practical risk assessment the role of the therapist

1 www.yorkshirecareequipment.com

© Yorkshire Care Equipment 2015

www.yorkshirecareequipment.com

Practical Risk Assessment – The Role of the Therapist Simon Love, Manual Handling Practitioner, LPS Training & Consultancy Ltd

© LPS Training & Consultancy Ltd 2015

Practical Risk Assessment –

The Role of the Therapist

Simon Love Manual Handling Practitioner

LPS Training & Consultancy Ltd

[email protected]




Aims & Outcomes






Aims To understand the underlying responsibilities

of the prescribing therapist

To understand the clinical decision making

process

To enable those undertaking manual handling

tasks to be safer




Learning Outcomes • To understand the difference between Delegation

and guidance

• To know the underlying responsibilities derived

from the therapists professional guidelines

• To understand the importance of competence

• To be able to utilize a simple algorithm to enable

the safer handling by carers

• To have the tools to be able to justify the

decisions made when risk assessing, using clinical

decision making






Therapists requirements

Therapist should work within their

professional competence

Have the:-

• Skills

• Knowledge

• Training

• Experience

• Seek expert advice




Delegation

To entrust a task to another person who will

perform this in place of the therapist

To delegate the task of an assisted

stand/Transfer to members of the ward

staff/Care home staff






Delegation COT Code Of Ethics And Professional Conduct

(COT 2005) states:

The Therapist owes a duty of care (H&S + Common

Law)

1. Therapist must be satisfied that the person

is competent to carry them out

2. Be aware of the persons manual handling experience

3. Observe the person carrying out the task

4. Ensure they are available for immediate support

5. Monitor and supervise regularly




Guidance

Professional verbal or written input

by the treating therapist to:

Carers of a private agency

Local authority home care staff

Service users family






Guidance to To Formal/paid workers

Ensure the therapist is competent

Consider the skills & Expertise required

Write a simple handling plan – Pictorial?

Provide detailed guidance to the delegated

supervisors of the care team




Guidance to unpaid carers

As for paid carers-In addition

They may need greater and continuing support

They should only carry out activities as guided by the

therapist

Remain within their own abilities

Manual handling tasks should be structured to the

needs and capabilities of the person and the carer

Instructions should be available in a suitable format






The Purpose of

Risk Assessment

To reduce the risks to a level that is:-

Reasonably Practicable









Cost in terms of:-

Time

Money

Resources

Benefit to:-

Therapist

Handler

Person




Risk Assessment

5 Steps to Risk

Assessment

Decide who

might be

harmed & how Evaluate the risks

and decide on

precautions Record the

findings &

implement Review and

update

Identify

the

hazards

HSE Risk Assessment. A brief guide to controlling risks in the workplace. 08/14




Decide who

might be


and decide on


findings &


update

Identify

the

hazards


Decide who

might be

harmed &

how Evaluate the risks

and decide on


findings &


update

Identify

the

hazards




Decide who

might be

harmed & how Evaluate the

risks and decide

on precautions Record the

findings &


update

Identify

the

hazards


Decide who

might be


and decide on


findings &


update

Identify

the

hazards




Decide who

might be


and decide on


findings &


update

Identify

the

hazards









Is Risk Assessment

the right word?

Risk Management

• Controlling risks in the workplace in order of

priority

• Reduce risks to a reasonably practicable level

• Use Clinical decision making




Who is Responsible

for Carrying out risk assessment?

• Employers

• Competent person

• All staff

“Competence will need to be in proportion to the degree

of complexity in any individual case”

Michael Mandelstam, The Column 16.1 Feb 2004






Personal on-the-spot Risk Assessment

Personal on-the-spot Risk Assessment Know the manual handling plan

Assess it – Is it safe?

Yes, its safe No, its unsafe

STOP

Do it. Report & Review

Get help. Now is it safe?

Follow the

handing plan

Choose an alternative.

Now is it safe?

Can you make it safe?

Yes No

Yes No

Yes No

Don’t do it. Report

& Review






STOP



Follow the

handing plan


Now is it safe?


Yes No

Yes No

Yes No


& Review

Know the manual handling plan



Yes, its safe No, its unsafe STOP



Follow the handing plan

Choose an alternative. Now is it safe?


Yes No

Yes No

Yes No

Don’t do it. Report & Review





The Load

Is the task unsafe?

The Individual Handler

The Task The Environment


The Load/Person

What do we assess? The Individual Handler





Pain continence

Stiffness

medication

Fatigue

confusion

Fear -anxiousness

Co-operation

Changing ability






Ability to Weight Bear

NWB MWB PWB FWB




The Egress Test






The load/Person

FIM Scores

Independent (7) to Total Assistance (1)

Arjo Mobility Gallery




The Person

Comfort Scales

Extreme discomfort (0) – Extreme comfort (10)

Activity Scales

No patient activity (0) – Full patient activity (10)




The Load







Borg perceived Exertion

No effort at all (0) – very, very difficult (10)

Time

Measuring the time staff have available

Competency Level

Consider the degree of skill required for the task






Stages of Competence

NOVICE – Little knowledge, needs rules, inflexible behaviour,

supervision essential

ADVANCED BEGINNER – Little perception of big picture,

small understanding of principles

COMPETENT – gaining insights, starting to see bigger

picture, good core/standard techniques

PROFICIENT – faster decision making, flexible, may adapt,

sees big picture

EXPERT – Decision made fast and efficiently, great

experience, quick intuitive analysis

Ref: NBE Manual Handling of Children, P Alexander & C Johnson





College of Occupational Therapists:

Manual Handling Guidance 2006

OT’s

• must be competent to instruct/provide guidance to others

• who delegate must be satisfied that the person is competent

• should take account of handler’s physical capability

• should consider the skills, knowledge and level of expertise

required

• should write a simple handling plan to guide staff

• should provide detailed guidance to supervisors







Chartered Society of Physiotherapist:

Guidance on Manual Handling in physiotherapy 2014

The Physiotherapist has a duty to:

• know the limits of expertise of the person delegated to

• consider whether the proposed intervention involves

hazardous manual handling

For support workers, the physio should:

• Take into account the competence of the person

• Leave clear written guidelines that include clinical reasoning

• Ensure there is regular monitoring


The Load

What do we assess?









The Load










Yes, its safe No, its unsafe STOP



Follow the handing plan

Choose an alternative. Now is it safe?


Yes No

Yes No

Yes No

Don’t do it. Report & Review







STOP



Follow the

handing plan


Now is it safe?


Yes No

Yes No

Yes No


& Review





STOP



Follow the

handing plan


Now is it safe?


Yes No

Yes No

Yes No


& Review







STOP

Report & Review


Follow the

handing plan


Now is it safe?


Yes No

Yes No

Yes No


& Review





STOP



Follow the

handing plan


Now is it safe?


Yes No

Yes No

Yes No


& Review







STOP



Follow the

handing plan


Now is it safe?


Yes No

Yes No

Yes No


& Review





STOP



Follow the

handing plan


Now is it safe?


Yes No

Yes No

Yes No


& Review







Making a balanced decision

Using our clinical Reasoning

• Understanding the thought processes

• Recording the journey




You could justify your decision based on Clinical

reasoning

• What are the underlying risks?

• What control measures are in place?

• Is the risk reduced to a level that is reasonably practicable?

Leaving a sling in place under a person






To leave the sling

under the person

To remove the sling


The Load

Is safe to leave the sling in?



• Person complaining of

pain/discomfort during removal

and insertion of sling

• No Tissue viability issues

• Person able to redistribute their

weight in sitting

• Person is compliant and able to

report discomfort

• Carers describing

discomfort/strain/difficulty

inserting & removing sling

• Carers have poor supervision

and sling has been observed to

be positioned poorly

• Space is limited at side of

chair

• Person sits out for 3 hours

max

• Number of transfers in and

out of chair are frequent

throughout the shift






Control measures in place

to leave sling in:-

• Person to be moved from the chair after a

maximum of 3 hours

• The sling fabric and style is Suitable (e.g.

spacer fabric, comfort recline/in-seat style

sling)

• Pressure areas are monitored and recorded

Ref: Jo-Anne Mellson, Slings: should they stay or should they go, Column,

Vol 25.3, 2013


The Load

Sling should be removed?



• Person doesn’t like the sling

staying in place

• Person has no pain/discomfort

during removal and insertion

• Person can be brought forwards

for insertion of sling

• History of pressure sores

• Person unable to redistribute

their weight in sitting

• Carers describing no

discomfort/strain/difficulty

inserting/positioning the sling

• Carers are well trained and

competent in correctly positioning

slings

• Number of transfers are limited

• Sling fabric – slip fit

• Space available at side of chair

for easy fitting






To use a handling

belt to assist to stand

a specific person

To recommend not

using the handling

belt


The Load

Is safe to use the handling belt?



• Manual handling training is good

quality & has included belts

• Staff are confident and competent

in their use

• The person’s family/carers are keen

to maintain his walking ability

Space is limited at side of chair • The task involves assisting

from the sofa or bed

• Its a better alternative to the

drag lift (currently performed by

person’s family)

• Person is keen to stand

• Person is happy to use the belt

• Stiff hips and limited forwards

flexion

• Good weight bearing ability once

in standing

• Can walk short distances

• Person doesn’t like ‘hands on’

approach






Control measures

for Use handling belts :-

• Good and clear risk assessment in place

• Effective manual handling training

• Good staff compliance

• Systems for effective monitoring and

supervision of the staff

• Sufficient and appropriate sizes and quantity of

belts are available


The Person

Use of handling belt is not

appropriate? The Individual Handler


• Person doesn’t really like it

• Person describes discomfort using

the belt

• Weight bearing ability is

unpredictable/fluctuates

• Knees often seen to slightly give

way

• Person tires towards end of day

• Staff are mis-using the belts and

‘lifting’ the person during the

transfer

• Inexperienced staff - novices

• Lack of in-depth training of the

hazards/inappropriate use of

handling belt

• Distances attempted are

too great

• Time of day

• Storage of handling belts not

close to task

• Care home layout requires

long distances to walk






Any Questions?

Simon Love

Manual Handling Practitioner

LPS Training & Consultancy Ltd

[email protected]

practical risk assessment the role of the therapist

Documents