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Library of Congress Cataloging-in-Publication Data
MacGregor, Hamish, author.
Moving and handling patients at a glance / Hamish MacGregor.
p. ; cm. (At a glance)
Includes index.
Summary: “Moving and Handling Patients at a Glance provides an accessible introduction to the key theoretical underpinnings of moving and handling, including the legal aspects, biomechanics, risk assessment and safe principles of handling”–Provided by publisher.
ISBN 978-1-118-85343-6 (paperback)
I. Title. II. Series: At a glance series (Oxford, England).
[DNLM: 1. Moving and Lifting Patients methods. 2. Moving and Lifting Patients nursing. WY 100.2]
RM700
615.8’2 dc23
2015033803
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.
Cover image: Photograph courtesy of Hamish MacGregor
The purpose of this book is to act as a reminder of how some moving and handling techniques are carried out. It is not a substitute for moving and handling training where you have had an opportunity to discuss, observe, practise and ask questions related to moving and handling. There may be some techniques that may differ in their execution from ones you have received during training or carried out in practice. This does not necessarily mean that one is right and the other is wrong, but there are often some minor differences in the way that techniques are carried out. As long as the safe principles of handling can be applied and a rigorous risk assessment has been carried out in the case of an individual patient, then the technique should be acceptable.
Throughout the book I have used the term handler. The reason for this is to use a neutral descriptive term that covers carer, nurse, therapist or anyone who is involved in the moving and handling of people.
I have also used the term patient. This term is to cover not only patient but client, service user, resident or anyone requiring assistance to be moved and handled.
The book is organised primarily as a practical textbook with the theory section at the beginning kept to a minimum. The reason for this is that there are other publications out there that deal with the theory of moving and handling extensively. I am often asked in training, ‘Do you have any pictures of that?’ hence the emphasis for this book. The techniques described are broken down into their component parts; therefore you may have to read a few chapters to get all the information on moving a patient in a particular situation. This is deliberate and is to maximise the amount of information given in as succinct a way as possible.
To use this book effectively, always read the text first as you are following the pictures on the opposite page. Looking at the pictures and their captions alone will not give you sufficient information.
The primary audience for this book is student nurses, but students of occupational therapy and physiotherapy could also find the book useful. The book may also be a good reference guide for anyone working in health and social care.
I would like to thank Keith Parkinson, my partner and co-director of Docklands Training Consultants Ltd, for his support in compiling this book and assisting greatly in the taking of hundreds of photographs. I would also like to thank Penny Clayden, Lyn Maddams, Glynis Watson and Teresa Yiannaco, freelance trainers with the company for their input in the development of this book — without this, the book would not have come to fruition. Finally I would like the thank Lewisham and Greenwich NHS Trust for allowing us to use their training rooms to take the photographs.
Hamish MacGregor
Chapters
This chapter covers three areas of legislation that relate to moving and handling. Chapter 2 will deal with four other areas. This is not a complete list but examples of the major pieces of legislation affecting moving and handling practice.
This act and its regulations impose a duty of care on every employer to ‘ensure as far as is reasonably practicable, the health, safety and welfare at work of all employees’. It not only puts duties on the employer but the employees too. A résumé of the act is given in Figure 1.1
The HSWA is a broad piece of legislation and could be described as an umbrella that covers a raft of other legislation that is more specific in its nature to moving and handling. The key areas are two-fold: first, the provision of equipment and a safe system of work to accompany this; second, the provision of information, instruction, training and supervision. The key to good moving and handling practice is not only good training. This should provide the handler with the skills to handle patients safely without injuring the patient or themselves. As important is that the handler has sufficient competent supervision in the workplace to ensure that good practice is maintained.
In addition the employees have to be willing to receive training. This puts responsibilities on the handler to ensure that they attend moving and handling training if it has been provided and they have been given the time to attend. The specifics of training are not defined, but terms such as ‘understandable’ and ‘suitable and sufficient’ are often used. This allows for a degree of creativity in delivering training so that on the job training can be as effective, if not more, than classroom-based training. The important thing is that any training carried out must be documented as to its content, date of delivery and where, with the handler and the trainer signing a document confirming this. If this does not happen then in the case of injury to staff or patient it is not possible to prove what training has taken place.
For more information on the HASWA see link below:
www.hse.gov.uk/legislation/hswa.htm
These regulations set out broad duties for improving health and safety, and introduce the requirements for risk assessment and health and safety.
The MHSWR require employers to carry out risk assessments on tasks considered to be hazardous in the workplace and reduce risks to a reasonably practicable level. These risk assessments must be carried out by a competent person.
A résumé of the main terms of the regulations is given in Figure 1.2. The term reasonably practicable is used in the regulations and there is a definition of this term below.
Reasonably practicable means that which is, or was at a particular time, reasonably able to be done to ensure health and safety, taking into account and weighing up all relevant matters including:
The general terms of the MHSWR can be easily applied to moving and handling activities, but the Manual Handling Operations Regulations 1992 as amended in 2002 (MHOR) are regulations that apply directly to the area.
These regulations again define the responsibilities of employers and employees.
The MHOR also gives us a definition of manual handling:
The definition of a load by the Health and Safety Executive (HSE) defines it as ‘a discrete moveable object. This includes, for example, a human patient receiving medical attention… ’
A résumé of the MHOR is given in Figure 1.3.
The interpretation of the MHOR directly affects all moving and handling practice. Avoiding patient handling is usually about maximising patient independence and constitutes the first key safe principle of moving and handling (see Chapter 5, Key safe principles of moving and handling). Assessing risk is key to all good patient handling and forms a cornerstone of good practice and the MHOR gives us a framework to carry this out (see Chapter 7, Risk assessment). The understanding of the risk assessment process allows the handler not only to ‘follow appropriate systems provided for the handling of loads by the employer’ but give them the tools to change the way the patient is moved as the patient condition changes.
For more information on the MHOR see link below:
www.hse.gov.uk/pubns/books/l23.htm
This regulation is aimed at ensuring that all lifting operations are properly planned, lifting equipment is used in a safe manner and that, where necessary, it is thoroughly examined by a competent person.
To decide whether LOLER applies it is necessary to answer two questions – is it work equipment and, if so, is it lifting equipment? The fact that equipment is designed to lift or lower a load does not automatically mean that LOLER applies. The equipment needs to be defined as ‘work equipment’ which is defined under the Provision and Use of Work Equipment Regulations 1998 (PUWER) (see below).
The definition of ‘lifting equipment’ is where the equipment lifts and lowers as its principal function.
Examples of the equipment that come under this definition are:
Equipment such as a variable height bed does not come under the regulations as its principal function is as a bed.
A résumé of the regulations is given in Figure 2.1.
In practice, the key issues here are:
The definition of work equipment is ‘any machinery appliance, apparatus, tool or installation for the use at work (whether exclusively or not)’.
For clear guidance on the equipment used under LOLER and PUWER please see the HSE website:
www.hse.gov.uk/pubns/hsis4.pdf
A résumé of the regulations is given in Figure 2.3 and full information is available on the HSE website. See link below:
www.hse.gov.uk/riddor/
RIDDOR places responsibilities on employers to report injuries deemed ‘reportable’ under the act. In relation to back or other musculoskeletal injuries that can happen to patient handlers, Part 4 of the regulation is the one that most commonly applied.
Accidents must be reported where they result in an employee or self-employed person being away from work, or unable to perform their normal work duties, for more than seven consecutive days as the result of their injury. This seven-day period does not include the day of the accident, but does include weekends and rest days. The report must be made within 15 days of the accident.
Accidents must be recorded, but not reported where they result in a worker being incapacitated for more than three consecutive days. If you are an employer, who must keep an accident book under the Social Security (Claims and Payments) Regulations 1979, that record will be sufficient.
In Figure 2.4, two areas of the Human Rights Act are highlighted.
This may not immediately spring to mind as relating to patient handling, but patient handling that is not carried out correctly could be regarded as ‘treatment which is inhuman or degrading’. Hoisting a patient with an incorrectly fitting or incorrect type of sling could be termed degrading.
With all aspects of patient handling, the handlers should always be aware of being respectful and maintaining dignity and privacy. The nature of many of the moving and handling tasks means that we may be using equipment to physically move people. It is important to remember the person that is being moved may be anxious or fearful and in an environment that is alien to them.
A short guide on the act is given in:
www.justice.gov.uk/downloads/human-rights/human-rights-making-sense-human-rights.pdf