€1.50

CARINGWITH MINIMAL

LIFTING

A safety and healthguide for those who

care for patients

SAFEMANUALHANDLING

CARE WITHMINIMALLIFTING

This guideline is intended to

assist those involved with, and

responsible for, patient

handling in the health care

sector. The guideline is not

intended as a legal

interpretation.

The size of theproblem

The accident statistics for 2006 show that injuriesdue to manual handling accounted for 38% of allaccident types in the Healthcare sector reported tothe Health and Safety Authority . Recent evidencedbased research has confirmed that interventionspredominantly based on technique training have noimpact on injury rates (Hignett 2003). The ManualHandling of Loads Regulation sets out a frameworkfor employers to avoid or reduce the risk of injuryfrom manual handling activity. The Health andSafety Authority guidance document titled“Management of Manual Handling in theWorkplace (2005) underlines the need formanagement commitment to implement amanual/patient handling management programmewhich takes account of the following:• the need to develop a policy statement of

manual/patient handling • the need to implement a manual/patient

handling risk assessment process• the need to consult with staff at all levels as part

of this process• the need to assign lead roles to competent staff

in the development of patient/manual handlingtraining and risk assessment programmes.

There is a duty to complete an Accident ReportForm (IR1) and send it to the Health and SafetyAuthority for all accidents which result in a personbeing unable to carry out their normal duties for aperiod of more than three consecutive days,excluding the day on which the accident occurred,following an accident at work. It is recommendedthat patient handling accidents should be recordedinternally in a manner which will allow analysis ofproblem areas.

Published in 1998, revised in November 2007 by theHealth and Safety Authority, the Metropolitan Building,James Joyce Street, Dublin 1.

© Health and Safety Authority. No part of this publicationmay be reproduced, stored in a retrieval system, ortransmitted in any form or by any means, electronic,mechanical, photocoying, recording or otherwise, withoutthe prior permission of the Health and Safety Authority.

SAFEMANUALHANDLING

Who is at risk?

Anyone whose work involves handling patientswith temporary or permanent mobility problems.In the context of this document this means allhealth care workers who may be involved inhandling patients whether in hospitals, nursinghomes, day care centres, in transit or the patient’sown home.

What can bedone?

� All those who handle patients are coveredby the Manual Handling Provisions of theSafety, Health and Welfare at Work(General Application) Regulations.

� Patient handling hazards and risks mustbe identified and assessed and controlledand the conclusion on each of these itemswritten into the Safety Statement requiredby Section 20 of the Safety, Health andWelfare at Work Act, 2005

� Patient care staff must be consulted aboutthe arrangements made to protect themfrom injury due to unsafe patienthandling in accordance with Sections 20and 26 of the 2005 Act. Suchconsultation should involve the SafetyRepresentatives, First Line Managers andothers as appropriate.

Avoiding andminimising

� Employers should have in place a minimalhandling policy which requires that fullbody lifting should be avoided except inlife threatening situations. Employersshould have a patient/manual handlingrisk assessment programme in place

� Where appropriate, patients should beencouraged to move themselves and worksystems designed so as to accommodatethis. This often helps with theirrehabilitation. Patients can also be shownhow to assist the carers in their ownhandling manoeuvres.

� Supporting, pushing and pulling shouldbe minimised by using rolling and slidingdevices.

SAFEMANUALHANDLING

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Characteristics of theworking environment

The “characteristics of the load” (as defined inthe Regulations) cannot be modified when theload is a patient. Factors that can be modifiedin the patient caring situation are the“characteristics of the working environment”.

These include:

� The condition of the floor in the ward orother room;

� The beds and trolleys, for example,should be at a safe height – ideally theyshould be adjustable;

� Adequate lighting for any handlingoperations;

� Adequate space for safe patient handling.

Assessing the handling

Despite efforts to minimise the manual handling,where there continues to be hazardous patienthandling, you should assess the following:

� Practices which involve working in anawkward, unstable or crouched position,including bending forward, sideways, ortwisting the body;

� The wearing of loose comfortable clothing, forexample trouser uniforms and suitable shoes;

� Lifting at arms length (for example inchildrens’ units);

� Handling manoeuvres which have a startingposition near the floor, overhead or at armslength;

� Situations which may involve handling anuncooperative or falling patient;

� The presence of patient attachments, such asdrips, catheters or other devices which may

restrict movement or access.

Patient assessmentdetails

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Name_______________________________

Mobility details_______________________________

Level of cooperation(if any)_______________________________

Who should assess?

� Site (i.e. hospital) assessments should becarried out by the Safety Manager/BackCare Manager of the hospital or nursinghome advised by the patient handlingtrainer or other competent person.Records of the site assessments should bepart of the overall Safety Statement.

� Unit assessments should be carried out bythe first line manager (all of whom shouldbe trained as operatives) advised by thepatient handling trainer or othercompetent person.

� Individual patient assessments should bedone on each patient in hospital and inthe community. These are done by patientcarers providing they have been trained inthis area. With difficult cases they shouldseek help from the patient handlingtrainer or other appropriate person.

Where appropriate, for example, in thenursing plan in hospitals, documented patientassessments should be regularly updated andavailable to everyone who handles the patientand should include the following:

Employers must…Have a policy on manual handling whichmust be included in their Safety Statement,which must address the following:The need to carry out patient/manualhandling risk assessments

� The minimisation to the greatest extentpossible of manual handling;

� Designate appropriate finance, time andstaff for safe patient handling;

� Ensure that employees are not exposed torisks as a result of patient handling;

� Designate and, where necessary, trainpatient handling trainers;

� Ensure regular training of staff and re-assessment of patient handling policies;

� Where necessary call on outside expertisefor training and assessments.

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Speciallifting needs _______________________________

Number of handlers Equipmentrequired_______________________________

Special needs(joints, wounds)_______________________________

Above:stretcher-hoist

Below: turntable

Appropriate equipment

Employers must ensure that adequatenumbers of well maintained handling aids areavailable and that these are used by theemployees.

They would typically include:

� Wheelchairs;

� Hoists (mechanical and electric);

� Sliding equipment (boards, bags, etc);

� Turntables;

� Handling slings.

Selection of staffStaff whose duties may involve working withpatients with impaired mobility, in accordancewith the Safety, Health and Welfare at Work(General Application) Regulations, should be:

� Physically suited to carry out the task inquestion. In the health care setting thiswill usually be assured by a preemployment medical examination,followed by appropriate training,monitoring and supervision of staff.

Training of staff

1. Training should be tailored to the needs ofthe departments or areas where the patienthandlers will be working.

2. Classes should be small enough to allowfor individual demonstrations andpractice. The ratio should be 1 trainer to 8students for practical skills development.

3. Delays in training should be avoided and,where required, employees should beindividually trained at induction ratherthan waiting for a suitable class.

4. Training should include classroom tuition,practical demonstrations and workplacesupervision. Workplace supervision is toensure that the lessons learned are beingapplied by both staff and management.

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SAFEMANUALHANDLING

Content of training

1. The law as it relates to patient handling.2. Basic information on the anatomy and

biomechanics of the spine and musclesand how injuries take place from manualhandling.

3. Instruction on personal fitness for patienthandling, including practical exercises forfitness, flexibility and muscle toning.

4. An introduction to the practical handlingpolicy as reflected in the Safety Statement.

5. An ability to carry out assessments onparticular patient’s handling problems asthey arise.

6. Information on the practical applicationof a minimal handling policy.

7. Demonstration of the use of all types oflifting aid and instruction on thefrequency of maintenance as required bythe Safety Statement.

8. The wearing of suitable clothing andfootwear.

9. Instruction on ensuring passageways, floorsand lighting allow safe patient handling.

10. Problem solving in patient handlingsituations.

Effectiveimplementation oftraining programmes

Training must be implemented using a top downapproach:

� Policy makers must themselves appreciate thesignificance of safe patient handling;

� Middle management and senior operationalstaff must themselves be trained in patienthandling;

� Newly trained personnel must be supervised toensure that practices taught in training areimplemented in the workplace;

� Records of staff trained must be kept.

Some specificproblems

� Pregnant patient-handlers are especially atrisk. The ligaments supporting thevertebral joints are weakened due tohormonal action, especially in the latterhalf of pregnancy and as a result the backis substantially more vulnerable to injury.Pregnant women generally have 30% ofthe lifting capacity of non- pregnantwomen. A pregnant patient- handler’ssize limits her capacity to lift safely.

� Coping with patients who refuse to behandled with lifting aids may causedifficulty. Staff faced with such patients,or their relatives, should call in seniormanagement and a trainer or othercompetent person.

� Staff should be encouraged to adopt apositive attitude towards minimalhandling and reassure patients that this isnecessary for their own safety and that ofthe patient-handler. To do otherwisecould mean injury and disability forthemselves or one of their colleagues.Under the Safety, Health and Welfare atWork Act and the General ApplicationRegulations staff are required to co-operate in relation to occupational healthand safety matters.

SAFEMANUALHANDLING

SAFEMANUALHANDLING

SAFEMANUALHANDLING

ISBN 1-84496-085-4 HSA0169

Caring with Minimal Lifting

Health and Welfare for Ireland

Working to

create aNational Culture

in Workplace Safety,Excellenceof

HEALTH AND SAFETYAUTHORITY

Tel. 1890 289 389

Callers outside Republic of Ireland

00353 1 6147000Fax. (01) 6147020

website: www.hsa.ie