1. 1 Manual Handling Marija Buttery Version 7, 2012

2. 2 What Is Manual Handling? Any event that involves: Lifting Lifting Lowering Lowering Pushing Pushing Pulling Pulling Carrying Carrying Moving, holding or restraining anything Moving, holding or restraining anything

3. Look, Think and Plan

4. 4 Ensure the Load is not too Heavy

5. 5 Why is it important? Because you do not want to injure yourself, a colleague or a patient!!

6. 6 Remember:  Prevention is better than cure!  If the lift/move is not necessary do not do it!  Always use the appropriate equipment or technique.  Ensure you are adequately trained to use equipment - if not DO NOT USE IT  Report faulty equipment, or lack of.  Ensure you colleagues comply with the work place procedure.  Continuous assessment and evaluation  You can do just a few of the stretches anytime during the day.  Stretch prior to doing any manual handling tasks.  Exercise and take short breaks frequently  Cool down after any heavy lifting/manual handling.  Exercise is one of the best ways you can improve your posture.  Include a variety of movements in your workday.

7. 7 Manual Handling Types of patient transfers Turn client using a slide sheet * Move client up a bed with slide sheet * Getting client out of bed * Standing client * Assisting client to walk * Assist client form floor to Chair (Verbal Instruction) * Getting client out of bed (Stand Hoist) Getting client bed to chair (Sling Hoist) Assisting client from floor (Sling hoist) Move client from bed to bed using slide board * Assessed

8. Manual Handling Legislation

9. 9 Risk Assessment (1) An employer must ensure that any manual handling that is likely to be a risk to health and safety is identified and assessed. (2) An assessment undertaken for the purposes of this regulation must take into account the following factors: a) The actions and movements involved in the manual handling. b) The workplace and workstation layout. c) The postures and positions that must be taken by each person involved in the manual handling. d) The duration and frequency of the manual handling. e) The location of the loads and the distances that they must be moved f) The weights and forces involved g) The characteristics of the loads and of any equipment that is used in the task.

10. 10 Risk Assessment h) The organisation of work at the workplace. i) The work environment. j) The skill and experience of each person who must carry out the manual handling. k) The personal characteristics of each person who must carry out the manual handling. l) The clothing that is worn during the manual handling. m) Any other relevant factor (as identified by the employer or any employee, health and safety representative or health and safety committee, or registered association consulted by the employer).

11. 11 Risk control (1) If a manual handling task is assessed as being a risk to health and safety, the employer must take such steps as are reasonably practicable to control the risk. (a) the employer must— (i) redesign the manual handling task to eliminate or control the risk factors (ii) ensure that the employees involved in the manual handling task receive appropriate training, (including training in safe manual handling techniques) Appropriate supervision.

12. 12 Risk control (b) where redesign is not reasonably practicable, or as a short-term or temporary measure, the employer must— (i) take one, or a combination of two or more, of the following measures as may be appropriate: (A) provide mechanical aids (B) provide personal protective equipment (C) arrange for team lifting (ii) Ensure that the employees receive appropriate training, supervision in: Correct use or application of any mechanical aids Personal protective equipment. Team lifting procedures.

13. 13 Duties of employees An employee must So far as is reasonable (but without derogating from any common law right) Apply any training provided for the purposes of this Division. Comply with any instruction given in supervision of the manual handling task.

14. Manual Handling Techniques

15. 15 General Hoist General hoist is a mobile device for moving patients. Vary in safe working load (SWL) Hoists can be manual (hydraulic) or electric (battery powered). Sling is used for attaching the patient to the hoist. Coded for size (S, M, L, XL) and load capacity Two main types of sling: Total body sling with head support Toileting sling.

16. 16 General Hoist Hoists can also be fitted with a variety of attachments. Used for moving a patient who is incapable of weight bearing for the duration of the task. Repositioning the patient in bed Transferring the patient between the items of origin and destination E.g. Bed/stretcher, Bed/chair, Chair/chair Toileting Lifting the patient from the floor.

17. 17 General Hoist Select the correct sling and place it under patient Patient in bed or on the floor the sling is applied by rolling the patient. Patient is sitting, rock patient forwards and then sideways to get the sling under them. Secure brakes item of origin Secure brakes item of destination Sling breaks off. Sling breaks off.

18. 18 General Hoist Position the hoist, lower boom and attach sling at all points. Ensure the patient’s arms are either contained within the sling or holding on to the spreader bar. Actuate the control to raise the patient sufficiently to just clear the item of origin Check all four points of sling contact. Move the hoist to the point of destination. During movement the patient is kept as low as possible. Point of destination, position the patient accurately and lower slowly. Use the spreader handle or handles on the sling to improve patient positioning.

19. 19 Precautions Do not attempt to adjust the sling once the patient is raised. Use the spreader to increase the width of the hoist and improve stability. Hoists can tip if pushed over any sloping surfaces. of sling / hoist Ensure the weight of the patient does not exceed the capacity of sling / hoist Applying the brakes to the hoist prevents the hoist from adjusting itself to the load. When parking the hoist after use, the brakes should be activated.

20. 20 Rolling Rolling over is used for a number of activities. Preparation for a number of nursing care activities:, Changing the bed, Patients positioning for pressure care, Position slings, slide sheets, slide boards. Preparation for getting out of bed

21. 21 Rolling Ensure the brakes are on.. Take all but one pillow out from behind the head. Back rest down. Patient to bend up knees or bend one or both up for them. Patient to move arm in the direction of the rolling or place it for them. Patient to turn head in the direction they are rolling. One nurse stands on destination side and holds the patient Nurse on origin side pushes on the patient’s legs, then uses the hip and shoulder to roll the patient.

22. 22 Precautions If one nurse technique. Ensure that the bedrail is up on the side that the patient is rolling to. Some orthopaedic conditions require a patient rolled without twisting.

23. 23 Slidesheet Description A rectangle of thin slippery fabric that can either be used singly or in combination with a second slide sheet or slide board. The slide sheet is placed under the patient to facilitate moving them in the bed.

24. 24 Slidesheet Specific preparation Roll the patient onto their side and place the partially rolled up sheet under the patient. Position the open side of the slide sheet on the same side as the pulling action is to occur: for rolling – your side towards the shoulders of the patient for pulling up the bed.

25. 25 Slidesheet Specific preparation. Ensure the slide sheet covers the heaviest part of the patient (Shoulders to past the hips.) Bed brakes on. Moving the patient up the bed. Encourage them to assist by bending their legs up and pushing down with their feet.

26. 26 Slidesheet Technique One handler – stands on the side of the movement. (Open end of slide sheet) One Handler One Handler – stand on other side of the bed. (Direction patient will face.) Maintain arms straight but with elbows relaxed and pull on the top layer of the slide sheet, shifting weight on to the back foot. Adopt a lunge position. 1 st handler pulls top of slide sheet. 2 nd handler assists by pushing patient through movement.

27. 27 Slide Sheet Precautions A single slide sheet is unidirectional. Two slide sheets can be multidirectional - used to move across, up, down the bed. Variation in slipperiness of the fabric, which can impact on both noise and forces required to use. (Be aware of force required!) Bed sliding devices can be unpredictably slippery (Be aware of force required!)

28. 28 Standup Hoist Description A stand up hoist is a mobile device for moving weight-bearing patients. Hoists vary in safe working load (SWL) and function Can be manual (hydraulic) or electric (battery powered). S Sling is used for attaching the patient to the hoist. Slings are coded for size (S, M, L, XL) Slings have a SWL. The sling is applied around torso about level waist and secured around the chest.

29. 29 Standup Hoist Indications for use Used for moving a patient who is capable of weight bearing for the duration of the task, but who can be unreliable. Transferring the patient between the items of origin and destination. Toileting. Dressing or undressing. Changing incontinence pads or dressings. Rehabilitation activities.

30. 30 Standup Hoist Specific preparation. Select the correct sling and place it around the patient. Secure the chest band or buckles. Position the hoist and attach sling at two points. Position the patient’s feet on the foot platform. Ensure the patient’s arms grip the handles. Ensure the brakes are on the items of origin and destination

31. 31 Standup Hoist Technique. Actuate the control to raise the patient sufficiently to just clear the item of origin. Raise the patient to clear the supporting surface. Move the hoist to the point of destination or to perform the required activity. At the point of destination, position the patient accurately and lower slowly.

32. 32 Standup Hoist Precautions Patient must be cooperative. Able to weight-bear and hang on to the hoist handles for the duration of the activity. correctly. Ensure that the sling is adjusted correctly. Do not attempt to adjust the sling once the patient is raised. Use the spreader to increase the width of the hoist and improve stability. Ensure the weight of the patient does not exceed the capacity of hoist or sling.

33. 33 Sit to Stand – Single Person. (walk belts can be used here.) Technique. (walk belts can be used here.) Patient’s feet should be positioned under the chair ie behind their knees. Patient should slide forwards on the chair. Position your feet and knees outside the patients – you can block one of the patient’s knees with your own. When the patient is ready Get them to push down on the armrests as you lean back pulling the patient towards you. Standing slightly to the side to avoid obstructing their head. Step back as patient approaches the upright position.

34. 34 Getting up From the Floor - Able Bodied Patients Patient should roll onto their side and flex their knees. Patient then places one hand on the floor and rolls onto their knees. As the other hand frees, the patient should place that on the floor so they assume a crawl position. Place a chair in front of them. Patient should grab the chair with each arm in turn, then place one foot on the ground. Instruct the patient to push down (or pull up) on the chair and raise themselves. Bring another chair in behind patient. Patient raises self just enough to allow second chair to be place under buttocks. Patient then sits onto second chair

35. 35 Action: Sit to stand – two persons Walk belts can be used here. Patient’s feet should be positioned under the chair ie behind their knees. Patient should slide forwards on the chair. Patient should move their shoulders forward and position their hands on the armrest. Each nurse stands either side of the patient Can block the patient’s foot with your own if this is comfortable and does not compromise your balance. (If using) Squat (lunge) and each grasp one handle at the front and one handle at the back of the walkbelt. (If using) When the patient is ready and in accordance with your ‘lifting command’, guide the patient forwards and upwards.

36. 36 Manual Handling and Stretching Simple stretches to reduce the risk of suffering an injury By completing the following stretches prior to undertaking any manual handling task, you are reducing the risk of injury. If any of the following stretches cause you pain or discomfort, STOP the stretch immediately.

37. 37StretchesPosition Stand with the feet shoulder width apart and the arms behind the body Action Grasp the left wrist with the right hand. Pull the left arm down and to the right. Tilt the head to the right. Hold this position for 10-15 seconds. Repeat the action with the right wrist, pulling the right arm down and to the left. Tilt the head to the left. Neck & Shoulders Position Stand and extend the arms upward and over the head. Interlace the fingers with the palms turned upward. Action Stretch the arms up and slightly back. Hold this position for 10-15 seconds. Variation This stretches the rectus abdominous muscles. Stretch to one side, then the other. Return to the starting position. This stretches the rectus abdominous muscles. Stretch to one side, then the other. Return to the starting position. Abdominal

38. 38 Position Stand and interlace the fingers behind the back. Action Lift the arms behind the back so that they move outward and away from the body. Lean forward from the waist. Hold this position for 10-15 seconds. Bend the knees before moving to the upright position. Return to the starting position. Position Stand with the arms extended to the front at shoulder height with the fingers interlaced and palms facing outward. Action Extend the arms and shoulders forward. Hold this position for 10-15 seconds. Return to the starting position. ChestUpper Back Stretch

39. 39 Position Stand with the feet shoulder width apart. Raise the right arm, bending the right elbow and touching the right hand to the back of the neck. Action Grab the right elbow with the left hand, and pull to the left. Hold this position for 10-15 seconds. Return to the starting position. Do the same stretch, and pull the left elbow with the right hand for 10-15 seconds. Position Stand. (For variation, lie on the stomach.) Action Bend the left leg up toward the buttocks. Grasp the toes of the left foot with the right hand, and pull the heel to the left buttock. Extend the left arm to the side for balance. Hold this position for 10-15 seconds. Return to the starting position. Repeat with the right leg. Extend the right arm for balance. Hold this position for 10-15 seconds. Return to the starting position. Overhead Arm Pull Thigh Stretch

40. 40 Position Lunge slowly to the left while keeping the right leg straight, the right foot facing straight ahead and entirely on the floor. Action Lean over the left leg while stretching the right groin muscles. Hold this position for 10-15 seconds. Repeat with the opposite leg. Groin Stretch Standing Calf Stretches Position Stand straight with the feet together, arms extended downward, elbows locked, palms facing backward and head and eyes facing front. Action Move the right foot to the rear about two feet, and place the ball of the foot on the ground. Slowly press the right heel to the ground. Slowly bend the left knee while pushing the hips forward and arching the back slightly. Hold for 10-15 seconds. Return to the starting position. Repeat with the left foot.

41. 41 Position Stand with the back straight and feet shoulder width apart. Extend the arms outward to shoulder height. Action Rotate the shoulders forward, and make a large circular motion with the arms. Repeat the action in the opposite direction. Do this three times in each direction. Position Stand with your feet shoulder width apart and hands on your hips. Action Rotate the hips clockwise while keeping the back straight. Repeat the action in a Counter clockwise direction. Do this three times in each direction Arm Stretches Hip Stretches

42. 42 References WorkCover NSWHead office phone: 13 10 50Fax: (02) 4325 4145 www.workcover.nsw.gov.au (visited17/02/09) Further Information NSW Nurses’ AssociationPhone: www.nswnurses.asn.au WorkCover SAwww.workcover.com National Occupational Health and Safety Commissionwww.nohsc- eu.gov.au Design4 Healthwww2.dir.qld.gov.au/design4health/ http://vetvirtual.external.utas.edu.au/csh/assets/manualhandling/ind ex.htm http://vetvirtual.external.utas.edu.au/csh/assets/manualhandling/ind ex.htm