Patient Handling & Back-care Presented by: P W IOSH Trainer BackCare999

Learning  Tell me and I will forget  Show me and I may remember  Involve me and I will understand

Course objectives By the end of the course, participants will:  Be able to demonstrate a working knowledge of key people handling.  Have a basic knowledge of human anatomy.  Understand principle-led moving and handling best practice.

Manual handling operations “any transporting or supporting of a load by hand or bodily force Includes:  Lifting, putting down, pushing, pulling, carrying or moving thereof  Using mechanical aids, e.g. trolleys

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Photos removed to reduce size – boxes in a factory setting

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Driving forces Addressing manual handling issues can lead to benefits:  Legal compliance: criminal law  Social: fewer sick days and less absenteeism  Moral: should not be injured for work  Market: bad H&S = bad publicity  Financial: accidents cost money - civil liability  Personal: avoid pain, loss, ongoing problem

Backs! 2012 campaign  5 million lost working days p.a. due to back pain  Back pain is the nation's leading cause of disability with 1.1 million people disabled by it. Wider context – 2008/9:  180 fatalities at work  130,000 other major injuries

Manual handling quiz What proportion of reported workplace accidents result from manual handling? 2008/9 reported injuries Other 13% Falls 8% Struck by 15% Slips trips 26% Handling 38% Chart removed to reduce size

Manual handling quiz Which of the following types of workplace has the highest proportion of accidents resulting from manual handling? a. Health care b. Retail c. Construction d. Agriculture

Sites of >3 day injury caused by handling Back 47% etc Graphic removed to reduce size

Types of injury from manual handling  Fractures  Damage to muscles, ligaments and tendons  Spinal disc injuries  Trapped nerves  Abrasions and cuts  Burns  Work related upper limb disorders  Hernias  Death

Work related upper limb disorders  WRULD or repetitive strain injuries (RSI) Tennis elbow Carpal tunnel syndrome Frozen shoulder  Caused by: Repetitive activities Carrying out an activity for a long period of time without adequate rest intervals Poor posture / non-neutral joint positions

Cause of injury  Traumatic stress  Cumulative stress  Degenerative change  Psychological causes

Vulnerable groups  Old  Young  Obese  Untrained  Those with existing injury  Tired  Pregnant women

3 most important things  Family  Home  Relationships  Wealth / ability to earn  Leisure / sports  Health

Practice lift  Demonstrate a typical lift  Demonstrate a good lift  What are the changes?

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Vertebrae & discs Nucleus Cartilage

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Prolapsed disc

Stresses without a load

The lever principle

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Principles of efficient handling  Dynamic stable base  Neutral position of body  Short levers – centre of gravity close  Correct secure hand hold  Good commands and communication

Muscles  Relaxed muscles  Body in neutral position  Static muscle fatigue  Use of major muscle groups  Graphic removed to reduce size

Team handling What are the problems? Photos removed to reduce size

Team handling  Planning of lift  Communication How to grasp When to lift What level to carry Which route Set down points on route?  Co-ordination  Disparity of individuals: size, speed, strength  Awkward areas

Team handling 1 person = 100% 2 people = 66% of individual capacity 3 people = 50% of individual capacity 1 = 60 2 = 80 3 = 90

Team handling  Consider other options Avoid Mechanise Use manual handling aids  Run through sequence of events verbally  Walk the route  One person take charge of giving instructions  Stick to established teams if possible

Problem loads Inanimate objects  Unexpected issues Light Heavy Centre of gravity  Intrinsically harmful Sharp edges Acids  Unpredictable behaviour Partly fixed load Liquids – centre of gravity Poor sealing of container People  Unexpected issues Light, heavy, C of G Weak side / strong side Collapsing  Intrinsically harmful Teeth & nails Hygiene  Unpredictable behaviour Change of mind Struggling Aggression

F L U E N C Y A mnemonic  Feet  Load  Unlock  Even  Natural  Control  Your back

Photos removed to reduce size man handling extinguishers

Pushing and pulling Pushing generally preferable:  Operator slip or trip – no load impact  Less risk of pulling load onto feet & ankles  No twisting to see where you are going  Better position for arm joints  Can often use both hands  Cage less likely to tip if fixed wheels leading But:  Visibility may be hindered 

Pushing and pulling considerations  Wheels: Initial direction & obstructions Size Fixed or rotating  Load: Stability / safety Visibility  Route Obstructions Slopes  Hands Between waist and shoulder height Neutral position Avoiding impacts  Legs: “A” frame to overcome inertia  Travel Slow speed Avoid starting & stopping

Pushing a wheelchair Pre-use checks  Wheels  Foot rests  Clothing of client  Brakes  Client understands what is happening Use  Dynamic stable base  Short levers

Health and Safety at Work etc. Act 1974 Section 2(1) general duty  "to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all his employees"

Health and Safety at Work etc. Act 1974  s3: duty to others who may be affected; contractors, visitors, neighbours & public  s7: employees duties: Take reasonable care of themselves and others Co-operate with employer s8: Not intentionally or recklessly interfere with or misuse anything provided for health and safety

Management of H&S at Work Regs 1999  Every employer shall make a suitable and sufficient assessment of the risks to health and safety of employees & non-employees.  Must implement suitable preventative and protective measures.

Management of H&S at Work Regs 1999  Regulation 4: hierarchy of control measures: E – Eliminate R – Reduce I – Isolate C – Control S – Signage P - PPE

Provision & Use of Work Equipment Regulations 1998 (PUWER) Work equipment must be:  Suitable  Adequately maintained  Inspected if necessary at regular intervals by a competent person Adequate information & training must be provided Risks adequately controlled, e.g. guarding

Lifting Operations and Lifting Equipment Regulations 1998 (LOLER) Lifting equipment:  Any equipment used at work for lifting or lowering loads including attachments used for anchoring, fixing or supporting it  Loads can include a person

Lifting Operations and Lifting Equipment Regulations 1998 (LOLER) What documentation / marking?  Safe working load marking (SWL)  Thorough examination Every 6 months for lifting people Otherwise 12 months

Lifting Operations and Lifting Equipment Regulations 1998 (LOLER) Lifting operations must be:  Properly planned by a competent person  Appropriately supervised  Carried out in a safe manner

Human Rights Act 1988 Blanket “no lifting” policy unlawful Regulations to not prescribe no risk regime Some manual handling inescapable at work Employees must accept greater risk if lifting people rather than objects All risk assessments based on individual needs and circumstances

Manual Handling Operations Regulations 1992  Identify manual handling tasks with significant potential for injury Can task be avoided? Can it be mechanised?  If not, conduct risk assessment to reduce risk to lowest level reasonably practicable Identify remedial actions Prioritise these actions Assign responsibility and target date

Manual Handling Operations Regulations 1992 Employers responsibility  Conduct risk assessments  Reduce risk of injury as far as to lowest level reasonably practicable Employees responsibility To use safe systems and procedures coming from the risk assessment

Control measures  Eliminate the need for task  Automate  Manual handling aids  People measures Safe handling techniques Team handling Personal protective equipment

Risk assessment  A logical and consistent way of assessing a situation and finding ways of making it safer  Logical: justify outcomes to regulator  Lead to action plan and improvement  Conducted by a competent person  Regularly reviewed After an accident If workplace or practices change

Risk assessment  Hazard Something with the potential to cause harm  Risk Likelihood of the harm occurring and its severity

Risk assessment – 5 steps  Identify the hazards  Identify who may be harmed and how  Evaluate the risk & decide on actions  Implement and document  Review

What factors contribute to manual handling risk?  Task  Load  Working environment  Individual capability Or  Task  Individual Capability  Load  Environment

 Is it necessary / urgent / how often?  Can the client help or does it involve taking the full body weight?  What is the distance to be travelled?  Is there height difference?  Will it involve stooping, twisting or turning?  Are other handlers necessary?  Is the client accessible?  What is the safest and most effective way of completing the task? 61 The Task

 Size of carer  Have they been trained?  Previous injuries / lack of fitness / pregnancy  Inflexibility of attitude / techniques. Am I being asked to do something unsafe?  Unsuitable clothing / shoes  Are they used to the environment  Time available  Are they able to work as part of a team 62 Individual Capability

Physical condition: -  Size, weight and shape  Pain  Mobility of limbs  Skin condition  Conscious / unconscious  Can they balance / weight bear?  Attachments e.g. catheters 63 Load Psychological State: -  Understanding  Anxiety / Fear  Uncooperative  Unpredictable

 Awkward tight spaces  Floor surfaces uneven, slippery or wet  Temperature / lighting / noise  Obstacles e.g. steps  Adjustable furniture e.g. profiling bed  Privacy 64 Environment

Controversial techniques Drag lift Graphic removed to reduce size

Controversial techniques The Australian lift Orthodox lift Graphic removed to reduce size

Controversial techniques Through-arm lift with two handlers Graphic removed to reduce size

Controversial techniques Arm and leg lug / hammock transfer Bear hug / pivot transfer Graphic removed to reduce size