Manual Handling -Clinical - Microsoftmel0207lsprod.blob.core.windows.net/uploads/healthecare/trdoc/hca... · Manual Handling -Clinical Workplace Ergonomics for Clinical Staff October

Manual Handling - ClinicalWorkplace Ergonomics for Clinical Staff

October 2015

Healthe Care Australia | ‹#›

Main Menu

� Training objectives

� Legislation

� Ergonomics overview

� Manual handling

• causes of strains

• Risk factors

• Assessment of tasks

� Managing the risks

• controls

� Lifting Mechanics

• Handling a load

• Correct lifting technique

� Patient handling

• Rolling

• Patient handling aides

� Other factors

� Office environment


Training Objectives

OBJECTIVE

To train staff in safe workplace ergonomic practices including manual handling of patients / clients / equipment and office workstation procedures.

INTENTED OUTCOME

At the end of the training the Trainee should have an understanding of the principles of safe manual handling and office workstation procedures and the knowledge and skills to facilitate manual task risk management in the Hospital.


Legislation

There are certain “Laws” in place that require employers to ensure the health and safety of staff / workers under their employ:

� Workplace Health and Safety Act 2011(Commonwealth), Division 2, Part 2, 19 Primary duty of care” – states that

“(1) A person conducting a business or undertaking must ensure so far as is reasonably

practicable the health and safety of:

(a) Workers engaged or caused to be engaged by the person and

(b) Workers whose activities in carrying out work are influenced or directed by the person”

� Each State and Territory has its own legislation, however the Commonwealth Legislation is the basis of any State legislation and is the “overriding” legislation


Legislation

There are also specific State and territory “Regulations” that also underpin

the requirements for organisations to ensure the health and safety of people

in their employ: For example

� WHS Regulation 2011(Commonwealth), Chapter 3, Part 3, 34 Duty to identify hazards

“A duty holder in managing risks to health and safety must identify reasonably foreseeable hazards that could give rise to risks to health and safety”

� Therefore, organisations have a responsibility to identify “foreseeable” hazards and do whatever is reasonably practicable to “manage” these hazards to reduce the level of risk.

� One of the major “hazards” identified in the Healthcare setting is “manual handling”, and one of the ways in which organisations attempt to reduce the risk to staff is to provide education and training around manual handling risks and ways to minimise the risk of injury


Ergonomics - overview � “Ergonomics” can be defined as “the study of people's efficiency in their

working environment”

� Quality ergonomics is achieved when the work people do is designed to suit their physical and mental abilities.

� Ergonomics seeks to improve the match between a job and a person’s physical abilities, information handling and workload capacities.

� Ergonomics therefore contributes to the planning, design and evaluation of tasks, jobs, systems, environments and organisations to make them compatible with the needs, abilities and limitations of people.

� Ergonomics can be segregated into different categories, however this tutorial will concentrate on “Physical Ergonomics” as this is most relevant to the hospital setting:

� Physical ergonomics – includes

– working postures,

– materials handling,

– repetitive movements,

– musculoskeletal,

– workplace layout


Ergonomics - overview

Whilst there are different categories of ergonomics this training

program will target two main risk factors in the Hospital environment:

� Manual Handling

� Office Workstation Design


Manual Handling – causes of strain

� Sprains and strains

injuries account for

approximately 50 to

60 per cent of

injuries across five

priority industries

including Health.

Causes of these injuries

include:

� Handling surgical loan sets

� Raising patients from the floor

� Handling patients

� Pushing trolleys and wheeled

equipment e.g. beds and carts

� Handling laundry bags


Manual Handling - risk factors

� There are many factors that influence manual handling risk, not just weight.

� Hazardous manual tasks involve one or more of 5 risk factors that directly impact on the body (direct stressors):

• Significant force - e.g. lifting a very heavy load from the ground

• Awkward or static postures - e.g. bent back or raised arm

• Repetitive movements - e.g. making the same type of movements over and over

• Vibration - e.g. use of a hand tool.

• Duration - e.g. long durations of performing a task.


Manual Handling – risk factors


Manual Handling - assessing tasksBefore engaging in any manual handling tasks, we need to assess the

“risk factors” to determine if it is a potentially “hazardous” manual

handling task. Assessment includes:

� Nature of the load – includes: size, shape, handholds / ease of grip, weight, stability, texture and temperature

� Work area design – the area where work is performed examples include: work benches and furniture –this includes the positioning and relationship of different elements in the work area to each other and the person due to the effect on working posture

� Load handling – transfer of loads or how the load is handled e.g.

physically lifted or mechanical aids

� Work organisation – can intensify task demands including staffing levels,

hours and speed of work, rest breaks, supervision, maintenance, task

variability, communication and reporting procedures

� Individual factors – include skills and experience, physical characteristics,

job satisfaction, personal protective equipment (PPE) and clothing


Managing the Risks - controls� After assessing the potential risks for manual handling, (as per the 5 risk factors) it

is now necessary to put particular controls in place.

� There is a hierarchy of controls, which assist to determine the best way to manage

a risk.

• Elimination – Can I eliminate this risk?

• Substitution – Can we replace the risk with something less risky?

• Engineering / Job design – Can we make changes, or create tools and equipment tochange the way the job is done to be less of a risk?

• Administrative – can we put a policy or procedure in place, provide training, to protectworkers?

• Personal Protective Equipment- Can we provide the worker with equipment to protectthem from the hazard?

� The stronger controls are preferred, however if these are not possible, we need to

move down the hierarchy to choose an effective control.


Managing the Risks - controls

� The following represents the hierarchy of controls from most effective to least effective. The most appropriate control for each circumstance needs to be considered


Lifting Mechanics� Any lifting that involves any of the 5 risk factors contains some risk of injury. As

such there is no best way to lift.

� Task redesign or mechanical aids that eliminate the need to lift is preferred.

� The further away a load is from the body, the greater the effort required to lift it. Disc pressures are smaller when the spine is upright.

� When force is applied with the back bent, the front part of the disc is squeezed.

� Combining bending forwards with bending sideways or twisting increases disc pressures.


Handling a Load

If a load must be handled manually: ASSESS THE LOAD FIRST

� Bend your knees (not your back) with feet apart

� Get a firm grip, lift with your legs (thighs) and keep the load as close to the body as possible

� Avoid lifting from a position where twisting or bending sideways is required to place the load, after prolonged periods with the back bent or prolonged exposure to whole body vibration.

It should be remembered that teaching lifting techniques is not aneffective risk deterrent by itself. Risk control relies on worker behaviour and correcting poor technique.


Handling a Load – Team Lifting

� This should not be considered the first and only option as it can bring its own risks due to mismatched workers e.g. size and physical strength.

� Workers may not exert force simultaneously or share the load equally or one may lose grip or balance and unexpected increases in load can occur.

� Mechanical aids is always the preferred option


Team Lifting

� Whilst mechanical aids are the preferred option when considering

manual handling controls, team lifting whilst not the preferred option, is

sometimes an option appropriate to a situation.

� Basic steps of team lifting include:

• Size up the load and check over-all conditions

• Wear suitable PPE including footwear

• Workers should be approximately the same size

• One person should be selected to coordinate the lift before the lift begins –

coordinate voice signals

• Maintain communication

• If available use handholds, handles or slots


Team Lifting – Team manual handling


Correct Lifting Technique


Patient Handling - Rolling

Rolling over is used in preparation for a number or nursing activities

including:

� Changing the patients position

� Changing the bed

� Positioning slings, side sheets and slideboards under the patient

� Preparing the patient for getting out of bed.

PREPARATION

� If required two staff should conduct this procedure

� Ensure the brakes are on

� Ensure one pillow is behind the head

� Put the back rest down.



METHOD

� Request patient to bend up knees or bend one or both up for them

� Request patient to move arm in the direction of the rolling or place it for

them

� Request patient to turn head in the direction they are rolling

� Second nurse to position on the destination side to hold the patient

when roll completed to prevent rolling off the bed

� First nurse on origin side pushes on the patient’s legs then uses the hip

and shoulder to roll the patient.



SAFETY PROCEDURE

� If performing this method alone ensure a bedrail is fitted and up on the

destination side of the roll

� Ensure the use of the appropriate aide (i.e. slide sheet) if required

� Assess patients’ strength and cognitive impairment to ensure

understanding of instructions to perform the transfer

� Ensure staff members maintain correct posture throughout the

procedure


Patient Handling Aides

� There are several patient handling aids available for use in

Hospitals including:

• Slide sheets

• Flexi / walk belts

• Hoists

• Pat slides

• Hover Mats

� Always assess the task first to ensure correct choice of aid.

� Ensuring that the correct aid is easily available to staff will increase the

chances of staff using the appropriate aid for the task.


Patient Handling Aides - Patslide

� Patslides are large plastic reinforced boards that have been stress tested

and are used for transferring a patient between a bed or treatment

table and a trolley.

� They are of assistance to bridge the gap between a trolley and bed.

They have a low friction surface allowing the person to slide the patient

using a sheet or slidesheet.



PREPARATION

� A patslide should used in a team with two persons minimum for a

conscious patient and more (four to six) depending on the weight,

condition, height and level of consciousness of the patient

� Secure brakes on trolley and bed with the patslide acting as a bridge

between the bed and the trolley

� One person should be selected to

coordinate the lift before the lift

begins – coordinate voice signals

� Maintain communication.



METHOD� Lay the patient supine. Use an appropriate rolling technique to roll the

patient

� Position a slide sheet under the patient ensuring that the majority of the

slide sheet is on the side of the move

� Place the patslide under the slide sheet

� Position the trolley/bed with the brakes

locked, use the patslide acting as a

bridge between the bed and trolley



� Staff is positioned on the receiving bed/trolley and pulls the slide sheet at

hip and shoulder level. Gently and slowly slide the patient across, using

two or more pulls if necessary

� Take care that the head and feet are safely moved in line with the body

� Once the patient is positioned, tuck the slide sheet under the patient

and remove the slide sheet and patslide by rolling the patient.



SAFETY

� Adopt an upright posture while rolling and holding the patient to position

the patslide

� Position the feet wide. One leg may need to be under the bed or trolley

to prevent overbalancing

� Grasp the edge of the sheet downwards

� Pull the patient across as a team grasping the sheet.


Patient Handling Aides – Slide Sheet

Slide sheets are a rectangle of thin

slippery fabric that can either be

used singly or in combination with a

second sheet or patslide.

They are placed under the patient to

facilitate moving in bed or in

combination with a patslide to

move a patient between a

bed and a trolley.


Patient Handling Aides – Slide sheet

PREPARATION

� A slidesheet should used in a team with two persons minimum for a

conscious patient and more (four to six) depending on the weight,

condition, height and level of consciousness of the patient.

� Ensure bed brakes are on and the bed is adjusted to the correct height

� Prior to commencing the procedure check the patient weight against

the safe working load of the slide sheet

� For patients over 90kg or who are very tall two slide sheets should be

used for the procedure



PREPARATION

� One person should be selected to coordinate the lift before the lift

begins – coordinate voice signals

� Maintain communication

� Inform the patient of the manoeuvre

and need for transfer

� Always have two layers of slide sheet

(either one folded or two separate sheets).



METHOD

� Adjust bed and / or trolley to safe working height

� Fold with the open end facing the direction of travel

� Roll the patient to position the slide sheet under the patient

� Hold the top layer only. Keep hands in contact with the bottom layer to

avoid separation of the sheet which will reduce the effectiveness. Hands

should be palm up

� Encourage the patient to assist with the transfer if able

� Do not lift the patient – slowly slide

� Once the patient is in the desired position roll to remove the slide sheet


Patient Handling Aides – Slide sheet

TECHNIQUE

� For two staff, stand on either side if the bed. Make sure the bed is at the

correct height for both staff to maintain easily reach.

� Maintain arms straight but with elbows relaxed and pull on the top layer

of the slidesheet

� Bend your knees to maintain your posture. Keep your back straight

� The power of the transfer comes from your legs and bodyweight


Patient Handling Aides– Walkbelts /

Flexibelts / “Pelican” belt.

Flexibelts are portable and lightweight devices for assisting patients with movement. The flexibelt is placed around the patient’s waist. They are fitted with two handles usually two on each side whichcan be grasped to support or guide the patient.

They are intended for only weight-bearing patients to give the patient ‘handles’ to enable the nurse to position themselves without obstructing the patient’s normal movement whilst maintaining good control of the patient’s movement.


Patient Handling Aides – Walkbelts /


PREPARATIONAssess patients’ size, strength and cognitive impairment to ensure

understanding of instructions to perform the transfer and selection of

belt size

� Visually inspect belt ensure material and seams are not damaged

� Inform patient of the manoeuvre, need for transfer and destination

� Ensure the patient feels respected and their dignity is maintained

throughout procedure

� Ensure that the patient is wearing shoes with a non-slip sole

� Apply pressure to buckles and handles to verify they will not open under

load.




METHOD

� Explain the procedure to patient and encourage them to assist in the

transfer

� Place belt around patient waist just above hips

� Each person grasps a handle and assists patient to stand

� Each person re-positions while supporting patient and assists patient to

walk to destination

� Assist patient to sit.




SAFETY

� Patient must be able to assist in the manoeuvre

� Maintain coordination between staff

� Ensure floor is clear of obstacles, contaminants and spills

� Send for cleaning at completion of patient use, as per hospital

procedure


Patient Handling Aides - Patient Lifters /

Hoists

� A hoist is a mobile device for the safe moving a patient who is incapable

of weight bearing for the duration of the task. Appropriate lifting hoists

are available throughout the Hospital.

� It is important to select the appropriate lifting device for the requirements

of the patient

� These devices are battery operated, so it is important that they remain

plugged in when not in use, and that batteries are re-charged and

changed when required, to ensure these pieces of equipment remain in

working order when they are required



HoistsPREPARATION

� Ensure the selection of the appropriate lifter / hoist for the task at hand

� Patient’s weight must be checked against the safe working load of the

lifting device ( this will be identified on the lifting device frame))

� Ensure that the battery has adequate charge prior to attempting to use

the hoist

� Select the correct hoist sling for the patient’s weight and inspect for any

damage, wear and tear

� Secure brakes on bed or chair patient is in and bed or chair patient to be

transferred to

� Ensure transit pathway is clear and free of obstacles.



HoistsMETHOD� Assess the patient to determine the appropriate sling and transfer method

� Explain to the patient the process prior to commencement and

encourage assisting if possible. At all times maintain patient’s dignity

� Remove the battery pack from the wall charger and insert into the hoist

battery fixture

� Roll up the sling then roll patient to position it under the patient. Roll

patient back and repeat this process.

� Ensure that the sling provides adequate support for the patient’s

shoulders

� Position the hoist and secure the brakes



Hoists

METHOD� Spread the legs of the hoist to provide a stable weight distribution

� Attach sling to Hoist frame ensuring that the same loop tab is affixed on

all four points of the hoist

� Hoist patient up a short distance to check patient comfort and sling attachments are secure to minimise patient injury.

� Steady the patient during hoisting process do not raise patient to highest point unless absolutely necessary

� Raise patient clear of bed or chair & transfer over destination secure the Hoist brakes

� Lower the Hoist slowly

� Remove the sling.



Hoists

SAFETY

� Emergency Stop Action – in the event of emergency depress the Red

Button to initiate emergency stop

� Do not attempt to adjust the sling once the patient is raised. Lower the

patient back

� Check for appropriate positioning of the sling

� Do not use if patient is uncooperative or non-compliant

� Loaded hoists can tip if pushed over sloping surfaces

� Following use promptly return hoist to storage area, plug in and recharge

battery if required.


Other FactorsLifting is only one small part of manual handling requirements and other

related factors such as push / pull and carry should not be overlooked.

In the Hospital environment awkward postures and duration of tasks,

not just weight, provides risks that must be recognised and controlled.


Other factors

The straight back lifting principles cannot be easily applied to a wide

range of work tasks. Carrying out manual handling tasks with arms fully

forward, above shoulder or outwards are major risk factors.


Office Environment

The office environment presents many ergonomic hazards including:

� Computers and personal devices

� Telephones

� Furniture

� Handling equipment

� Storage systems

� Lighting

� Ventilation

� Electrical


Office Environment� Chair / desk selection are important and must be correctly adjusted.

� The entire sole of the foot should rest on the floor with the back of the

knee slightly clear of the edge of the seat.

� Preferably the chair and desk can be adjusted so the feet rest on the

floor however a foot rest can be used.

� If the desk is adjustable it should be in a position to allow the operator to

adopt the correct position. Armrests should not obstruct correct

keyboarding or prevent the chair from sliding under the desk. If

necessary the armrests should be removed.


Office Environment

� Document trays and boxes should be sufficiently strong that they do not

buckle when fully loaded and should be of a shape and size that can be

comfortably lifted when full.

� Storage of heavy and frequently accessed items should be at a

comfortable height that not require the use of a ladder.

� Computer screens should be adjusted so the top of the screen can be

read without tilting the head backwards to do so. Working documents

should be located between the screen and keyboard or alongside the

screen and keyboard to ensure the same focal distances for both.


Office Environment

� Glasses should be used if required.

� Keyboards should be in a lowered position with wrists in a neutral

position, if appropriate use a wrist rest.

The keyboard should be in front of the

screen or document holder directly in

front of the user near the front edge

of the desk to reduce reaching.

The mouse should be as close

as possible to the keyboard to

reduce reaching.


Office Environment

� Like flying a plane, it is always advisable to perform a “pre work check” of your environment

� Many staff these days share their office desks / chairs and office space

� Make sure before you commence your work that you check:

• ensure an appropriate surface for smooth operation of the mouse.

• desk height (if adjustable) to ensure correct setting

• chair adjustment (height / tilt / backrest position

• keyboard / mouse / screen position.


Office Environment


In Summary

� Correct manual handling and ergonomics is an important safety strategy to prevent long term injuries amongst staff.

� In the health and community services industry, body stressing accounted for 52%* of workers compensation claims with half of these claims due to muscular stress while handling objects other than lifting, carrying or putting objects down

� Employers and employees have a responsibility to identify manual handling or ergonomic hazards, assess the risks associated with that hazard, control or eliminate the risk, and continually review each situation to ensure the safety of all staff.

� It all depends on you implementing the appropriate manual handling techniques suitable to the situation and applicable to the task.


Everyone is responsible for:


Acknowledgment / References

� Work Cover, NSW. (2006). Smart Move, Safe Manual Handling- Manual Handling Training Resource DVD.

� Healthe Care Belmont Private Hospital, “Workplace Ergonomics (Clinical) Tutorial” , R Knudsen

� Healthe Care Hurstville Private Hospital, “ Manual Handling Safety Brief”, 2015

� Healthe Care Marian Centre, “ Manual Handling and Hazard Management”, 2015

Documents

Manual Handling -Clinical - Microsoftmel0207lsprod.blob.core.windows.net/uploads/healthecare/trdoc/hca... · Manual Handling -Clinical Workplace Ergonomics for Clinical Staff October