1. Manual Handling Training

2. The aim of this topic is to provide you with an understanding of the risk management approach to manual handling activities

3. Learning Outcomes Communicate risks involved if incorrect manual handling techniques are followed. To instruct all staff of the importance of safe work practices in regards to manual handling. Demonstrate correct Manual Handling Techniques under the guidelines of the Work Health and Safety Regulations 2011

4. What is manual handling?

5. What is Manual Handling? Manual handling is defined as the use of force exerted by a person to… Lift Lower Carry Push Pull Move Hold Restrain

6. In regards to the work of nurses, manual handling is required in almost everything you do in the course of your work each day from pushing trolleys, carrying meal trays, making beds, putting away stock, moving furniture & providing care to patients.

7. Why do you need to be aware of Manual Handling? Workplace injury can affect your whole life. what job you do, your family & leisure activities. Duty of care to protect self, employer & co-workers. (WHS Act 2011). Monetary penalties can apply for breach of WHS Act by WorkCover to worker, supervisor and employer.

8. Workplace Injuries – Statistics provided by WorkCover NSW There were 11,610 manual handling injuries in 2004/05 Manual Handling injuries in 2004/05 cost $224 million & involved 82,557 weeks in time lost The proportion of workplace manual handling injuries from all workplace injuries in 2004/04 was 31% for males & 34% for females

9. The principle agencies involved in manual handling cases were materials handling (crates, cartons & boxes) & patient handling. Together, these 2 categories accounted for a quarter of all manual handling claims. Over 62% of workplace injuries resulted in sprains & strains, costing $434 million in 2004/05

10. Manual Handling is the single largest cause of injuries to nurses. Why? The risk of injuries is increased due to the number of possible variables when handling patients. It should be noted that musculoskeletal disorders can be cumulative in nature & are often the result of multiple stress & strains over time.

11. How much ‘weight’ would a nurse move in a typical shift?

12. Manual Handling weights moved by Health Care Workers Total Weight lifted over an 8hr period have been assessed as; Nursing Staff 1224 kg Patient Services 902.5kgs

13. Trends in patient handling… Research has consistently identified 4 nursing tasks associated with low back pain: 1.Frequency of moving patients in the bed 2.Manually transferring patients between the bed & chair 3.Manual lifting of patients from the floor 4.Sustained postures such as stooping

14. What has changed over the years? Many of the traditional manual techniques used by nurses are now considered too risky to be performed at all i.e. prohibited Appropriate patient handling equipment has been progressively introduced Training took on a different focus - less focus on techniques & more training on prevention of injuries Nurses started looking beyond the technique or the equipment

15. Your back…. The key support structure in your back is the spinal column – made up of 33 bony vertebrae. These bones & joints are supported by strong muscles & ligaments & are padded in between by discs.

16. Lumbar Spine (1 – 7) (1-12) (1 – 5) CENTRE OF GRAVITY

17. Back pain may arise from any one of these structures through: Poor posture Spinal rotation Bending forward when lifting Excessive weight Poor muscle tone Lifting a load too far from the body amongst other things

18. The abdominal muscles act as a natural corset that supports the spine during lifting, pushing etc. The back & stomach are not designed for lifting. They only have a supportive role. The most important muscles for moving heavy objects are the thigh (quadriceps), buttocks (gluteals) & calf muscles.

19. Centre of gravity – where is it? Is around the S1 area (sacrum / tail bone) & is affected by posture & weight The muscles in your back balance the forces created by postural change when carrying loads Keeping the load close to the centre of gravity reduces the strain on your back muscles & spine

20. Spinal disk injury EXAMPLES OF A BULGING DISK

21. Other common areas for injuries include….. Knee

22. Shoulder

23. How can you look after your back?

24. Caring for your back Keep fit & active Avoid being overweight Maintain good posture Think before you lift at all times – not just at work Rest Remember…Push before you pull before you lift!!!!!

25. Complete group activity: ‘Why do manual handling injuries occur?’

26. What would be the ‘key principles’ for handling ANY load?

27. Know your own limits Maintain balance – position your feet Keep the load close to the body during movement Avoid twisting your back or neck Keep wrists in a neutral position when pulling, pushing or steering

28. Keep movements smooth Look in the direction of travel Use a lunge position when performing forward or backward movements If lifting from below mid-thigh height, lunge or squat Steer using body weight rather than arms

29. So we now know what Manual Handling is…now what?

30. We need to be aware & be able to identify ‘risk factors’ that can cause manual handling injuries

31. So what are the ‘Risk Factors’?

32. Identifying Manual Handling Risk Factors Awareness of actions & movements Work space or station layout Posture & positions Duration & frequency Location of loads (i.e. below waist height) Distances of transfer Weight & forces required

33. Characteristics of loads & equipment (e.g. shape of load can make manual handling awkward Work organisation (e.g. preparation for the lift) Skills & experience of the person doing the manual handling Age or special needs Clothing being worn when manual handling Any other factor considered relevant.

34. One of the key principles of the “Work Health & Safety Regulation 2011” is ‘risk management’ - the process of: – Identification – Assessment – Elimination or control of hazards in the work place. – Ref www.workcover.nsw.gov.au

35. To meet your legal obligations…. We all have a duty to ensure the health, safety and welfare at work of our colleagues, & to ensure that people are not exposed to risks to their health or safety while they are at your workplace. This means their safety is EVERYONE’S responsibility.

36. How do we risk manage?

37. How do we Risk Manage? FOUR EASY STEPS………… ‘I’ - Identify - Discover all the hazards you have ‘A’ - Assess - Decide how important each one is ‘C’ - Control or eliminate - Do something about the hazards ‘R’ - Review – Did your control measures work?

38. When performing a manual handling risk assessment on a patient consider…. Physical capabilities Medical condition Mental status Communication Equipment available The working space Staff training / needs Work organisation Employees clothing Frequency & length of time required

39. Under each of the given headings on the table of the next slide, list what you think should be considered when assessing a patient PATIENT/ CLIENT ASSESSMENT…

40. Considerations Physical function Mental status / cognition Medical condition Communication

41. Physical function Control of arms & legs Weight Height Balance Tone Sensation Vision Body awareness Hearing Range of movement

42. Mental status & cognition Aggressive Unpredictable Resisting Confused Agitated Judgment Memory Concentration

43. Medical condition Pain Fractures Medication Recent change Fatigue Delicate skin Attachments of drips, catheters etc

44. Communication Ability to speak Language barriers Body language Confidence

45. Use of machines & equipment

46. What do you think would be the main piece of equipment that you would work with every single day?

48. Guidelines for making a bed Ensure the brakes are on & that you have enough room around the bed to move comfortably Ensure the bed is at a safe height Ensure the head of the bed is flat Lower the bed rails Remove / relocate the bed side table to have enough room Once finished, ensure you arrange everything as it was

49. The only way to eliminate the risks associated with handling people is to not perform client handling. We will now explore ways to do this, however, many patients are not capable of moving themselves or assisting in moving themselves, so nurses need practical techniques & equipment to reduce the risks associated with handling patients.

50. PLEASE NOTE A healthcare worker has a professional responsibility towards the patient, but this does not extend to putting themselves at risk. Patient’s have rights & they have responsibilities. Every member of the community has the common law duty not to place others at risk by what they do or what they fail to do

51. When providing care to patients, nurses should always refer to the Care Plan. The Care Plan lists the handling aids, techniques & special instructions for care of each individual patient When a patient is capable of moving himself then this eliminates the handling risk for the nurse. Even if the patient can partly assist, the handling risk is reduced

52. Name any type of machine &/or equipment that nurses use as manual handling aids

53. Wheelchairs, walking sticks, quad sticks, walking frames. Commodes, shower chairs, bed pans Hand rails, ramps, non slip flooring Mechanical lifters Specifically designed tools for ADLs e.g. utensils, door knobs Scooters Cushions Over bed frames, triangles, slidesheets, overchair tables Pelican belts (walk belts)

54. What do you think the general guidelines or rules would be for the use of equipment?

55. Take care whilst using the equipment Only use for its manufactured purpose only As per manufacturers guidelines Only use the equipment if you have been trained to do so Be aware of & follow the facilities safe work practise Store appropriately Keep equipment clean Don’t forget to charge batteries for lifters

56. What do you think the general guidelines would be for the maintenance of the equipment?

57. Should only be attended by a trained person i.e. maintenance personnel Must be done as per manufacturers instructions & facility procedure

58. Guidelines for the use of mechanical lifters

59. Types of hoists ‘Sit–to–stand’ lifter

60. Full body lifter / Sling lifter

61. Each of these pieces of equipment will require the following… The main hoist / machine A sling or strap of some description depending on the task A battery Possibly a separate hand control unit

62. Before you use any piece of equipment you MUST…. Check that all joints & straps are serviceable & not frayed or worn Check the electric hoist is charged & working Plan the procedure Check your environment i.e. is it free of clutter Explain to the patient what you are going to do Have a 2 nd staff member to assist – this is a requirement by ALL healthcare facilities If you are not familiar with the equipment then do not use it & risk an injury to yourself or the patient

63. General instructions for use Reassure the patient Check the hoist – is it the appropriate type to use? Is the patient suitable? Is the patient’s weight within the safe working load on the label on the machine? Is the machine in good working order? Do you know how to use it? Do you know where the emergency features are? Do you have the correct type of sling & size?

64. Remember – using a hoist will eliminate lifting but not manual handling Hoists were designed as lifting devices NOT transport devises, so they should not be used to move people about!

65. Non-mechanical aids

66. Slide sheets

67. Transfer belts

68. Chair lifter

69. Pat slide / Slide board

70. HoverMatt

71. Walking frame

72. Crutches

73. DVD: ‘Moving & Handling of the Elderly’

74. Groups are to decide how best to move the following patients. There will be more than one option!! List the techniques or equipment IDENTIFY any special conditions GROUP ACTIVITY

75. Patient in bed needs to go the x-ray department Task 1

76. Possible solutions: Coach the patient to get up by themselves & transfer to trolley or wheelchair – bed may be lowered If unable, raise the height of the bed to just above the trolley height & use slideboard If unable - Use hoist

77. Patient in chair wants to go back to bed Task 2

78. Possible solutions Lower bed height & coach the patient to do it themselves If unable, lower bed height & use walkbelt If unable, lower bed height & use sit-to-stand lifter In unable, lower bed height & use full body sling

79. Patient has slipped down the bed Task 3

80. Possible solutions Coach the patient to reposition themselves – wiggle up the bed If unable, get the patient to bend their knees the anchor their feet while they propel themselves up the bed – they can use the monkey bar If unable, raise the height of the bed & use the slide sheets to move the patient Use the knee break if fitted to stop future slipping

81. Patient is on the floor Task 4

82. Possible solutions Check first to see if the patient is injured & if not Coach the patient to get up themselves – you may need to position a chair so they can pull themselves up on this If unable, apply a walkbelt & coach to get up with minimal assistance – the chair can be used as well If unable, use a sit-to-stand lifter if you believe they can weight-bear If unable, use a full body sling If injured, you may need a Jordan Frame attachment for the full body hoist

83. Falls prevention strategies – general safety interventions Assess the patient before you move or help them Explain the procedure to the patient Make sure the patient has appropriate foot wear on. No slip-on shoes or slippers Provide an appropriate armchair with wheel locked at the patient’s bedside

84. Falls prevention strategies – general safety interventions Ensure the pathway to the bathroom is free of clutter & properly lighted Place walking aids within easy reach Consider patient’s medication that could affect level of alertness Make sure the flooring is safe

85. Falls prevention strategies – general safety interventions DO NOT leave ‘at risk’ patients unattended When transporting patients on stretchers/bed have bed rails up Inform & educate patient’s family members regarding a plan of care to prevent falls Communicate with other staff members the patients that are ‘at risk’ during shift changes etc

86. Falls Management Under no circumstances attempt to manually lift the patient from the floor. Make the patient comfortable Assess the patient for possible complications e.g. CVA, heart attack bleeding wounds broken bones If patient ok – attempt to help them to stand by rolling the patient onto their side, then onto all fours & then into a kneeling position. Using a chair as a prop, help the patient to stand If patient not ok to do this, then an ambulance or another nurse should be called & lifting devices used.