Manual handling is the process of moving an item by lifting, lowering, carrying, pushing or pulling. It’s very important to ensure that correct processes and equipment are used to assist staff in care homes and nursing homes when they have to move and reposition residents. Staff in care homes may also need to move heavy items such as care equipment, laundry, catering equipment, janitorial supplies, deliveries or waste. Maintenance and support staff may also be expected to undertake handling activities.
What are the important factors to consider when moving a patient?
- The weight of the patient
- The number of times the patient has to be picked up and carried
- The distance the patient is being carried
- Where the patient is being carried from and to – what height are they at or position are they in
- What physical processes will the care provider need to do in order to move the patient
Poor moving and handling practice can lead to:
- back pain and musculoskeletal disorders, with potential inability to work
- moving and handling accidents – which can injure both the person being moved and care staff
- discomfort and a lack of dignity for the person being moved
What are musculoskeletal disorders?
Musculoskeletal disorders or MSD, covers any injury, damage or disorder of the joints or other tissues in the upper/lower limbs or the back.
Statistics from the Labour Force Survey (LFS) indicate that MSD cases, including those caused by manual handling, account for more than a third of all work-related illnesses reported.
MSDs can be caused or made worse by:
- poor manual handling procedures
- heavy manual labour
- moving incorrectly or awkwardly
- an existing injury
There is evidence that, as well as manual handling, heavy manual labour, awkward postures and a recent or existing injury are all risk factors in the development of MSDs.
The Manual Handling Operations Regulations 1992 (MHOR) require employers to:
- Avoid hazardous manual handling operations as far as is reasonably practicable, by changing the task to avoid moving the load or by automating or mechanising the process.
- Make a suitable and sufficient assessment of the risk of injury from any hazardous manual handling operations that cannot be avoided.
- Reduce the risk of injury from those operations so far as is reasonably practicable. Where possible, provide mechanical assistance, for example, a hoist. Where this is not reasonably practicable then explore potential changes that can be made to the task, the load and the working environment.
The following legislation may be relevant for assessing moving and handling risks:
Creating a manual handling policy
Whatever the size of your business you should communicate and follow a statement of policy about moving and handling procedures which should include
- the organisation’s commitment to managing the risks associated with moving and handling people and loads
- details of who is responsible for doing what
- details of your risk assessment and action planning processes
- a commitment to introduce measures to reduce the risk
- arrangements for training
- arrangements for providing and maintaining handling equipment
- how do you monitor compliance with the policy and what regular reviews are carried out
- information for staff on reporting pain and injuries
Employers must reduce the risk of injury to staff and residents by:
- avoiding those manual handling tasks that could result in injury, where practical
- assessing the risks from moving and handling that cannot be avoided
- putting measures in place to reduce the risk where possible
- follow appropriate systems of work and use the equipment provided
- co-operate with their employer and let them know of any problems
- take reasonable care to ensure that their actions do not put themselves or others at risk
When can moving and handling risks arise?
- moving and transferring people
- aiding with treatment
- carrying out daily activities (such as bathing) with individuals who with specific needs
- stresses and strains arising from adopting awkward or static postures when caring for and treating people
What are risk assessments?
Care providers will need to carry out risk assessments. There are two types of risk assessments:
Generic risk assessments look at the overall needs of the care home; the type and frequency of tasks, overall equipment needs, staffing and the environment, what moving and handling would be required in emergencies.
Individual assessments look at the specific moving and handling needs of individual residents.
Generic risk assessments
Generic risk assessments need to balance the safety of care home staff with the needs, safety and rights of the residents. Manual handling policies and practice should ensure these needs are noted, and identifying health and safety issues can help to resolve any issues and amend and improve the day to day running of the care home.
Individual risk assessments
Individual risk assessments should be person-centred and, where possible, involve the resident and their family in decision making. Keeping everyone involved will help to reassure them about the quality, safety and usage of equipment.
An individual risk assessment should be part of a care plan and include details such as:
- what can the user of the care service do, or not do, on their own
- how can the individual support their own weight and other factors eg pain, disability, spasm, fatigue, tissue viability or tendency to fall
- the extent to which the resident can assist in/co-operate with transfers
- whether the resident needs assistance to reposition themselves/sit up when in their bed/chair and how this will be achieved, eg providing an electric profiling bed
- specific equipment needed – including bariatric where necessary – and, if applicable, type of bed, bath and chair, as well as specific handling equipment, type of hoist and sling; sling size and attachments
- the assistance needed for different types of transfer, including the number of staff needed –hoisting tasks sometimes need two members of staff to ensure safe transfer
- arrangements for reducing the risk and for dealing with falls, if the individual is at risk
- patient needs and abilities can change over the course of a day so this should be taken into account
Specialist advice and training on how to help some users with specific moving and handling needs may help both the resident and the carer to move comfortably and safely. Experts who can provide specialist advice include occupational therapists, physiotherapists, manual handling advisers, ergonomists with experience in health and social care, professional bodies or organisations such as the National Back Exchange or Chartered Society for Physiotherapists.
Recording and reviewing risk assessments
It’s a legal requirement to record the findings of your risk assessment if you have five or more staff. However, it is good practice to keep a record of risk assessments and you must communicate the findings of your assessment to all relevant staff.
Risk assessments should be reviewed periodically and whenever circumstances change to ensure they remain current.
There should also be arrangements in place to ensure that moving and handling activities are monitored to ensure that correct procedures, techniques and equipment are being used.
Care Home equipment
The type and amount of equipment needed in a nursing or care home will vary according to the specific needs of the individual and to ensure the safety of the staff and the residents.
Necessary equipment may include:
- a selection of hoists – eg hoists to raise fallen individuals from the floor, standing hoists, mobile hoists
- bath hoists or bath lifts and/or adjustable height baths
- slings of different types and sizes eg toileting sling, chest sling, hammock sling
- slide sheets
- transfer boards to assist in moving between wheelchairs and furniture
- turntables to assist in turning residents
- electric profiling beds
- handling belts to assist residents who can support their own weight to stand up
- lifting cushions used to assist people to get up from the floor or bath
- bed levers, support rails/poles
- emergency evacuation equipment
- suitable walking aids, hand rails
- bariatric equipment
Moving and handling equipment used for health and social care may be classified as medical devices. The supply and design of such devices or equipment is regulated by the Medicines and Healthcare Products Regulatory Agency (MHRA). Guidance on managing medical devices and information on how to report defects, adverse incidents or problems with equipment can be found on the MHRA website .
How to use hoists safely
Make sure that you use hoists safely and correctly. Here are some of the problems that could arise:
- selection of the wrong size sling – too small or too large and the person could slip through
- wrong type of hoist or sling for the individual, or task – which can lead to inadequate support and a risk of falling.
- incompatibility of a hoist and sling can result in insecure attachment between the two. Follow the manufacturer’s advice.
- failure of equipment due to lack of maintenance/inspection.
- leaving a vulnerable person unattended in a hoist; or in a position where they might be at risk of falling.
- overturning of the hoist due to being placed on the wrong surface, transporting an individual over a long distance on a hoist, or not following the manufacturer’s instructions
- failure to use a safety harness, belt or attachment appropriately.
An individual risk assessment and care plan for hoisting should specify:
- which hoist to use for which task
- type and size of sling and any configurations of loops or leg attachments
- use of any additional safety devices such as safety belts
- number of carers needed to carry out the task
- any other relevant information specific to the person being hoisted
You must communicate this information to staff and keep it accessible for easy reference.
Maintenance of lifting equipment
Where lifting equipment, including hoists and slings, is used by people who are at work, the Lifting Operations and Lifting Equipment Regulations (LOLER) apply.
More information on LOLER and safe hoisting and maintaining lifting equipment can be found at:
How LOLER applies to health and social care (HSE information sheet HSIS4)
How can Fairfield Care support you?
Fairfield Care can support your LOLER requirements and general safety and maintenance of care equipment such as hoists and slings, plus care beds, baths and mattresses. Contact the team on 01234 324535 or visit our website