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1 Clinical Staff Manual Handling Handout June 2016

The Manual Handling Service

Training Session Handout

For Patient Handling Staff

2016


Handout Contents

Introduction Manual Handling Operations Regulations (responsibilities) Definition of Manual Handling Individual Manual Handling Risk Assessment of Patients Patient Manual Handling Risk Assessment Form & Care Plan Other related legislation Incident Reporting Manual Handling Service Manual Handling Policy & Appendices (list of contents) Manual Handling Equipment Promoting Healthy Back Care Principles of Lifting & Lowering Principles of Pushing & Pulling Manual Handling Operations Regulations weight thresholds (DIAG 2001) Team Handling Prevention & Management of Falling/Fallen Patient/Person The Manual Handling of the Heavy (Bariatric) Patient

References -

Manual Handling Operations Regulations (HSE guidance)

Trust Health & Safety Policies and handbooks

COCH Manual Handling Policy

The handling of People (6th Edition) Published by Backcare

Moving & Handling of Plus Size People published by National Back Exchange

North West Health Sector Core Skills Framework Useful Resources –

Back Care App: available on iTunes and Android google play.

NHS Employers Back in Work Back Packs (6 information booklets free to download.(PDF format)


Introduction

This hand out covers the general information about manual handling that all employees should be aware of. It is to be considered in conjunction with Health & Safety Legislation, the Trust’s manual handling policy and other relevant Trust health & safety policies. It gives general guidance on the Manual Handling Operations Regulations 1992, as amended by the Health and Safety (miscellaneous Amendments) Regulations 2002 (the Regulations). Manual handling is a frequent activity for most employees. Without sufficient knowledge of the implications and risk involved in manual handling there is the likelihood of an injury for the person or for those around them. Manual handling accidents account for 40% of work related sickness absence in the health & social care sector. Manual handling injuries are part of a wider group of musculoskeletal disorders (MSD’s) such as upper limb disorder. Medical and scientific knowledge stresses the importance of an ergonomic approach to remove or reduce the risk of manual handling injury. Ergonomics is sometimes described as ‘fitting the job to the person, rather than the person to the job’. The ergonomic approach looks at manual handling as a whole, taking into account a range of relevant factors, including the nature of the task, the load, the working environment and individual capability of the worker. The physical risk factors can be harmful to the body and can lead to the development of MSD’s, however psychosocial risk factors also need to be taken into account, e.g. working relationships with managers, colleagues, workloads, lack of control of the work etc.. The Regulations apply to a wide range of manual handling activities involving the transporting or supporting of a load, and further information on this can be found in the sections titled ‘Definition of Manual Handling’ and ‘Legislation relevant to manual handling’.

Manual Handling Operations Regulations

(i) Definition of Manual Handling Manual Handling is defined as any transporting or supporting of a load (including lifting, lowering, pushing, pulling, intentionally dropping or throwing, carrying or moving thereof) by hand or by bodily force. The load may be moved or supported by the hands or by any other part of the body i.e. shoulder. Effort may be applied directly to the load, or indirectly by hauling on a rope or pulling on a lever. Introducing mechanical assistance, e.g. a sack truck or a powered hoist, may reduce but not eliminate manual handling since human effort is still required to move, steady or position the load.

A load may be an inanimate object, person or animal.


(ii) Employers Responsibilities Avoid the need for employees to undertake any manual handling activity at work, which involves a risk of injury:

Avoidance Mechanisation/Automation

Each employer where it is not possible to avoid handling a load shall Assess the task looking at:

Task – Do they involve? Holding loads away from the trunk? Twisting? Stooping? Reaching upwards? Long carrying distances? Strenuous pushing or pulling? Unpredictable movement of loads? Repetitive handling? Insufficient rest? Work rate imposed by a process?

Individual Capabilities of employees – does the job: Require unusual capability? Hazard staff with a health problem/learning difficulty? Hazard staff who are pregnant? Need special information or training? Is movement restricted by clothing or personal protective equipment? Is there anything else which makes the task more hazardous?

Load(s) – are they: Heavy? Bulky/unwieldy? Difficult to grasp? Unstable? Unpredictable? Harmful i.e. sharp or hot?

Environment – are there:

Constraints on posture? Poor floors? Variations in levels? Hot/cold/humid conditions? Strong air movements? Poor lighting?

Other – are there: Workload pressures/changes? Communication problems? Training deficiencies? Problems with PPE?


Following this assessment each employer will take appropriate steps to Reduce the risks of injury to employees to the lowest level reasonably practicable Manual Handling Risk Assessment does not always result in the need to spend money or take a long time to complete. Review or Reassessment should be carried out when thought that the previous assessment is invalid. What is a Manual Handling Risk Assessment? Assessing manual handling risks means:

Being aware of the problems Determining how concerned you need to be about a problem Taking action to reduce risks A formal approach to identifying and provision of equipment for safer manual

handling.

Examples of ways to reduce risks: Change layout of working area Split large, heavy load into smaller, lighter loads Provide mechanical way of moving the load i.e. hoists, trolleys. Provide handling devices Allocate more staff to the job Train staff to do the job in the least hazardous way Redesign storage area so that heavy things are stored at waist level Provide staff with clothing that allows freedom of movement Order items in smaller quantities Rotate staff doing the job Improve the lighting Have poor flooring repaired or renewed.

(iii) Employees Responsibilities

Each employee while at work shall: Follow training Take reasonable Care of themselves and others who may be affected by their acts and omissions at work. Co-operate with their employer Tell someone if there are risks from health & safety


Individual Manual Handling Risk Assessment of Patients The formal documented assessment of individual patients who require assistance with moving and handling should be carried out as per the Trust’s Manual Handling Policy, and should be updated as appropriate. The assessment is documented on appendix 12 (Patient Risk Assessment) and risk reducing measures documented on the patient’s individual care plan. In addition to the form sections, staff should also consider the department/ward generic manual handling risk assessments and the following key risk factors for the patient when completing the individual patient care plan:

How much help does the person need? No help? How much help? If equipment is required what are the benefits/dangers of the equipment/process. Patient expectations/wishes. Have these been discussed and considered? Does the

patient have any views/concerns about manual handling and the way it is being planned? Are they reluctant to use equipment?

Are there any legal factors that need to be considered? Does the care plan infringe the patient’s human rights or could it be discriminatory? Is the duty of care affected?

Do methods chosen encourage independence? Are the Physiotherapy team or Occupational Therapy team involved? Do you need to consider the therapeutic manual handling care plan before making a decision?

Is the patient able to weight bear? With no assistance/with assistance of staff or equipment.

Pain/medication – Has the patient had pain control, does the patient take any medication that affects their mobility? Does timing of drug administration need to be considered to ensure best effects occur with moving and handling tasks?

Tissue viability/infection - Does the patient require any special considerations related to their skin or need disposable equipment due to infection?

Ability to communicate with others? Can the patient explain their situation to you and follow requests?

Predictability? Is the patient always the same or are there times when they are better than others? Are they easily tired/have difficulty sustaining effort?

Is the patient a child or vulnerable in some other way? Behavioural risks? Is the patient likely to be anxious, passive, show inappropriate

responses or be violent or aggressive? Are there any triggers to the behaviour? Cultural issues? Possible differing expectations regarding gender of carers, authority &

acceptance, methods of managing patient handling tasks. Physical abilities/operations or interventions – Has the patient a disability or a health

problem that effects how much they can help? Does the patient have any problems with muscle tone or weakness, spasm, tremor, contractures, and /or stiffness? Can the patient balance themselves in lying, sitting or standing?

Comfort – is the method to be used comfortable and not causing difficulties, such as skin damage, pain, undue stress on any part of the body?

Body Shape/height/weight or will special equipment be required to support them. Is the equipment available appropriate?

Falls – If there is a history or a risk of falls then the Trust’s falls assessment should be used and considered when devising the care plan.

Does the patient’s clothing effect the manual handling task


Completing the individualised patient’s care plan For those staff using meditech system on the computer, ensure that any individual care planning needs are added to the basic patient care plan that is available on screen as follows:

AI – Add intervention

MOB – mobility

LOOK UP and tick all appropriate techniques to be used to handle the patient.

If the patient is being hoisted, details of the model of hoist used, size, make and type of sling prescribed for the patient must be documented.

Individualise by adding specific issues e.g. the patient may have had an amputation, or have hearing difficulties etc. these factors should be taken into consideration when documenting handling care.

For those staff who do not document patient care on meditech and use paper copies of the individual assessments(primarily outpatient departments), should complete the individual patient manual handling assessment form, and document the care plan on the back of the form and place the form in the patient’s notes. The minimum requirement for documentation on the care plan is:

* Date, Name of staff member completing the notes, time/location. * Details of manual handling task/problem * Description of Task undertaken to achieve the desired outcome. * Documenting equipment used and any particulars Including principles of safer manual handling, details of equipment required, and how many staff taken to perform the task.

APPENDIX 12 RISK ASSESSMENT FORM

NAME:

DOB:

ID STICKER:

INDIVIDUAL PATIENT MANUAL HANDLING RISK ASSESSMENT TOOL

PLEASE ADD UP THE SCORES FROM EACH SECTION THAT APPLIES TO THE PATIENT. COMPLETE ON ADMISSION AND AS CONDITION CHANGES

DATE

Time

MOBILITY

FULLY MOBILE 0

Assistance of 1 or 2, +/- walking aid 1

Risk of falls / unstable 2


Unable to mobilise / Full assistance required

3

PSYCHOLOGICAL

Alert + orientated 0

Anxious 1

Confused 2

Non-compliant/passive 3

BODY WEIGHT

Less than 8 stone (51kgs) 0

Between 8-12 stone (51-76kgs) 1

Between 12-20 stone (76-127kgs) 2

Bariatric 20 stone+ (127kg+) 3

ENVIRONMENT

Adequate space to perform tasks 0

Patient + attachments 1

Restricted space 2

OTHER

VISUAL/HEARING IMPAIRMENT 1

PAIN 1

Surgical / Medical - Minor 1

Surgical / Medical - Major 2

Head injury / Brain disease 3

TOTAL SCORE

ASSESSORS SIGNATURE:

SCORING SYSTEM

SCORE 0-3

Low risk score

SCORE 3-9

Medium risk score

SCORE 10+

high risk score

Consult care plan &

document any specific manual handling requirements

Consult care plan &

document specific manual handling requirements to reduce risk identified

Consult care plan &

document specific manual handling requirements to reduce risk


Paper Individual Patient Manual Handling Care Plan

For those staff who do not document patient care on Meditech and use paper copies of the individual assessments(primarily outpatient departments), should complete the individual patient manual handling assessment form, and document the care plan on the back of the form and place the form in the patient’s notes.

The minimum requirement for documentation on the care plan is:

Date, Name of staff member completing the notes, time/location.

Details of manual handling task/problem

Desired outcome

Description of Task undertaken to achieve the desired outcome.

Including principles of safer manual handling, details of equipment required, and how many staff taken to perform the task.

Date, time and name/designation of staff member

Location Details of manual handling task

Description of Equipment used

Description of task undertaken to achieve outcome/how many staff to perform task.


Other Related Legislation Provision and Use of Work Equipment Regulations (PUWER) The regulations pull together the laws governing equipment used at work. ‘Work Equipment’ is broadly defined to include everything from hand tool, through machinery of all kinds, to complete plant. Staff should refer to the Trust Health & Safety policy and associated handbooks. Lifting Operations and Lifting Equipment Regulations (LOLER) The regulations are designed to ensure the safe use of lifting equipment and the law requires

The equipment is suitable, strong and stable enough for use and marked with the safe working load including accessories and equipment.

Positioned and installed to minimise risks from the load falling or striking people Used safely i.e. the work is planned , organised and performed by competent

people Ensure all lifting equipment and its accessories are marked with a safe working

load.

Subject to initial and ongoing ‘Thorough Examination’ (usually detailed within a written scheme of examination drawn up by a competent person and where appropriate regular inspection by competent people). Ensure that all written records are kept for the lifetime of the equipment or for 2 years.

Further guidance on how the Trust complies with this regulation is included in the Trust Health & Safety Policy and the Manual Handling Policy and appendices.

Incident Reporting

The Trust has one reporting system for recording accidents/incidents and near misses. All Manual Handling Incidents should be reported using this system. All incidents reported are investigated which is overseen by the Manual Handling Service. Investigation of incidents helps us to identify risks, and recommend control measures to eliminate or reduce them. It is also important for staff to report near misses using the same system. For information on how to report an incident log on to the Trust’s intranet A – Z site. Click on ‘I’ and click on ‘Incident reporting’.

Manual Handling Service

The Service reports to the Trust’s Risk, Health & Safety Committee. The Manual Handling Service can be contacted for specific advice. The formal manual handling training courses are held in the Education & Training Centre. The Service also supports link trainers in clinical and non-clinical areas with support for training in the workplace locally.


How to contact us Telephone Extension 5750 or 5883 Bleep 2676 (office hours only) Email - we can be found in the COCH address book under “Handling Manual” Details of Manual Handling courses can be found in the Training Directory. To book onto a course please follow instructions for each specific course contained in the Training Directory.

Manual Handling Policy & Appendices

Manual Handling Policy The Manual Handling Policy is to be found on the Trust’s ‘share-point’ site, on the intranet. The following documents are appendices to the main policy document and should be used/read in conjunction with it:

Appendix 1a – Example Risk Assessments Lifting or Carrying An inanimate load

Appendix 1b – Example Standard Operating Procedures Lifting Or carrying an inanimate load

Appendix 2a- Example Risk Assessment Pushing or pulling Inanimate loads

Appendix 2b- Example Standard Operating Procedures Pushing or pulling inanimate loads

Appendix 3a- Example Risk Assessment moving a patient using a hoist

Appendix 3b- Example Standard Operating Procedure Moving a patient using a hoist

Appendix 3c- Example Standard Operating Procedure Moving a patient using Arjo Sara Plus standing hoist

Appendix 4a- Example Risk Assessment Moving a supine Patient bed to bed, bed to trolley etc

Appendix 4b Example Standard Operating Procedure Moving a p Supine patient bed to bed, bed to trolley

Appendix 5a- Example Risk Assessment Moving a patient on a flat surface

Appendix 5b- Example Standard Operating Procedure Moving a patient on a flat surface

Appendix 6a- Example Risk Assessment Manually lifting or carrying people

Appendix 6b- Example Standard Operating Procedure Manually lifting or carrying people

Appendix 7a- Example Risk assessment Moving a patient from or to a sitting position

Appendix 7b- Example Operating Procedure Moving a patient from or to a sitting position

Appendix 8a- Example Risk assessment Supporting a patient with walking

Appendix 8b- Example Standard Operating Procedure Supporting a patient with walking


Appendix 9 – Guidance on Completing Manual Handling Risk Assessments & Checklists

Appendix 9b- Review of Generic Manual handling Risk Assessment (Review Form)

Appendix 10 – Manual Handling of Loads: Assessment Form (Lifting and Carrying)

Appendix 11 – Manual Handling of Loads: Assessment Form (Pushing and Pulling)

Appendix 12 – Individual Patient Manual Handling Risk Assessment Tool & Care Plan

Appendix 13 – Induction Checklist for New Staff (Clinical)

Appendix 14 – Induction Checklist for New Staff (Non-Clinical)

Appendix 15 – Lifting Operations and Lifting Equipment Regulations - Procedure for Thorough Examination for lifting accessories for patients (Hoist Slings/Emergency Transfer Sheets)

Appendix 16 – Prevention & Management of Falling/Fallen Patient/Person

Appendix 17- Emergency situations

Appendix 18 - Role of the Manual Handling Link Trainer

Appendix 19 – Audit Tools

Appendix 20 – Guidelines on manual handling of bariatric patients Including equipment list

Therapeutic Manual Handling Policy – contact Therapy Services Manager

Manual Handling Equipment Manual handling equipment used to assist patients fall under the broader policy of Medical Devices -Staff that operate or use medical devices should not use any device until they have received training and supervision, and provide evidence of self-assessment of competence to their respective manager, to minimise the risk to patients and to others. Staff should refer to the Trust’s Medical Devices Training Policy for procedures to follow. Manual Handling equipment is considered in the policy to be Therapeutic Devices and therefore staff should review their competency as below:

Low Risk = Therapeutic Devices. Every 3 years

It is the responsibility of senior managers, ward/department manager, and Heads of Department to ensure that staff within their areas of responsibility, have received training to enable them to use manual handling medical devices in a safe and effective manner. This can be supported by the equipment manufacturer, and the manual handling link trainer for the area. All manual handling medical devices/equipment are on the Trust’s Medical Devices Catalogue. All manufacturer user guides, and relevant competency checklist are available to see/download, and all staff should complete competencies, providing they have had information, instruction, training and supervision. Equipment Hire Hired Lifting Equipment -


Staff should check inspection records for hired equipment, and the hire company are responsible for providing sufficient information and training for its safe use. Within hours all hire of manual handling equipment must be arranged with Facilities, Equipment Library Manager Out of hours all equipment hire must be arranged through the Trust Site Co-ordinators bleep 2705 Reporting Faulty/broken Manual Handling Equipment If equipment is involved in an incident and is thought to be faulty, take out of use, inform Manual Handling, Health & Safety Adviser and the Estates Department as soon as possible. If equipment is found to be faulty (not involved in an incident) Take the equipment out of use and attach ‘out of use’ note on it. Requisition to Estates Department. In urgent cases ring Estates. Decontaminate & attach a Decontamination Certificate to equipment. When reporting faults with hoisting equipment please advise Estates with the make, model of hoist, serial number and the location

Hoist slings that are found to be faulty should not be used. They should be sent to the Manual Handling Service to be inspected and condemned. If slings are ‘soiled’ the coloured tag should be cut off (therefore making the sling not fit for use), laundered, and then sent to the Manual Handling Service. Please Refer to HSE Hoisting Guidance ‘Getting to grips with hoisting people’ which is available

to download at www.hse.gov.uk/pubns/hsis3.pdf.

Promoting healthy back care The spinal cord is a thick cord of nerve tissue which is enclosed by the spine. Together with the brain it forms the central nervous system. The vertebrae are the bones which act as the building blocks of the spine. They can be damaged by impact injury. The vertebral column consists of 33 vertebrae, 24 prescaral (moveable) vertebrae, the sacrum and the coccyx. The intervertebral discs act as shock absorbers – they are soft fibrous discs with a jelly like centre and are positioned between vertebrae. They allow the spine to move by cushioning movements between the vertebrae. This complexity and the amount of movement it allows can leave it vulnerable to damage. Ensuring good musculo-skeletal health is essential to enable safe manual handling. Common injuries include damage to joints, muscles, tendons and ligaments, intervertebral discs Less common damage includes repetitive strain injury, hernias, abrasions/bruises, wear & tear and fractures. Common factors that can cause injury include having to hold a static posture, bending or twisting, lifting heavy loads and poor seating posture. Soft tissue injuries tend to be the cause of the majority of reported back injuries. Cumulative strain is when these injuries occur as a result of repetitively carrying out these activities.

http://www.hse.gov.uk/pubns/hsis3.pdf


Principles of Lifting & Lowering

Think, Plan & Prepare

Assess load

Foot position

Firm hold

Spine in line

Hips and Knees flexed

Support the load close

Avoid twisting or leaning

Head up

Move smoothly

Put down then adjust Promoting Healthy back care - what you can do

Always ensure a good posture Keep moving to avoid static postures Don’t flex the back while lifting, don’t straighten legs

before raising the load Avoid twisting the back or leaning sideways especially

while the back is bent. Try to use chairs with adjustable back rests etc. to give

good support and aid good posture. Stay active and exercise. Particularly strengthen

abdominal and back muscles. Maintain a healthy weight


Manual Handling Principles for Pushing and Pulling 1 Environment Clear adequate space Clear adequate pathway 2 Placement of feet Stride position 3 Starting posture Slightly bent knees 4 Hand position Between waist and shoulder level 5 Grip Firm grip or whole hand flat contact - not finger tips 6 Spine posture Spine in line 7 Test push If assessed as too heavy the load MUST NOT be moved. Seek help 8 Push action Stand tall, push with legs Walking motion

9 Consider Backwards is easier but you cannot see where you are Going Pushing/Pulling Guidelines

Assuming force is applied with hands between knuckles and shoulder height the figures below highlight the recommended maximum amount of force that needs to be applied to push/pull a load Before a risk assessment is required. Male Female Stopping & Starting 20kgs 15kgs (200 (150 Newtons) Newtons) Keeping the load 10kgs 7kgs In Motion (100 70 Newtons) Newtons)


Manual Handling Operations Regulations weight thresholds (DIAG 2001)

There is no such thing as a 'safe load' but the Health and Safety Executive has issued the

diagrams below, which can be taken as a rough guide to where tasks begin to require more

careful analysis. (e.g. the use of Appendix Form 2 or 3). The diagrams assume that the load is

readily grasped with both hands; that the operation takes place in reasonable working

conditions and that the person is in a stable body position. Each diagram is intended to show

how limits vary as the load is moved away from the body and above or below waist height.

It is claimed that the guideline figures will apply to 95% of men and women. Additional

reductions must be made if the task involves twisting: by 10% for a 45 degree turn and 20% for

a 90 degree twist. A correction for highly repetitive operations - up to twice a minute - brings the

guideline down a further 30%. If the rate increases to five to eight times a minute, the guideline

load should be reduced 50%.

It is not necessarily wrong for a load to be in excess of the guideline figures but the further the

load increases, the greater responsibility management carries. Certainly, anything approaching

twice the guideline figures without very specific risk assessment and training could well attract

enforcement action and litigation.

These are guideline figures – not ‘weight limits’

Approximate boundaries within which a load is unlikely to create risk

Reasonable level of protection for 95% of workers

Assumes that the load is easy to grasp with both hands

That the task/operation takes place in reasonable environment

That the handler has a stable body position

That the handling is infrequent (up to 30 operations/hour) Lifting and Lowering


Each box in the diagram above contains a guideline weight for lifting and lowering in that zone. Using the diagram enables the assessor to take into account the vertical and horizontal position of the hands as they move the load, the height of the individual and the reach of the individual handler. As can be seen from the diagram, the guideline weights are reduced if handling is done with arms extended, or at high or low levels, as that is where injuries are most likely. Handling Whilst Seated

Team Handling

Handling by two or more people may make possible an operation that is beyond the capability of one person, or reduce the risk of injury to a single handler. The load that a team can handle safely is less than the sum of the loads that the individual team members could cope with when working alone. As a guide the capability of a two-person team is two-thirds the sum of their individual capabilities and for a three-person team the capability is half the sum of their individual capabilities There may be additional difficulties if:

Team members get in the way of each other The load does not have enough good handholds The background noise level is too high to allow easy communication between team members

For safe team handling there should be enough space for the handlers to manoeuvre as a group. They should have adequate access to the load, and the load should provide sufficient handholds. One person should plan and then take charge of the operation, ensuring that movements are co-ordinated. However, there should be good communication between team members. Think about the dignity and safety of everyone.

The diagram here provides guidance on lifting whilst seated. The guidelines only apply when the hands are kept within the box zone indicated. If handling beyond the box zone is unavoidable, a more detailed risk assessment should be made.


Prevention & Management of Falling/Fallen Patient/Person

Guidance can be found in the Trust Manual Handling Policy & the Trust policy Prevention & Management of falls.

Approximately 20% of patient falls are likely to occur during moving and handling activity, but the majority of falls are not witnessed and the patient/person is found lying on the floor (Hignett & Sands 2009, Sturman 2008)

The reasons why people fall are complex and influenced by contributing factors such as illness, mental health, medication, age and environmental factors, (Masud & Morris 2001 and Steinhoef et al 2002) these study results break down the risk factors into three groups, intrinsic factors including the medical, physical and functional ability of the person, extrinsic factors are concerned with the environment, and behavioural factors are concerned with the mental health and cognitive level of the person.

Most patient falls can be prevented, and risk assessment is the key to successful management. The aim of the risk assessment is to identify the risks and implement reasonably practicable control measures aimed at reducing the risks of the person falling in the first place, thus reducing risks to both staff and patients.

A Trust’s Falls assessment and assessment of the individual patient’s mobility should be carried out. During assessment staff should consider the potential injuries to the patient should they fall, which will determine the handling strategies for the individual patient’s care plan. The therapy team should also be involved and will carry out a therapeutic manual handling risk assessment to identify their treatment/mobility plan.

Care staff can liaise with the therapy team on how the patient is mobilising, and should be aware that the patients abilities may be variable, e.g. the patient may be able to stand/transfer with one carer in the morning, but after therapy treatment, visiting time, the patient may be tired and their abilities decrease so that they may need to use a hoist in the evening. The assessment and care plan must be flexible and identify the various ways the patient may be mobilised.

Staff should encourage each patient to be as independent as possible, but consider when mobilising that they may tire and need equipment or a chair close by to allow rest when required.

Falling patient intervention guidance

The handling of the falling/fallen patient presents a high risk of injury to both the patient and any handlers. The extent of the risk of ‘catching’ the falling patient is significant, but it is acknowledged that it is human nature to want to prevent harm to people in receipt of care. Therefore all clinical and medical staff should receive appropriate training from the Manual Handling Service including theoretical and pictorial discussions regarding systems to manage the falling person.

Training on the practical aspects of managing the falling/fallen patient and some emergency situations may expose the staff to techniques, which have an inherent risk. These situations are discussed and partly demonstrated on all ‘patient handling’ manual handling training sessions. This training stresses the importance of balanced decision making between staffs duty of care to the patient/person and also their responsibility to protect themselves.


Fallen Patient guidance – All patient handling staff receive training on appropriate methods for rescuing a fallen patient from the floor using equipment.

Controlled Lowering of the Falling Person

There is no definitive answer as to whether you should or should not intervene with a falling person. Thorough individual risk assessments should be carried out for those at risk of falling. Assistance can be given to a falling patient where reasonably practicable. Controlled lowering of the falling person should begin with releasing the hold of the person and move behind them. Ensure you have a stable base, with one foot slightly in front of the other (Fig 1). The front knee should be bent more than the back knee. Use hands to grasp the person’s trunk, near their hips (Fig 1). Allow the person to slide down the front leg until they are lowered safely to the floor (Fig 2). You should avoid flexing your back too much. You should finish the manoeuvre by kneeling behind the person on the floor (Fig 3).

Fig 1 Fig 3

Fig 2


The Manual Handling of the Heavy (Bariatric) Patient

A guideline has been produced to provide Trust staff with additional guidance on the management of bariatric patients – this is appendix 20 of the main Manual Handling Policy. The guideline should be read in conjunction with the Trust’s Manual Handling Policy, and other Trust policies related to treatment and care of bariatric patients.

The purpose of the guideline is to minimise handling risk by giving additional information above and beyond the main Manual Handling Policy to assist staff to safely manage the handling of the bariatric patient. In line with the Trust’s Manual Handling Policy, the risk assessment of bariatric patients should always consider as a priority, the avoidance of manual handling where possible, for example: Treating a patient in their wheelchair where possible to avoid transfer onto an examination couch in Out-Patients Department. The manual handling of a bariatric person will be beyond the capability of an individual handler. The person’s weight and body dynamics will exceed the capability of most carers and a potentially hazardous situation may ensue. For the purpose of the guideline the bariatric patient is defined below

Definition: The term bariatric is used to describe the field of medicine that focuses on the causes, prevention and treatment and management of obesity and its associated diseases (Mosby’s Medical Dictionary 2006)

Typically, bariatric weights are defined as a body mass index (BMI) of over 35kg/m2 plus any co-morbidities, or a BMI over 40kg/m2, or a person being 45kgs over their ‘ideal weight’ (NICE 2006)

Admission of Bariatric Inpatient

Inform matrons (hospital site co-ordinators out of hours) to arrange additional bed space requirements and contact Manual Handling if additional manual handling equipment is required. If additional furniture is required e.g., armchairs, commodes etc., staff should contact the Porters, and if there is no suitable equipment/furniture within the hospital, then contact the Equipment Library to make arrangement to hire in.

Planned Admission

Pre-assessment preparation should be carried out where possible to consider the evaluation of medical history and background information. Staff should plan for any attendance at the hospital i.e., OPD or admission by completing a manual handling risk assessment and notifying Manual Handling as early as possible if staff foresee that there may be a lack of appropriate equipment.

Urgent Admission

In the event of an unplanned or emergency admission the nurse in charge should inform Matron or Hospital Co-ordinator and, where possible Manual Handling Service to ensure that the appropriate equipment is available

Refer to Bariatric Equipment List (appendix 20 of the policy).

Assessment of the (Bariatric) Patient

On admission of the bariatric patient staff are required to undertake appropriate risk assessment for the moving and handling of the patient, identify hazards and document risk reducing measures on the patient’s care plan as with any individual patient manual handling risk assessment. All staff have a responsibility to inform managers/matrons/colleagues of bariatric patients with manual handling risks. Clinical ward or department staff should consider if the bariatric patient will require transfers for treatment to other departments, e.g. operating theatres, x-ray. Inform those departments of the patient’s risks and needs, inform the Porters Department as soon as possible before the transfer is imminent.

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