Moving and Handling Level 2 Update 2018/19 - Leicestershire Partnership NHS Trust - Leicestershire ...

Leicestershire Partnership NHS Trust

                      Moving and Handling Level 2 Update
                                              2018/19

Moving and Handling Level 2 Update Document
January 2018

Introduction

Welcome to your Moving and Handling Level 2 Update for 2018/2019. This session forms part
of an on-going programme of training for all patient handling staff.

The aim of this programme is to provide staff with the knowledge that will assist them to reduce
their risk of back injury in the workplace.

Much of this information also applies outside the workplace; staff will be encouraged to consider
this during these situations.

You will be required to update your knowledge on a 2 yearly basis.

Contents

        Introduction – aims, objectives, and ground rules.
        Summary of relevant legislation.
        Back injury and the NHS.
        Risk Assessment.
        Summary of anatomy and physiology.
        Principles of safe handling.
        Unsafe / High risk moves.
        Practical work: approved techniques and problem solving, including reference to:
                        Anatomy & Physiology: Risk Assessment, Principle of Safe Handling.

        Training records and evaluation.
        Useful Links
        References

Moving and Handling Level 2 Update Document
January 2018

Aims and Objectives
Aim

The aim of this session is to review and build upon the practical application of manual handling
in the workplace.

Objectives

At the end of the session you will be able to:

        Explain the importance of risk assessment in relation to patient handling.

        Demonstrate what measures you might consider when moving and handling patients that
         would reduce the risk of injury.

        Participate in a problem solving approach relevant to your area.

Ground Rules – PLEASE READ THIS SECTION CAREFULLY.

These rules are designed to make the training session safe for all participants. You are
expected to be fit enough to undertake this training.

You must inform the trainer, prior to the practical session, if – for any reason – you are unable to
participate fully in this part of the training, this could be for health, medical issues, pregnancy or
if you have given birth within the last 6 months.

This information will be treated in strict confidence. However, your training is not complete until
you have successfully taken part in the practical session, and the words “unable to take part in
the practical session –training incomplete” will be added to your training record and you will be
recorded on ULearn as ‘not completed’.

You are strongly advised to notify your manager of any illness or injury, which prevents you from
safely undertaking manual handling duties, in line with your legal and contractual
responsibilities.

You are required to wear your usual work clothing and appropriate footwear – flat heeled, non-
slip, fully enclosed shoes – for the practical session.

You must only perform manoeuvres under the supervision of a trainer.

Trainers can at any time, stop you taking part in an activity in the interests of safety.

Moving and Handling Level 2 Update Document
January 2018

Summary of Relevant Legislation

Health and Safety at Work Act 1974

Employers have to:

        Protect the health and safety of their employees
        Protect the health and safety of others who might be affected by the way they go about
         their work.

Employees have to:

        Take care of own health and safety and that of others.
        Co-operate with their employer

Management of Health and Safety at Work Regulations 1999

Employers have to:

        Assess health and safety risk to employees and others, to identify the precautions
         required by health and safety law.
        Take particular account in their assessment of risks to new and expectant mothers and
         their unborn and breast feeding children.
        Provide employees with adequate training and instruction.

Employees have to:

        Use equipment provide by their employers as instructed.

Moving and Handling Level 2 Update Document
January 2018

Back Injury and the NHS

        In the NHS, manual handling accidents account for 52% of all sickness absence.
                                                             Ref: MHOR 1993 amended 2002

        The total annual cost to the NHS is 400 million pounds per year, enough to employ
         16,000 nurses.
                                                             Ref: Back Care 2011 (Cited Nursing Times)

        The highest compensation paid to date is £803,000.

According to the Royal College of Nursing:

        1.5 million working days are lost every year because of back injuries to nurses

        80% of nurses have time off with back problems each year; 3600 healthcare workers are
         forced to retire early as a result of back injury

                                                                                 (Back Care (cited Nursing Times 2011))

It’s not only nursing staff that experience back pain:

        As many as 1 in 6 physiotherapists may move speciality or leave the profession as a
         result of injury.
                                                Ref: Guidance in Manual Handling, Chartered Society of Physiotherapists, 2002

        30% of catering, domestic and portering staff in the NHS experience back pain regularly.
                                              Ref: Back in Work Sheet No 1, Department of Health, 2002

Moving and Handling Level 2 Update Document
January 2018

Risk Assessment
A moving and handling risk assessment is a way of examining our work activities that relate to
moving and handling with the purpose of helping us decide:

1.       How to perform a job without endangering ourselves

AND

2.       What safety precautions we need to use.

The Management of Health and Safety at Work Regulations (1999) impose a requirement
upon employers to undertake an assessment of any risk to the health and safety of their
employees. This piece of legislation is supported and extended by the Manual Handling
Operations Regulations (1992), which have established a hierarchy of measures in order to
reduce manual handling risks:

 AVOID handling where ever possible.
  Many manual handling tasks are performed without an assessment that might indicate that
  equipment could be used, or that the patient could be encouraged to help themselves. In
  essence we should ask ourselves the question “does the task need to be done?”

 ASSESS the risks of those tasks that cannot be avoided.

 REDUCE the risk as far as reasonably practicable.

 PROVIDE INFORMATION for example on the weight of the load to be handled

Knowing if there is a risk to injury is a matter of judgement in each case. However there are
things to look out for, such as bad postures, awkward or heavy loads, cramped working areas,
excessive fatigue or history of back problems. Staff can often highlight which activities are
unpopular or difficult.

Manual handling risk assessments offer many benefits and may potentially:

    Protect the staff and patients
    Reduce injures
    Stop some injuries occurring
    Change the culture of an organisation
    Identify equipment needs

Training is very important but remember that, on its own, it cannot overcome a lack of
mechanical aids, unsuitable equipment and inappropriate systems of work. Risk
assessments will be an asset in partnership with training.

Moving and Handling Level 2 Update Document
January 2018

Summary of Anatomy and Physiology

                         7 Cervical Vertebrae

                     12 Thoracic Vertebrae

                        5 Lumbar Vertebrae

                     5 Fused sacral Vertebrae

             4 Fused coccygeal Vertebrae

Moving and Handling Level 2 Update Document
January 2018

Summary of Anatomy and Physiology

The spine is a column of 33 bones – called vertebrae separated from one another by ‘cushions’
of elastic tissue – the intervertebral discs.

The spine has 3 main functions:

-        To support the upper body
-        To allow mobility
-        To provide a protective casing for the spinal cord

The spine of a newborn baby is ‘C’ shaped having two primary curves in the chest and sacral
regions. Once the infant lifts its head and, later begins to walk, the secondary curves of the
neck and the lower back regions develop, and the spine takes on its characteristic 3 curved ‘S’
shape.

With the exception of the intervertebral disc, all the structures of the vertebral column have a
liberal nerve and blood supply.

Each intervertebral disc is comprised of a fibrous outer ring - the annulus fibrosus -, which holds
in place the inner jelly like nucleus pulposus. The discs act as hydraulic sacks that dampen the
shock of spinal actions and allow limited movement between vertebrae. It is the combined
actions of each disc all the way up the spine that provides the remarkable ability of the back to
stretch and move.

Moving and Handling Level 2 Update Document
January 2018

The Intervertebral Disc

Moving and Handling Level 2 Update Document
January 2018

Principles of Safe Handling
Apply these principles whenever manual handling is required:
Whenever moving or handling movable objects you need to remember your posture and
balance.

Wide stable base

Feet about hip-width apart, one foot slightly in front of the other, and with weight balanced
evenly between them. Once the load has been moved or lifted, the feet should move in the
direction of the load.

Keep natural curves of the back

Do not bend or twist – and remember, this includes your neck.

Elbows in

Keep your elbows tucked into the side of your body, to avoid increased stress on the neck. This
will also, automatically, bring the load in close to your body.

Bend knees

Use your powerful leg and buttock muscles

Bend your knees, but avoid squatting: it puts great strain on your knee joints

Head up/chin in

Look face on to the load to avoid twisting your neck. Hold your chin in slightly to avoid
extending your head back. Lead off the lift with your head – where the head goes the rest of the
body will follow.

Hold load close

The closer the load is held to the body, the less stress there is placed on the back.

                                                                      Health and Safety Executive (2003)

Moving and Handling Level 2 Update Document
January 2018

Unsafe / High Risk Techniques
There are a number of ‘traditional’ techniques which are now considered unsafe / high risk, and
which must no longer be used.

Legally it is the Manual Handling operations Regulations, 1992 - made under the Health and
Safety at Work Act 1974 – which govern all manual handling activities, and to which reference
should be made; the important publication here is Manual Handling operations Regulations1992
Guidance on regulations L23 (Health and Safety Executive, 1992).

All unsafe / high risk moves have either caused injuries to NHS and private sector patients,
handlers, or both and as a consequence, have featured in court cases. They are no longer
considered to be good practice AND MUST NOT BE USED for planned moving and handling
interventions.

However not every manual handling situation can be planned for in advance, for example, when
there is a sudden exceptional, life-threatening incident (e.g. flood, building collapse or
explosion) and one or more of these unsafe high risk moves might be used.

A cardiac arrest is certainly life-threatening to the patient, but would not be considered an
exceptional circumstance in a healthcare setting and you should follow the ‘Resuscitation
Guidelines’ for handling a collapsed person.

Only approved moves are to be used by organisation staff for planned moving and handling
interventions. Trainers and Manual Handling Key Workers should use this document as a
reference and/or contact the moving and handling advisor if they are in any doubt regarding the
safety of any moves.

         IT IS ORGANISATIONAL POLICY THAT STAFF DO NOT USE NON-APPROVED MOVES.

         You should not lift patients because:

             They weigh too much and are unpredictable
             It is difficult or impossible for staff to get into a safe position to lift
             Staff are at risk of injury in all manual handling techniques
             Most lifts include a risk of injuring the patient
             Manual lifts are not therapeutic; they do not improve the patient’s mobility.

Moving and Handling Level 2 Update Document
January 2018

Unsafe / High Risk Moves
The Drag Lift - This includes any way of handling the patient in which the handler places a
hand or an arm under the patient’s axilla (armpit), whether the patient is being moved up the
bed, sat up in the bed, being assisted from sitting to standing, or being assisted to change from
one seated position to another – and regardless of whether the handler is facing or behind the
patient, or whether there is more than one handler.

                                              An example of a drag-lift

Moving and Handling Level 2 Update Document
January 2018

An example of the worst kind of drag-lift

Moving and Handling Level 2 Update Document
January 2018

The Orthodox Lift - a two-person lift, in which the handlers place one
arm around the patient’s back and the other under the patient’s thighs. The handler’s may clasp
each other’s wrists, or they may hold the far side of the patient. Handling slings are sometimes
used. In all cases these lifts are dangerous.

                                              The orthodox lift

Two-sling lift - (not shown) with slings placed under the patient’s
lower back and thighs, the handlers stand either side of the patient with one knee on the bed;
this is a total body lift.

The shoulder lift - (shown below) Also known as the ‘Australian’ lift, regardless of whether the
‘Free arm’ is placed on the bed for ‘support’ or placed around the patient.

Moving and Handling Level 2 Update Document
January 2018

Front transfer with one nurse - this includes the pivot transfer, the
elbow lift and the ‘Bear Hug’, regardless of whether a belt or sling is used

                                              An example of the ‘bear hug’ lift

         You should not lift people because:

                  They weigh too much and are unpredictable

                  It is difficult or impossible for staff to get into a safe position to lift

                  Staff are at risk of injury in all manual handling techniques

                  Most lifts include a risk of injuring the patient

                  Manual lifts are not therapeutic; they do not improve the patient’s mobility.

For recommended patient handling techniques, refer to the Leicestershire Partnership
NHS Trust document ‘PROCEDURES FOR THE MOVING AND HANDLING OF PATIENTS’

Moving and Handling Level 2 Update Document
January 2018

Useful Links
All policy documents are available via the Policy Document Store available on E-source.

References
Manual Handling Policy

Using Hoists to Move Patients Policy

Procedures for the Moving and Handling of Patients

Heavy Patient Pathway

Code of Practice for the use of Electric Profiling Beds

Backcare in collaboration with The Royal College of Nursing and The National Back Exchange.
(cited Nursing Times) 2011

The Guide to the Handling of People a systems approach 6th Edition 2011 BackCare.

Chartered Society of Physiotherapists (2000): Manual Handling for Chartered Physiotherapists.
Available from: http://admin.csp.org.uk/admin2/uploads/-38c9a362-ed71ce5fa5-
77d7/gimh4cp.PDF;LAST Reviewed Jan 2001.

 Health and Safety Executive (2004) Manual Handling Operations Regulations (1992) (As
amended), Guidance on Regulations, 3rd Edition London:HMSO

Back in Work, Sheet No 1, Department of Health (2002)

Contacts

Moving and Handling Advisor, Leicestershire Partnership NHS Trust ,

For details of training records contact the Learning and Development Administration Services

Learninganddevelopment@leicspart.nhs.uk

Moving and Handling Level 2 Update Document
January 2018