Moving Handling Legal cases Barts Health Musculoskeletal Health

Moving & Handling Legal cases Barts Health Musculoskeletal Health in the Workplace Conference 1 st November 2019 01/11/19 DFH Ergonomics Ltd 1

Lecturer z Danielle Holmes z MSc (Health Ergonomics), RNT, ONC y info@handlingpeople. co. uk y www. handlingpeople. co. uk DFH 01/11/19 Ergonomics Ltd 2

Aims z To link legal cases to practice z Applying the relevant legislation to moving and handling practice z Using evidence based guidance to promote best practice DFH 01/11/19 Ergonomics Ltd 3

UK Health & Safety Law y Health & Safety at Work etc Act 1974 y MHSAW (Management of Health & Safety at Work Regulations) 1999 y PUWER (Provision & Use of Work Equipment Regulations) 1998 y y y MHOR (Manual Handling Operations Regulations)1992 (as amended), 2002 LOLER (Lifting Operations & Lifting Equipment Regulations)1998 MCA (Mental Capacity Act) 2005 Safeguarding Vulnerable Groups Act 2006 Care Act 2014 Equality Act 2010 y Human Rights Act 1998 y Children’s Act 2004 etc y 01/11/19 DFH Ergonomics Ltd 4

Professional + other guidance z CODE OF CONDUCT e. g. NMC, HCPC z PROFESSIONAL GUIDANCE e. g. COT, CSP z NICE guidance z e. g. Pressure ulcers: prevention and management z Falls in older people: assessing risk and prevention z Head injury: assessment and early management DFH 01/11/19 Ergonomics Ltd 5

Wilkie v Oxfordshire Health Authority z S/N Wilkie worked in the HDU of the Coronary Care Unit. Her shift was from 21. 00 hrs until 07. 30 hrs. z The HDU unit had 5 King fund hospital beds. z M & H training given 1991, a 2 day Key Lifter’s Course z Injured 1 st September 1994 DFH 01/11/19 Ergonomics Ltd 6

Wilkie v Oxfordshire Health Authority z Male pt, weighed 82. 6 kg. Coronary artery by pass graft, conscious and able to follow instructions. z The patient was lying on his back and needed to sit up. He was very tense. z z an intravenous infusion a urinary catheter a chest drain a cardiac monitor. 01/11/19 DFH Ergonomics Ltd 7

Wilkie v Oxfordshire Health Authority z Method to get the pt in a sitting position NBPA DFH 01/11/19 Ergonomics Ltd 8

Wilkie v Oxfordshire Health Authority z The method used to move him up the bed DFH 01/11/19 Ergonomics Ltd 9

What legislation and guidance applies in this case? z Manual Handling Operations Regulations 1992 (MHOR) z Health and Safety at Work etc Act 1974 DFH 01/11/19 Ergonomics Ltd 10

MHOR 1992 z Employer's key duties y avoid hazardous manual handling x SFAIRP (Edwards v National Coal Board 1949) y assess those that cannot be avoided using criteria (TILEE, weight, push & pull force) y reduce the risk SFAIRP x automate/mechanise x use ergonomic approach x ensure employees are trained and competent x review the assessment x have you reduced the risks 01/11/19 DFH Ergonomics Ltd 11

MHOR 1992 as amended 2016) (guidance z Duties of Employees under Manual Handling Operations Regulations 1992 as amended y Co-operate in assessments y Report defects y Use the equipment y Attend training y Follow Safe Systems of Work DFH 01/11/19 Ergonomics Ltd 12

MHOR 1992 as amended 2016) (guidance z Assessments should be: y Generic Assessment y Specific assessment x In consultation with employees x Takes place at more than one location x Involves dealing with emergencies DFH 01/11/19 Ergonomics Ltd 13

Manual Handling Operations Regulations 1992 as amended z Generic Assessments y Generic Assessments [also known as Standard Operating Procedures (SOP’s)] x E. g All wards and departments etc y There is also a requirement to make Generic Assessments available to Staff and to Safety Representatives DFH 01/11/19 Ergonomics Ltd 14

Manual Handling operations Regulations 1992 as amended z Was hazardous manual handling avoided? y Task Bed moves, y Individual Nurse/s y Load male pt CPG, 82. 6 kg y Environment HDU y Equipment/other factors Kings Fund bed, Ambulift Model D hoist y IVI , chest drain, Monitor, unrinary catheter y Weight guidance 82. 6 kg DFH 01/11/19 Ergonomics Ltd 15

Manual Handling Operations Regulations 1992 as amended DFH 01/11/19 Ergonomics Ltd 16

Guidance to the Manual Handling Operations Regulations 2016 z LOAD - LIFTING AND LOWERING - WOMEN DFH 01/11/19 Ergonomics Ltd 17

Guidance to the Manual Handling Operations Regulations 2016 z LOAD – APPENDIX LIFTING AND LOWERING - MEN DFH 01/11/19 Ergonomics Ltd 18

Assessment z What is the probability/likelihood of harm occurring given the existing controls/precautions that are already in place? Use the table below to assign a code. z z If harm/severity of harm occurred what are the likely consequences to person(s) or Care Home? Use the table below to assign a code. z z The Severity number and Likelihood number need to be plotted on the matrix. This gives the Risk Rating. DFH 01/11/19 Ergonomics Ltd 19

Assessment DFH 01/11/19 Ergonomics Ltd 20

Assessment TASK RISK to Staff/ Risk to patient BED moves Sit up Slide Down Turn Move to edge Shoulder injury/dislocation/fracture to staff and patient Back injury to staff P. Ulcers by dragging heels over bed linen etc DFH 01/11/19 Ergonomics Ltd 21

Assessment Risks Likelihood Severity Consequence Dislocation/shoulders/ bruises/fractures 5 X 4 Catastrophic/Stop Back injury 5 X 4 Catastrophic/Stop Pressure ulcers to heels 3 X 3 Undesirable/ action DFH 01/11/19 Ergonomics Ltd 22

MHOR 1992 z Reduce the risk SFAIRP y Automate/mechanise y Use an ergonomic approach y Ensure employees are trained and competent DFH 01/11/19 Ergonomics Ltd 23

Wilkie v Oxfordshire Health Authority z The Defendant argued that z Specific Assessments were not completed in HDU as it was “life and death”. z There was a Maxilift Hoist in the Equipment Library z Staff trained in Moving and Handling DFH 01/11/19 Ergonomics Ltd 24

Wilkie v Oxfordshire Health Authority z Generic Assessment 5 HDU beds z Bed moves y Patients move themselves y Sliding sheets Ambulift Model D can be adapted for hoist slings to reposition patients. z EPB x 5 01/11/19 DFH Ergonomics Ltd 25

Wilkie v Oxfordshire Health Authority z Case was won by Claimant y Cost to Defendants y 4 days in Court y S/N Wilkie awarded £ 133, 000 y No contributory negligence y Trust bought EPB’s for the Hospital DFH 01/11/19 Ergonomics Ltd 26

Accident z Female 80 years, history of mobility problems associated with her right knee, foot is literally pointing sideways and cannot take her weight. Bilateral Cataract, Mobile in her own home with an aid, and wheelchair z Wheelchair when outside. z Required a hinge knee brace & urgent total knee replacement DFH 01/11/19 Ergonomics Ltd 27

Assessment z Surgical Pre-Operative Assessment form z Do you suffer any other neurological disorder? right side drop foot pins and needles z Do you use any mobility aids ? wheelchair and Zimmer frame z How far can you walk? few steps with aids, unsteady due to pain in knee DFH 01/11/19 Ergonomics Ltd 28

Operation z 07. 00 hrs Admitted. y y y Ward Nursing Assessment Mobility x 2 Transfer from/to bed x 2 Moving in chair x 1 Risk of falls medium z 18. 30 hrs Returned to ward with hinged brace. z 22. 00 hrs Analgesia DFH 01/11/19 Ergonomics Ltd 29

Nursing Assessment z 2 weeks prior to admission z Surgical Pre-Operative Assessment form z Do you suffer any other neurological disorder? z right side drop foot pins and needles z Do you use any mobility aids ? wheelchair and Zimmer frame z How far can you walk? few steps with aids, unsteady due to pain in knee DFH 01/11/19 Ergonomics Ltd 30

Post Op Day 1 z 09. 00 hrs Physio notes y y Rx Fitted Hinged Knee Brace to 0 -70° Sit→Stand min (A) of 2 to R/F. Mobilised FWB approx 5 m R/F and min (A) of 1. Needed prompts with foot placement and use of R/F y Mobilise with N/S to and from toilet DFH 01/11/19 Ergonomics Ltd 31

ACCIDENT z Clinical notes y Patient fell on way back from toilet witnessed by student nurse. Observations done. Patient vomited, transferred back to bed. Patient hit back of head no lacerations. SHO informed. Relative informed z Pt statement z I told them I was in pain and felt I could no walk. I was left in the toilet I was told by consultant that I would stay in bed on day 1 as it was complex knee surgery. No one was with me DFH 01/11/19 Ergonomics Ltd 32

Assessment z Was the nursing assessment correct and reviewed? y on arrival to Ward. z Nursing Assessment y y Mobility Transfer from/to bed Moving in chair Risk of falls x 2 x 1 medium y On return from Theatre DFH 01/11/19 Ergonomics Ltd 33

Assessments z On returning from Operating Theatre the risk assessment ought to have been reviewed by the nurses z What is meant by – Mobility x 2 z The physio gave a R/F to the patient. z Was this the correct piece of equipment? DFH 01/11/19 Ergonomics Ltd 34

Reducing the risk? z Walking frames DFH 01/11/19 Ergonomics Ltd 35

Injury z Not disclosed z Training records, accident form, SIRI, M & H Policies z Pt suffered a comminuted fracture to midshaft femur which took 2 years to heal and left her with reduced mobility. z Settled out of court for £ 340, 000 DFH 01/11/19 Ergonomics Ltd 36

Accident z z z A man in his own home answered the door bell. He was stabbed 18 times by a person unknown to him. His girlfriend called emergency services. Open heart massage was performed in A + E Transferred to ITU y y 01/11/19 Ventilator Chest drains Urinary catheter IVI DFH Ergonomics Ltd 37

An Intensive Care Environment DFH 01/11/19 Ergonomics Ltd 38

Risk Assessment y Task Bed moves, turned chest physio/toileting y Individual Dr. Nurses , Physiotherapist, y Load unconscious 37 yrs on ventilator, IVI , chest drains, urinary catheter y Environment ITU y Equipment/other factors EPB P. R. mattress, y Weight guidance 130 kg y Pushing/pulling guidance n/a DFH 01/11/19 Ergonomics Ltd 39

The MHOR 1992 as amended 2002 guidance 2016 z Employer's key duties y avoid hazardous manual handling x SFAIRP y assess those that cannot be avoided (TILEE or LITEE) y reduce the risk x SFAIRP x use ergonomic approach x automate/mechanise x ensure employees are trained y review the assessment x have you reduced the risks? 01/11/19 DFH Ergonomics Ltd 40

Multidisciplinary Assessment z Every time the nurses try to turn him on his side manually he drops his B/P and stops breathing. z Risks z Pressure Ulcers /Chest infection DFH 01/11/19 Ergonomics Ltd 41

Guidance to the Manual Handling Operations Regulations 2016 z Assessment criteria z Task bed moves z Individual Dr, Nurse, Physiotherapist, Radiographer etc z Load 37 yr old unconscious pt , 72 kgs, 1 m 80 z Environment crowded with appliances z Equipment EPB & mattress DFH 01/11/19 Ergonomics Ltd 42

Individual (Staff) z ITU members of staff z Radiographer z Physiotherapist z Trained in moving and handling? DFH 01/11/19 Ergonomics Ltd 43

Patient z Pressure ulcers to y occiput , y sacrum grade 4 y heels grade 4 y What would you do? DFH 01/11/19 Ergonomics Ltd 44

Patient Turning Systems z Toto z Turning Mattress DFH 01/11/19 Ergonomics Ltd 45

Patient Turning Systems z V 5 DFH 01/11/19 Ergonomics Ltd 46

Linet Multicare Bed DFH 01/11/19 Ergonomics Ltd 47

Risk Assessment & Handling Plans z Information to be given in a Patient/Client Mobility/Handling Care Plan y The way in which the Patient/Client is to be handled x the method to be used to move the Patient/Client x The equipment to be used x The number of people needed y New equipment and other changes needed y Review date DFH 01/11/19 Ergonomics Ltd 48

Defendant z Apologised for P. U. z inevitable but said they saved his life z Claimant won his case z Settled out of court DFH 01/11/19 Ergonomics Ltd 49

Record Keeping z Nurse wrote y “Pressure areas intact has 2 black heels “ z Doctor wrote in clinical notes y “Mobilise” z What dothese words mean ? DFH 01/11/19 Ergonomics Ltd 50

What is your Rehabilitation Plan for your Patient z Sling hoists DFH 01/11/19 Ergonomics Ltd 51

What is your Rehabilitation Plan for your Patient ? z Standaid hoist z z HSE (1211) Getting to grips with hoisting DFH 01/11/19 Ergonomics Ltd 52

What is your Rehabilitation Plan for your Patient ? z Walking hoists DFH 01/11/19 Ergonomics Ltd 53

Reducing the risk DFH 01/11/19 Ergonomics Ltd 54

Reducing the risk DFH 01/11/19 Ergonomics Ltd 55

What is your Rehabilitation Plan for your Patient ? z Walking frames DFH 01/11/19 Ergonomics Ltd 56

What is your Rehabilitation Plan for your Patient ? Crutches DFH 01/11/19 Ergonomics Ltd 57

What is your Rehabilitation Plan for your Patient ? z Tripods DFH 01/11/19 Ergonomics Ltd 58

What is your Rehabilitation Plan for your Patient ? z Walking sticks DFH 01/11/19 Ergonomics Ltd 59

Regina v Sabrina Hewitt (2013) z An 85 year old elderly lady, 1. 55 m (5 ft 1 in) weighed 38. 1 kg (6 st). She suffered from dementia. z Transferred back to bed from her wheelchair z both carers reported that the incident occurred when the lady hit her head on the bed's headboard as she was being transferred from her wheelchair into her bed. z Ms Hewitt states that she lied and that she fell out of the hoist sling and hit her head on the floor. z She later admitted that she went back and revised her original explanation. that Mrs Boyle had fallen to the floor. DFH 01/11/19 Ergonomics Ltd 60

Regina v Sabrina Hewitt (2013) z Toiletting sling Hammock sling DFH 01/11/19 Ergonomics Ltd 61

Regina v Sabrina Hewitt (2013) z Nurse did not call ambulance until 11 pm z Pt admitted to hospital z Patient Died DFH 01/11/19 Ergonomics Ltd 62

Regina v Sabrina Hewitt (2013) z Both carers arrested by the police for manslaughter z Coroner stated fall was contributory not main cause of death. z Plea changed to contributory negligence DFH 01/11/19 Ergonomics Ltd 63

Regina v Sabrina Hewitt (2013) z Hoist slings were kept on a hat stand in the corridor z Room was small y mobile hoist y 3600 mm x 4700 mm (360 cm x 470 cm ) y Hignett S Keen E determining the space needed to operate a mobile hoist and an overhead patient hoist Professional Nurse 2005 March (7) 40 -42 z Training was given no lesson plans disclosed z Both carers stated cross the leg pieces DFH 01/11/19 Ergonomics Ltd 64

Regina v Sabrina Hewitt (2013) z Manual handling risk assessment in place. Evaluate monthly or any change in mobility. z Always two carers to transfer using Oxford hoist and a slide sheet when moving in bed and she is unable to reposition in bed. z To use a wheelchair to mobilise and pushed by one carer. z 2 to toileted [sic] using Oxford hoist and access sling small size x two carers. z Evaluate mobility care plan monthly DFH 01/11/19 Ergonomics Ltd 65

Regina v Sabrina Hewitt (2013 z Judge dismissed the jury z Both carers are not to work in care again z 200 hours community service DFH 01/11/19 Ergonomics Ltd 66

Risk Assessment & Handling Plans z Summary y Risk Assessments, both generic and specific, and Mobility/Handling Care Plans are legal documents y They are to be kept for each Patient/Client y They must reflect the Patient/Client’s handling needs y They must be reviewed to take account of the Patient/Client’s changing needs DFH 01/11/19 Ergonomics Ltd 67

Other Documentation z z NICE guidance e. g Falls 2013, Head Injury MHRA Bed Rail assessment tool National Patient Agency Guidance MHRA safety notices DFH 01/11/19 Ergonomics Ltd 68

Publications z HSE y Manual Handling Operations Regulation 1992 as amended 2002 and General guidance - revised 2016 y Industry specific guidance from H. S. E. y PUWER 1998 y LOLER 198 z Back. Care y Guide to the Handling Patients revised 4 th edition - RCN & NPBA y Guide to the Handling of People 5 th & 6 th editions Backcare y Safer Handling of People in the Community z Professional bodies y RCN, NMC, COT, CSP, RCM, HCPC etc. 01/11/19 DFH Ergonomics Ltd 69

Moving and Handling Legal Cases z All photographs are used with permission from the authors z Please use the resources that you have z i. e TVN, CI Nurse, BC team z I thank you for your time z Any Questions? 01/11/19 DFH Ergonomics Ltd 70