Back Care 999 Patient Handling Backcare Presented by

Back. Care 999 Patient Handling & Back-care Presented by: PW IOSH Trainer

Learning ØTell me and I will forget ØShow me and I may remember ØInvolve me and I will understand

Course objectives By the end of the course, participants will: ØBe able to demonstrate a working knowledge of key people handling. ØHave a basic knowledge of human anatomy. ØUnderstand principle-led moving and handling best practice.

Manual handling operations “any transporting or supporting of a load by hand or bodily force Includes: ØLifting, putting down, pushing, pulling, carrying or moving thereof ØUsing mechanical aids, e. g. trolleys

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Photos removed to reduce size – boxes in a factory setting

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Driving forces Addressing manual handling issues can lead to benefits: ØLegal compliance: criminal law ØSocial: fewer sick days and less absenteeism ØMoral: should not be injured for work ØMarket: bad H&S = bad publicity ØFinancial: accidents cost money - civil liability ØPersonal: avoid pain, loss, ongoing problem

Backs! 2012 campaign Ø 5 million lost working days p. a. due to back pain ØBack pain is the nation's leading cause of disability with 1. 1 million people disabled by it. www. hse. gov. uk/betterbacks/index. htm Wider context – 2008/9: Ø 180 fatalities at work Ø 130, 000 other major injuries

Manual handling quiz What proportion of reported workplace accidents result from manual handling? 2008/9 reported injuries Other 13% Falls 8% Struck by 15% Slips trips 26% Handling 38% Chart removed to reduce size

Manual handling quiz Which of the following types of workplace has the highest proportion of accidents resulting from manual handling? a. Health care b. Retail c. Construction d. Agriculture

Sites of >3 day injury caused by handling Back 47% etc Graphic removed to reduce size

Types of injury from manual handling ØFractures ØDamage to muscles, ligaments and tendons ØSpinal disc injuries ØTrapped nerves ØAbrasions and cuts ØBurns ØWork related upper limb disorders ØHernias ØDeath

Work related upper limb disorders ØWRULD or repetitive strain injuries (RSI) • Tennis elbow • Carpal tunnel syndrome • Frozen shoulder ØCaused by: • Repetitive activities • Carrying out an activity for a long period of time without adequate rest intervals • Poor posture / non-neutral joint positions

Cause of injury ØTraumatic stress ØCumulative stress ØDegenerative change ØPsychological causes

Vulnerable groups ØOld ØYoung ØObese ØUntrained ØThose with existing injury ØTired ØPregnant women

3 most important things ØFamily ØHome ØRelationships ØWealth / ability to earn ØLeisure / sports ØHealth

Practice lift ØDemonstrate a typical lift ØDemonstrate a good lift ØWhat are the changes?

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Skeleton photo removed to reduce size

Vertebrae & discs Cartilage Nucleus

Discs Photos removed to reduce size www. spineuniverse. com/displayarticle. php/article 1431. html

Prolapsed disc

Stresses without a load

The lever principle

Centre of gravity Graphic removed to reduce size

Centre of gravity Graphic removed to reduce size

Centre of gravity Graphics removed to reduce size

Centre of gravity Photos removed to reduce size

Principles of efficient handling ØDynamic stable base ØNeutral position of body ØShort levers – centre of gravity close ØCorrect secure hand hold ØGood commands and communication

Muscles ØRelaxed muscles ØBody in neutral position ØStatic muscle fatigue ØUse of major muscle groups ØGraphic removed to reduce size

Team handling What are the problems? Photos removed to reduce size

Team handling Ø Planning of lift Ø Communication • • • How to grasp When to lift What level to carry Which route Set down points on route? Ø Co-ordination Ø Disparity of individuals: size, speed, strength Ø Awkward areas

Team handling 1 person = 100% 2 people = 66% of individual capacity 3 people = 50% of individual capacity 1 = 60 2 = 80 3 = 90

Team handling ØConsider other options • Avoid • Mechanise • Use manual handling aids ØRun through sequence of events verbally ØWalk the route ØOne person take charge of giving instructions ØStick to established teams if possible

Problem loads Inanimate objects Ø Unexpected issues • Light • Heavy • Centre of gravity Ø Intrinsically harmful • Sharp edges • Acids Ø Unpredictable behaviour • Partly fixed load • Liquids – centre of gravity • Poor sealing of container People Ø Unexpected issues • Light, heavy, C of G • Weak side / strong side • Collapsing Ø Intrinsically harmful • Teeth & nails • Hygiene Ø Unpredictable behaviour • Change of mind • Struggling • Aggression

FLUENCY A mnemonic Ø Feet Ø Load Ø Unlock Ø Even Ø Natural Ø Control Ø Your back

Photos removed to reduce size man handling extinguishers

Pushing and pulling Pushing generally preferable: Ø Operator slip or trip – no load impact Ø Less risk of pulling load onto feet & ankles Ø No twisting to see where you are going Ø Better position for arm joints Ø Can often use both hands Ø Cage less likely to tip if fixed wheels leading But: Ø Visibility may be hindered Ø http: //www. hse. gov. uk/research/rrpdf/rr 009. pdf

Pushing and pulling considerations Ø Wheels: • Initial direction & obstructions • Size • Fixed or rotating Ø Load: • Stability / safety • Visibility Ø Route • Obstructions • Slopes Ø Hands • Between waist and shoulder height • Neutral position • Avoiding impacts Ø Legs: “A” frame to overcome inertia Ø Travel • Slow speed • Avoid starting & stopping

Pushing a wheelchair Pre-use checks ØWheels ØFoot rests ØClothing of client ØBrakes ØClient understands what is happening Use ØDynamic stable base ØShort levers

Health and Safety at Work etc. Act 1974 Section 2(1) general duty Ø "to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all his employees"

Health and Safety at Work etc. Act 1974 Ø s 3: duty to others who may be affected; contractors, visitors, neighbours & public Ø s 7: employees duties: • • • Take reasonable care of themselves and others Co-operate with employer s 8: Not intentionally or recklessly interfere with or misuse anything provided for health and safety

Management of H&S at Work Regs 1999 ØEvery employer shall make a suitable and sufficient assessment of the risks to health and safety of employees & non-employees. ØMust implement suitable preventative and protective measures.

Management of H&S at Work Regs 1999 ØRegulation 4: hierarchy of control measures: • • • E – Eliminate R – Reduce I – Isolate C – Control S – Signage P - PPE

Provision & Use of Work Equipment Regulations 1998 (PUWER) Work equipment must be: ØSuitable ØAdequately maintained ØInspected if necessary at regular intervals by a competent person Adequate information & training must be provided Risks adequately controlled, e. g. guarding

Lifting Operations and Lifting Equipment Regulations 1998 (LOLER) Lifting equipment: ØAny equipment used at work for lifting or lowering loads including attachments used for anchoring, fixing or supporting it ØLoads can include a person

Lifting Operations and Lifting Equipment Regulations 1998 (LOLER) What documentation / marking? ØSafe working load marking (SWL) ØThorough examination • Every 6 months for lifting people • Otherwise 12 months

Lifting Operations and Lifting Equipment Regulations 1998 (LOLER) Lifting operations must be: ØProperly planned by a competent person ØAppropriately supervised ØCarried out in a safe manner

Human Rights Act 1988 Blanket “no lifting” policy unlawful Regulations to not prescribe no risk regime Some manual handling inescapable at work Employees must accept greater risk if lifting people rather than objects All risk assessments based on individual needs and circumstances

Manual Handling Operations Regulations 1992 ØIdentify manual handling tasks with significant potential for injury • Can task be avoided? • Can it be mechanised? ØIf not, conduct risk assessment to reduce risk to lowest level reasonably practicable • Identify remedial actions • Prioritise these actions • Assign responsibility and target date

Manual Handling Operations Regulations 1992 Employers responsibility ØConduct risk assessments ØReduce risk of injury as far as to lowest level reasonably practicable Employees responsibility • To use safe systems and procedures coming from the risk assessment

Control measures ØEliminate the need for task ØAutomate ØManual handling aids ØPeople measures • Safe handling techniques • Team handling • Personal protective equipment

Risk assessment ØA logical and consistent way of assessing a situation and finding ways of making it safer ØLogical: justify outcomes to regulator ØLead to action plan and improvement ØConducted by a competent person ØRegularly reviewed • After an accident • If workplace or practices change

Risk assessment ØHazard • Something with the potential to cause harm ØRisk • Likelihood of the harm occurring and its severity

Risk assessment – 5 steps ØIdentify the hazards ØIdentify who may be harmed and how ØEvaluate the risk & decide on actions ØImplement and document ØReview

What factors contribute to manual handling risk? ØTask ØLoad ØWorking environment ØIndividual capability Or ØTask ØIndividual Capability ØLoad ØEnvironment

The Task Ø Is it necessary / urgent / how often? Ø Can the client help or does it involve taking the full body weight? Ø What is the distance to be travelled? Ø Is there height difference? Ø Will it involve stooping, twisting or turning? Ø Are other handlers necessary? Ø Is the client accessible? Ø What is the safest and most effective way of completing the task? 61

Individual Capability Ø Size of carer Ø Have they been trained? Ø Previous injuries / lack of fitness / pregnancy Ø Inflexibility of attitude / techniques. Am I being asked to do something unsafe? Ø Unsuitable clothing / shoes Ø Are they used to the environment Ø Time available Ø Are they able to work as part of a team 62

Load Physical condition: Ø Size, weight and shape Ø Pain Ø Mobility of limbs Ø Skin condition Ø Conscious / unconscious Ø Can they balance / weight bear? Ø Attachments e. g. catheters Psychological State: Ø Understanding Ø Anxiety / Fear Ø Uncooperative Ø Unpredictable 63

Environment Ø Awkward tight spaces Ø Floor surfaces uneven, slippery or wet Ø Temperature / lighting / noise Ø Obstacles e. g. steps Ø Adjustable furniture e. g. profiling bed Ø Privacy 64

Controversial techniques Drag lift Graphic removed to reduce size

Controversial techniques Graphic removed to reduce size The Australian lift Orthodox lift

Controversial techniques Through-arm lift with two handlers Graphic removed to reduce size

Controversial techniques Graphic removed to reduce size Arm and leg lug / hammock transfer Bear hug / pivot transfer