitness, and their skill level, to lower the individual to the floor in a controlled manner allowing the person to slide down the front leg of the handler. This technique does come with risks as the handler’s balance may be compromised.  It is therefore recommended the following factors must be considered and dynamically risk assessed in each case.

Bariatric handling/plus size 

The terms “bariatric” and “plus size” are used interchangeably.

The origin of the word bariatric comes from the Greek word Barys meaning heavy and Baros meaning weight. Bariatric medicine is defined as the study of obesity and its causes (Mosby 2006), but the definition of those who may be described as bariatric is less clear. 

According to Naylor et al (2005) as cited in Handling of People Guide (2014), persons are defined as being morbidly obese if they have a body mass index (BMI) of 40 kg/m or more, or they have a BMI of between 35kg/m and 40kg/m with comorbidities. The manual handling of bariatric individuals presents an increased risk to staff and the individual alike. 

Staff must be aware of their duty of care in respect of the social, emotional and psychological care of a bariatric person. These individuals should expect to be treated with respect, dignity and without prejudice. Rush, in her ‘Overview of Bariatric Management (2006), pointed to the ‘prejudice and discrimination’ against the obese person in society.  Further guidance can be found on the Department of Health website ‘Human Rights in Healthcare’ and can be used to further guide staff in their duty of care.

Knowledge of bariatric body shapes is important as it has an impact on the way a person is able to assist in movement and will therefore have implications on the delivery of care.

The excessive weight of a bariatric person will increase joint stress, affect body movement, and decrease lung function. Following long periods of hospitalisation, regaining mobility is critical for the bariatric person.  Planning should include multidisciplinary team approach with input as required from the moving and handling practitioners. 

A thorough risk assessment to identify appropriate equipment, techniques and number of people required is paramount.  Consideration should be given even in cases where an individual is ambulant, as to how staff would safely assist them from the floor in the event of a fall or if evacuation from a building was required. 

Staff must be aware of the safe working load (SWL) of all equipment including furniture and fittings in their areas. (Models will vary across sites). This must not be exceeded When considering individual equipment requirement safe working load (SWL), width, height, and care/nursing requirement must all be considered. 

Maintaining skin integrity is an integral part of bariatric management. Each body shape comes with associated risks of skin damage.

The effective management and safer handling of bariatric persons requires a collaborative multidisciplinary and multiagency approach.

Equipment

All equipment must be suitable for use, for its intended purpose, in line with (Provision and Use of Work Equipment Regulations (PUWER) 1998).  For instance; bed sheets must not be used as a handling aid as this is in breach of PUWER.

Staff must only use equipment for which they have received adequate training.  

Where equipment is issued to individuals, it is the responsibility of the prescriber to carry out a suitable and sufficient clinical assessment.  This will include an assessment of risk and the provision of safe systems of work, identifying how equipment must be used with individuals. It is the responsibility of the staff using the equipment to seek further guidance if they are still unsure about how to use equipment via their employer.

Where risk assessments have been completed by the appropriate professional and an equipment need has been identified, managers/team leaders must ensure that sufficient resources are available to allow the prompt provision of the required equipment.  If the equipment is not available for use, then this must be reported to the line manager, documented in the person’s care plan and the assessed task not performed until the equipment is in place.

All staff involved with the prescription of equipment must be aware of the range of mechanical and other moving and handling equipment available.  Managers/team leaders must ensure that all such equipment used by their staff in individual’s homes, which has been issued via the community equipment store, is maintained regularly in accordance with relevant legislation and manufacturer’s instructions.  All staff have a responsibility to carry out appropriate pre-use checks and ensure that the equipment is clean and in good working order before using it, and report all faults and failures.

All staff have a responsibility to use moving and handling equipment correctly and to report any malfunction or potential malfunction immediately.  The equipment must have a notice applied which should be dated to alert other people to the potential problem and moved to a safe place. (It cannot be used until checked/serviced and deemed safe by a competent person).

Equipment must be provided and used following an assessment.  It should be suitable and sufficient for the purpose and for the person for whom it was provided.  It should not be used for any other person for whom it was not assessed.

Specific lifting appliances, e.g. hoists, must have a current test certification which must be signed and dated by a competent person.  It must specify the safe working load which must not be exceeded.  This is in accordance with LOLER (1998) and PUWER (1998). 

In General terms staff must: 

·       Make use of equipment that allows for the elimination of Lifting individuals e.g. Hoists (where appropriate taking into consideration rehabilitation goals).

·       Make use of equipment that allows for safer handler posture. E.g. Bed raisers, Hi-lo Beds. Whilst striking a balance between handler and person’s wishes.

·       Make use of friction lowering equipment such as, Slide Sheets and in-bed systems where appropriate and following assessment etc.

·       Individuals who have fallen or put themselves on the floor will NOT be lifted up from the floor manually if suitable equipment is available. The following factors should be considered: 

• • Should the emergency services be called?
  • Is the person able to stand up independently with verbal prompting? Backward chaining
  • Is a Hovermatt / Hoverjack available on site to undertake a flat lift? Where available this should be the first option
  • Is a lifting cushion available i.e. manger Elk/ Camel or Raizer 11? These must only be used if there is no injury identified
  • Is a hoist available? This option should only be considered if other options have been explored first and staff are certain no injury has occurred

Useful links further information:

http://www.hse.gov.uk/work-equipment-machinery/loler.htm

http://www.hse.gov.uk/pubns/hsis4.pdf

http://www.hse.gov.uk/pubns/hsis3.pdf

Further reading

• The Guide to The Handling of People 5th edition edited by Jacqui Smith
• The Guide to The Handling of People, a Systems Approach 6th edition edited by Jacqui Smith Hop 6 
• The Guide to The Handling of People, Person Centred Practice (HOP 7) edited by Jacqui Smith