Handle with care

Nurses, ambulance staff and care and nursing assistants are among those who report the most accidents as a result of manual handling in the workplace.
   
Health and Safety Executive (HSE) official handling statistics reveal that 15 per cent of all reported handling cases are made up from the injuries sustained in the occupations listed above.
   
Tasks that involve manual handling include transporting or supporting a load by carrying, pulling, lifting and pushing. In the case of a healthcare professional, this could include lifting patients, pushing wheelchairs and even simply lifting a box.
   
Often manual handling if not done correctly can result in musculoskeletal disorders (MSDs).

Over the last decade the total number of new cases of MSDs in Great Britain dropped from around 216,000 in 2001/02 to 141,000 in 2011/12. However, it’s still the most common work-related illness reported to GPs and when handling patients, care must be taken at all times
   
The HSE’s latest provisional figures reveal that those in the health and social care sector have the highest number of reported handling injuries such as strains, sprains, cuts and trapped fingers. The figures also suggest that these injuries account for 40 per cent of work-related sickness absence.

The Law
The Health and Safety at Work Act of 1974 places an overarching, general duty on employers to ensure the health and safety of their workers and those affected by the nature of their business, in this case patients.
   
As part of this, employers must have a health and safety policy and arrangements put in place to ensure they are able to abide by the law. There is also a general duty on employees, they must work with the employer to take care of their own safety, and also that of others.

The Manual Handling Operations Regulations 1992 (as amended) deals specifically with manual handling risks.
   
Written within the regulations employers must; avoid the need for hazardous manual handling, so far as is reasonably practicable; where hazardous manual handling can’t be avoided assess the risk of injury; and reduce the risk of injury from hazardous manual handling, so far as is reasonably practicable.
   
On the other hand it is written in the regulations that employees must; follow appropriate systems of work put in place for their safety; make proper use of equipment provided; co-operate with their employer on health and safety matters inform the employer if they identify hazardous handling activities; and take care to ensure that their activities do not put others at risk.

Guidance on handling
Over half of the moving and handling injuries in healthcare involve the handling of people. Safe lifting techniques for objects can’t always be applied in the same way when the load is a person. The European Agency for Safety and Health at Work has produced guidance for those working in the healthcare sector, which highlights why handling patients in different environments and circumstances can be particularly hazardous.
   
The guide includes a lot of food-for-thought. It looks at the task in hand and the amount of physical effort that is needed to carry it out, or keep control of equipment and tools. It also highlights whether a member of staff will be repeating the same motion or a number of motions frequently throughout their working day and how this can have an impact.
   
According to the guidance, a patient cannot be held close to the body, they do not have handles which can be used to ‘pick up’ and they may be unpredictable, so it could be difficult to know what will happen whilst handling them.
   
Also, the guidance encourages staff handling the patients to actually pay attention to the environment they are carrying out a task in. Assessing whether slip, trip and fall hazards may be present and if there are any limitations in the work area such as the size of the room, or equipment that may be in the way. Other issues can also apply in a busy environment where there is not always assistance on hand, whereby staff may feel the pressure to just ‘get on with it’. The individuals capability should also be taken into account.

This may include whether the job requires unusual height or strength, if it puts those with a health problem or those who are pregnant at risk and whether the job requires specialist knowledge or training to complete it safely.
   
Jane White, research and information services manager at the Institution of Occupational Safety and Health (IOSH), said: “Employers shouldn’t think that managing the risk is simply a matter of sending workers on a training course and buying some equipment.”
   
Back in August 2008, a care assistant won £8,000 in compensation because she suffered a back injury and consequently lost her job. This came after having to hold the full body weight of an elderly resident while lifting her to get her dressed.
   
It was reported on the Thompson solicitor’s website that when commenting on the case Mrs Yates said: “Very often we were dealing with very frail residents who simply couldn’t help themselves. On this occasion my colleague and I had to support the full bodyweight of this very elderly lady and I did my best under the circumstances as I would for any of the residents. If I’d known how to dress her or any other of the residents properly, or been given access to training, I would have adopted a safer method instead.”
   
Miss White, added: “The Department for Work and Pensions state that the number of employer cases, recoveries and compensation settlements have steadily declined in the last five years. However, this does not mean employers and employees can afford to be complacent when it comes to managing the risks. It is always a good idea to involve employees and safety representatives when carrying out an assessment and considering possible solutions.”

Policy
Policies are a good place to start with if you want to know about the general organisational position and strategy over matters. Health care providers may need to develop one for moving and handling if carrying out a wide range of these types of activities. This would fit within the overall health and safety policy and clearly include who is responsible for what, the training arrangements, the risk assessment and action plan processes, the system for reviewing and monitoring compliance with the policy and information for staff regarding how to report injuries and health issues.
   
The big challenge for organisations is turning what is written on paper into something that is live, active and very much effective in practice. A survey carried out by the Royal College of Nursing showed that the main barriers to compliance were due to a lack of supervision or enforcement and a perception that it is quicker to handle patients manually when there are low staffing levels, or time pressures. Therefore, adequate resources should be made available and addressing incorrect thinking as well as practices during training and refresher courses will help. It is also important that any policy is monitored regularly to incorporate change.

Risk assessments
When looking at patient handling, the HSE advise that two types of risk assessment are usually needed – a generic assessment and an individual assessment.
   
The generic assessment would consider factors such as staffing, the type and frequency of moving/handling tasks (including during emergency situations), equipment needs and the environment. Whereas an individual risk assessment would take account of the specific moving and handling needs of care service users and form part of the process for their care plan. The person carrying out any assessment should be correctly trained and competent to do so. Assessments should be reviewed periodically or when circumstances change.
   
It is also useful to record the risk assessment main findings, though this is not necessary if it’s a simple activity that’s easy to explain or the manual handling task is low risk and will be very quick to finish.

Training
Training in moving and handling is important for anyone having to lift, carry or even move patients. In this case, a moving and handling foundation course should develop staff understanding and ability in a number of areas.
   
Strong evidence points to effectively reducing manual handling injuries using ergonomic interventions which adopt a multidimensional approach. This would entail an organisation having in place steps or initiatives which aim to make sure that tasks, information, equipment and the environment suit the workers. It would also involve the participation of workers and managers, the tailoring of training to suit the person and specific task requirements, along with equipment or task design/redesign.
   
So, just as it is important for workers to know what correct safe techniques are, it is also key for a training course to emphasise changing attitudes, habits and behaviour and promote risk awareness among workers and managers.

Equipment
When selecting equipment to help with patient handling, the needs of the patient and the needs of the employee should both be taken into account. Where possible, equipment should be tested on a trial basis before a purchase is complete, as this will ensure the product is fit-for-purpose. By involving employees that will be using the equipment and asking for patient feedback, a clear picture of whether the equipment is of use will soon materialise.
   
Other factors to take into consideration when choosing lifting equipment are where the equipment will go and whether there is enough room for the equipment, is the equipment CE marked and how much maintenance the equipment could need going forward.

Emerging issue
With worldwide figures more than doubling since 1980, one very real and growing global concern is obesity. This presents obvious implications for health and social care service providers. According to the Department of Health website in Britain, if the trend continues and no action is taken 60 per cent of men, 50 per cent of women and 25 per cent of children would be obese by 2050.
   
In research report 573, the HSE look into the manual handling risks and process planning for bariatric patients. In their research, they found 40 - 70 per cent of Trusts did not have a bariatric policy. The manual handling of these patients presents a specific challenge partly due to individual factors but also due to the lack of policies, space, equipment and vehicles for safe care, treatment and transportation. In addition to shaping strategic policies to equip the NHS, recommendations included; ensuring that the design of vehicles and buildings accommodate bariatric patients; designing equipment to suit the range of bariatric sizes and shapes; training to support the assessment of bariatric patients and use of specialist manual handling and clinical equipment; and operational policies to lead on process planning, assessment and management of manual handling for bariatric patients.
   
As you can imagine, the cost of manual handling injuries is high. Every situation where manual handling is involved is different and may require a unique solution. With the correct training and knowledge and a good policy and monitoring system in place the number of injuries could be substantially reduced.

Further information
www.iosh.co.uk