Introduction - Disclaimer
Disclaimer
The risks associated with moving and handling tasks are complex and varied and each situation must be judged on its own merits through a process of a suitable and sufficient risk assessment carried out by a competent person(s). The guidance in this package is not intended to be in any way prescriptive and it is insufficient for users to follow any aspect of the contents without undertaking an adequate risk assessment that takes full account of all prevailing circumstances.
This package is designed to increase awareness of the issues involved in carrying out moving and handling tasks and is not a substitute for full and proper practical training.
This package does not provide certification of competence in moving and handling.
Introduction - Introduction
Teacher's Comment
Introduction - Pre assessment
Teacher's Comment
We constantly move and handle loads in our everyday lives. Let's see what you know about correct moving and handling.
Pre Assessment
1. When supporting a patient, you should hold them:
2. The Manual Handling Operations Regulations 1992 state that when approaching a moving and handling task you should:
3. When carrying out a risk assessment before carrying out a moving and handling task, the T.I.L.E abbreviation is used. What does this stand for?
4. You are helping a patient to walk, they begin to feel unsteady on their feet and fall to the ground. You should:
5. You have been asked to assist a patient in standing up. You should:
6. You have been asked to move a patient onto their side. You should:
7. Secondary back pain is:
8. When helping a patient to stand you should:
9. When helping a patient to walk:
10. When helping a patient sit in an upright position in bed you should:
11. What are the functions of the intervertebral discs?
12. Which position will have the most pressure on the lumbar spine?
The Cost of Moving and Handling - Personal Stories
Teacher's Comment
Did you know that one third of absences lasting more than 3 days in the healthcare setting are due to moving and handling injuries (2).
But there is also a significant personal cost:
Spinal Awareness - Back Injuries
Back Injuries
Back pain accounts for around 40% of absences in the health service every year (3).
There are various ways inappropriate moving and handling can cause back pain:
As the back is one of the most likely places for an injury to occur, it is important to know how the spine works, the injuries that can occur when moving and handling, and how posture and biomechanics can have an effect on your spine.
Spinal Awareness - Structure and Function of the Spine
The spine consists of 33 vertebrae with intervertebral discs in between each. The spine is divided into 4 Regions:
1. Cervical
2. Thoracic
3. Lumbar
4. Pelvis, including sacrum & coccyx (fused vertebrae)
These form the normal s-shaped curvature of the spine:
1. The cervical lordosis
2. The thoracic kyphosis
3. The lumbar lordosis
A good posture maintains this curvature and reduces the pressure placed on the intervertebral discs between the vertebrae.
The spinal cord travels down through the spinal canal.
Spinal Nerves
The spine serves to protect the spinal cord. The articular processes and facets of the spine allow movement of the head, neck and trunk. The vertebrae also bear much of the weight placed on the back.
The intervertebral discs act to absorb shock and transmitted force. They contain a soft jelly-like centre called the nucleus pulposus surrounded by a tough external layer called the annulus fibrosus.
Pressure on the discs may cause the soft nucleus pulposus to bulge and prolapse. Flexion causes the soft nucleus pulposus to bulge back. This can put pressure on the nerves close to it causing damage.
Spinal Awareness - Biomechanics
Safe moving and handling relies on an awareness of both the body's biomechanics and the need for good posture and smooth movement. Biomechanics studies the structure and movement of a person. This is influenced by our centre of gravity.
Whilst standing at rest your body's centre of gravity lies at the pelvis.
The lower our centre of gravity is toward the ground the more stable we are. The parts of the body that support our weight, such as our feet and legs, act as a base. Our base is at its most stable when our line of gravity (a line passing through our centre of gravity) lies within the base. This is why when we change posture it is important to adjust our base to remain as stable as possible.
Spinal Awareness - Lifting
Lifting
The deep muscles of the back are mainly postural - other muscles such as the muscles of the arms and legs provide much of the lifting power.
The pictures below set out the steps involved when lifting a load to ensure you maintain a stable base.
Teacher's Comment
Figure 1. Demonstration of incorrect posture whilst lifting a load
Spinal Awareness - Looking after your back
Teacher's Comment
Correct posture in any physical activity is one which:
In order to prevent repetitive-strain back pain maintaining good posture is essential.
Maintenance of Good Back Care
Organise yourself to develop a working system to reduce back strain at home and work.
Spinal Awareness - Test Yourself
Name the 4 regions of the spine?
Cervical region, Thoracic region, Lumbar region, Pelvis including sacrum and coccyx
Through what part of the spine does the spinal cord travel?
Spinal Canal
What two components make up the intervertable disc?
Nucleus pulposus (the soft centre) and annulus fibrosus (the tough outer exterior).
What can happen if a disc prolapses?
It can put pressure on the spinal nerves causing damage.
Which of the following are important functions of the spine?
What are the functions of the intervertable discs?
Support the load of the spine, absorb shock, assist in movement and shape.
Describe what constitutes a stable base?
Whilst standing at rest your body's centre of gravity lies at the pelvis. The lower our centre of gravity is towards the ground the more stable we are. The parts of the body that support our weight, such as our feet and legs, act as a base. Our base is most stable when our line of gravity (a line passing through our centre of gravity) lies within the base. This is why when we change posture it is important to adjust our base to remain as stable as possible.
Risk Assessment - Risk Factors
Every moving and handling task involves a degree of risk. It is always best to follow a ‘minimal-lift’ policy and avoid moving and handling.
When considering moving and handling it is essential to follow these 3 guiding principles:
Make sure to carry out a REVIEW of the task once it's finished to find out how it can be improved for the next time.
However, it is not always reasonable or practical to avoid moving and handling. For example, if Mr Jones requires assistance to get to his bed and cannot do it on his own we must find ways to reduce the risks involved as much as possible.
The best way to reduce the risk of any moving and handling task is by using the TILE abbreviation to perform a risk assessment
T = Task
I = Individual Circumstances of both you and the patient
L = The Load being handled
E = The Environment you are working in
By considering these risk factors you can reduce the risk to both yourself and the patient. This T.I.L.E risk assessment should be carried out before any task is under taken.
Risk Assessment - TILE risk assessment
Risk Assessment - Risk assessment form
Risk Assessment Form
Other members of your team may have completed formal risk assessments. Below is an example of a risk assessment chart that may be used to assess a patient (5). You should make sure to consult this or gain the appropriate advice before undertaking any moving and handling task.
Risk Assessment - Test Yourself
What does the TILE approach to moving and handling risk assessment stand for?
T - Task
I - Individual Circumstances
L - Load
E - Environment
How should the patient be involved in moving and handling tasks?
The patient should be informed of the procedure and consent gained. You must establish what the patient can do for themselves. It is recommended that the patient carry out the task as much as possible - it is always best to avoid moving and handling where reasonably practicable.
A Risk Assessment should only be performed with heavy loads or strenuous repetitive movements.
Legislation - Legislation on Moving and Handling
Teacher's Comment
Legislation exists to ensure that both the patient and the person performing the task are protected.
The Manual Handling Operations Regulations 1992 provides guidelines for health care workers when performing a moving and handling task.
i. The PRIORITY when approaching a moving and handling task is first to AVOID it if reasonably possible.
ii. Employees should have the skills to assess the task for any risks and hazards.
iii. The risk should be reduced to the lowest level possible.
iv. The employee should be able to carry out the task and be able to manage the load using the appropriate technique.
At the end of any moving and handling task there should be an evaluation of how well it was performed and what improvement could be made in the future.
Employers and employees have a legal responsibility to adhere to these guidelines when considering a moving and handling task of any kind.
This is outlined in the Health and Safety Executive's Getting to Grips with Manual Handling: A Short Guide (6)
Further Moving and Handling Legislation
The Human Rights Act 1998
Avoidance of moving and handling must be balanced with a patient's basic human rights as covered by the Human Rights Act 1998 (7).
A patient's right to dignity and freedom from discrimination must be taken into account when assessing the risk of a moving and handling task. For example, if a patient is incapable of reaching the toilet unassisted, or must be moved to prevent pressure sores, it is a care worker's duty to help the patient. To ensure that a disabled person's rights are protected and that quality of life is maintained often moving and handling operations must take place.
Teacher's Comment
It is your duty to report any incident/injury in relation to a moving and handling incident.
Legislation - Test Yourself
What is the first principle of the Manual Handling Operations Regulations 1992?
The first principle of the Manual Handling Operations Regulations 1992 is to avoid moving and handling tasks if reasonably possible.
The Manual Handling Operations Regulations 1992 state that when approaching a moving and handling task you should:
Why should the Human Rights Act 1998 be taken in to consideration when approaching a moving and handling task?
Although moving and handling tasks should be avoided where possible to protect your health, the dignity and quality of life of a patient must be taken into account as well.
Techniques - Bed demonstration
Teacher's Comment
Remember, it is important to aviod moving and handling if possible. Often the patient may be able to move themself.
If you are required to help move a patient it is essential to employ the correct techniques.
Before going through some exemplar videos of moving and handling techniques, please familarise yourself with the main elements of a profiling bed.
Techniques - Sitting to Standing
Techniques - Assisted Walking
Techniques - Sitting a Patient Back Down into a Chair
Techniques - Managing a Falling/Collapsing Patient
Managing a falling patient is a highly dangerous technique and poses considerable risk. It should only be attempted after appropriate training and if you feel comfortable and confident doing it.
If you do not feel confident do not intervene but try and clear the area to make the environment as safe as possible.
Techniques - Getting Out of Bed
Techniques - Getting Back into Bed
Techniques - Sitting Up in Bed
Techniques - Moving a Patient onto their Side
Techniques - Hoist demonstration
Summary - Remember Matthew?
In summary:
The Manual Handling Operations Regulations 1992 set out guiding principles:
The best way to reduce the risk of any moving and handling task is by using TILE risk assessment:
T = Task
I = Individual Circumstances of both you and the patient
L = The Load being handled
E = The Environment you are working in
Summary - References
References
1. Health and Safety Executive. Moving and Handling in Health and Social Care.
2. Health and Safety Executive. Manual Handling: Manual Handling Operations Regulations 1992 (as amended).
3. NHS Employers. Manual Handling.
4. Kumar, Parveen. Clark, Michael. Eds. Kumar and Clarke, 7th Edition. London: Saunders Elsevier; 2009.
5. Health and Safety Executive Northern Ireland. Backs in Action: a Guide for the Healthcare Sector.
6. Health and Safety Executive. Getting to Grips With Manual Handling: A Short Guide.
7. Equality and Human Rights Commission 2009. Evaluating the Impact of Selected Cases Under the Human Rights Act on Public Services Provision.
Further Reading:
Summary - Acknowledgements
Project Team
Moving and Handling Advisory Team
Videos
* School of Medicine, Dentistry and Biomedical Sciences, Queen's Unversity Belfast
^ School of Nursing and Midwifery, Queen's Unversity Belfast
1 Ergonomic Team, Belfast Health and Socal Care Trust
Summary - Post assessment
Teacher's Comment
Now you have finished the learning package. Test yourself again.
Post Assessment
1. When supporting a patient, you should hold them:
2. The Manual Handling Operations Regulations 1992 state that when approaching a moving and handling task you should:
3. When carrying out a risk assessment before carrying out a moving and handling task, the T.I.L.E abbreviation is used. What does this stand for?
4. You are helping a patient to walk, they begin to feel unsteady on their feet and fall to the ground. You should:
5. You have been asked to assist a patient in standing up. You should:
6. You have been asked to move a patient onto their side. You should:
7. Secondary back pain is:
8. When helping a patient to stand you should:
9. When helping a patient to walk:
10. When helping a patient sit in an upright position in bed you should:
11. What are the functions of the intervertebral discs?
12. Which position will have the most pressure on the lumbar spine?
Certificate - Certficate of completion
To generate a certificate of completion for your ePortfolio please download the Word document.
Teacher's Comment
You need to enter your:
Answer the two questions with a maximum of 50 words per question
Then save the document for inclusion in your portfolio.
Certificate - Assessment Feedback
Getting Student Answers
To generate feedback on your pre and post assessment:
1. Click on the 'Generate PDF' button in the bottom left hand side of the package, this will appear when you have 100% completed the course content.
2. Select 'Student's Answers'. This will download to your device.
NOTE: The package does not save your responses so if you have closed the browser before printing you need to redo the assessment.
Welcome to this package, it should take you approximately one hour to complete the following chapters. Once you have worked your way through the learning material you can print out your personal learning record by clicking the 'Generate PDF' in the bottom left of the screen.