MOVING AND HANDLING POLICY GENERAL … Moving...7.4 Techniques to be used in the Moving and Handling of patients, 15 including the use of appropriate equipment 7.5 Ordering equipment

MOVING AND HANDLING POLICY

GENERAL POLICY NO 49

Version: 1 Ratified by: Quality and Governance Committee Date ratified: September 2012 Name of originator/author: Patient Safety Advisor Name of responsible committee/individual:

Quality and Governance Committee

Date issued: September 2012 Review date: September 2013 Target audience: All employed staff within the

organisation UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM THE TRUST WEB SITE

THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION

2/40 GP 49 Moving and Handling Policy - Version 1

Contents

Section Page

1. Introduction 6

1.1 Risk Assessment 6

2. Statement of Intent 7

3. Scope 7

4. Definitions 7

4.1 Moving and Handling 7

4.2 Load 7

4.3 Staff 7

4.4 Competent Person 7

4.5 Risk Assessment 7

4.5.1 Hazard 8

4.5.2 Risk 8

4.5.3 Likelihood 8

4.5.4 Consequence 8

4.5.5 Control Measures 8

5. Duties/Responsibilities: Individuals 8

5.1 Chief Executive 8

5.2 Director of Quality and Governance 8

5.3 Head of Quality and Governance 8

5.4 Health and Safety Advisor 8

5.5 Divisional Managers / Heads of Service 9

5.6 Service Leads 9

5.7 Moving and Handling Advice Team 9


Section Page

5.8 Community Equipment Service Manager 9

5.9 Team Leaders 10

5.10 Staff 10

6. Duties/Responsibilities: Groups and Committees 11

6.1Trust Board 11

6.2 Quality and Governance Committee 11

6.3 Quality, Patient Experience and Risk Group 11

6.4 Health Safety and Wellbeing Group 11

6.5 Divisional Governance Meetings 12

7. People and Patient Moving and Handling 12

7.1 How the Organisation risk assesses the Moving and Handling of 12 patients

7.1.1 When must a patient Moving and Handling risk assessment 12 be completed?

7.1.2 Documentation to be used to risk assesses the Moving and 12 Handling of patients.

7.2 How action plans are developed as a result of risk assessments 13

7.3 How Moving and Handling action plans are followed up 14

7.4 Techniques to be used in the Moving and Handling of patients, 15 including the use of appropriate equipment

7.5 Ordering equipment for Moving and Handling from the Community 16 Equipment Service

7.5.1 Provision of Moving and Handling equipment outside of the 17 Community Equipment working hours

7.5.2 Equipment Problems Out of hours 17

7.6 Stand aid Hoists 18


Section Page

7.7 Therapeutic Handling 18

7.8 Patient Handling Assessment in an Emergency 19

7.9 Very Heavy Patients (bariatric) 19

7.9.1 Equipment for Very Heavy Patients (bariatric) 19

7.10 Moving and Handling following a fall 20

8. Inanimate Load Manual Handling 20

8.1 Inanimate Loads (objects) 20

8.2 How the Organisation risk assesses the Moving and Handling 20 of inanimate loads (objects)

8.3 How action plans are developed as a result of risk assessments 21

8.4 How action plans are followed up 21

8.5 Techniques to be used in the Moving and Handling of inanimate 22 loads (objects), including the use of appropriate equipment

9. Arrangements for access to appropriate specialist Moving 22 and Handling advice.

9.1 Out of Hours 22

10. How Wirral Community NHS Trust records that all 22 permanent staff complete Moving and Handling training in line with the training needs analysis

11. How Wirral Community NHS Trust follows up staff who do 23 not complete moving and handling training

12. Action to be taken in the event of persistent non-attendance 23

13. Incident Reporting 23

14. How Wirral Community NHS Trust monitors policy compliance 23 with the following:

Duties Techniques to be used in the moving and handling of patients, including the use of appropriate equipment

Techniques to be used in the moving and handling of objects, including the use of appropriate equipment


Section Page

Arrangements for access to appropriate specialist advice

How the organisation risk asses the moving and handling of patients and objects

How action plans are developed as a result of risk assessments How action plans are followed up How Wirral Community NHS Trust records that all permanent staff complete moving and handling training, in line with the training needs analysis

How Wirral Community NHS Trust follows up those who do not complete moving and handling training

Action to be taken in the event of persistent non-attendance

15. Equality Impact Assessment 24

16. Associated documents 24

17. References 24

18. Appendices 24

Appendix 1: Manual Handling Operations Regulations 1992 26 (as amended) Guideline figures for loads

Appendix 2: People Moving and Handling Risk Assessment 27

Appendix 3: People Moving and Handling Action Plan 29

Appendix 4: Stock equipment order form 32

Appendix 5: Non-stock equipment order form 33

Appendix 6: Stand aid assessment record 34

Appendix 7: Risk Assessment for inanimate load Moving and 36 Handling

Appendix 8: Action Plan for inanimate load Moving and 37 Handling

Appendix 9: Monitoring Tool 38


1. Introduction Wirral Community NHS Trust recognises the inherent risk of injury to staff associated with Manual Handling tasks involving both patients and inanimate loads. Compliance with this policy whilst performing such tasks does not guarantee that an injury will be avoided; however, compliance with the policy will help to significantly reduce the likelihood of an injury occurring.

Wirral Community NHS Trust is committed to ensuring that when manual handling activities are undertaken, the safety of staff, patients and others will be paramount. The Trust acknowledges its duty to take all reasonable steps to reduce all incidents of injury arising from moving and handling inanimate and animate loads, through a pro-active approach to risk assessment, and timely and effective action in response to reported incidents.

It is important to recognise that there is no threshold below which manual handling becomes, or can be considered ‘safe’. All manual handling tasks contain risks, and injuries can occur regardless of age, strength, fitness or experience.

1.1 Risk Assessment

Guideline figures for loads are provided in the Manual Handling Operations Regulations 1992 (as amended). These figures are provided as guidance only (Appendix 1). A risk assessment should be carried out either when the weight exceeds the guidance figures given, or where factors regarding the task, individual, or environment affect the manual handling activity and have the potential to harm the patient and / or member of staff.

Inappropriate manual handling practices are likely to result in musculoskeletal injuries. An injury can occur as a result of one single incident of poor or inappropriate handling, but they are more commonly caused by repetitive poor handling techniques. This could include inappropriate or poor posture and positioning. Injuries to the back can also occur where there is no load being handled but solely due to poor posture.

Staff must follow this policy to ensure Trust compliance with Regulation 4 of the Manual Handling Operations Regulations 1992 (as amended) which requires employers to:

1. AVOID the need for staff to perform hazardous manual handling as far as reasonably practicable. 2. ASSESS the risk of injury from any manual handling operation or task that cannot be avoided. 3. REDUCE the risk of injury from hazardous manual handling as far as reasonably practicable for all concerned. 4. REVIEW the risk assessments at regular intervals and as and when any changes occur. The Procedure for Risk identification and management GP45 details the Risk management process and should be consulted in relation to the management of Risk assessments.


2. Statement of Intent The aim of this policy is to ensure that Wirral Community NHS Trust meets all of its statutory obligations with respect to moving and handling, and that all staff working within the Trust are informed, and understand their responsibilities and accountabilities in relation to inanimate handling and people handling.

The policy aims to:

Reduce moving and handling activities, and where these cannot be avoided,

to ensure a risk assessment approach is adopted to reduce the risk of injury.

Reduce the incidence of musculoskeletal disorders affecting staff by a marked downward trend in reported musculoskeletal disorders and associated sickness absence.

Protect patients from harm arising from poor manual handling by ensuring

best practice for moving and handling. 3. Scope

This policy is applicable to all members of staff. There is an expectation, that every member of staff will understand their accountability and responsibilities in relation to inanimate load handling and people handling.

4. Definitions

4.1 Moving and Handling Moving and Handling can be defined as any transporting or supporting of a load, including lifting, putting down, pushing and pulling, carrying or moving, by hand or bodily force. It could involve one or more staff, and the use of equipment.

4.2 Load The term ‘load’ is a generic term which includes people, objects or equipment.

4.3 Staff The term ‘staff’ is used throughout this policy to include Wirral Community NHS Trust employees, volunteers, agency staff, temporary staff and students.

4.4 Competent Person A person can be deemed as competent on the basis that they have sufficient training and experience or knowledge to enable them to identify hazards, assess their importance and put measures in place to reduce risk of injury to all concerned.

4.5 Risk Assessment A systematic review of all work activities and working environments to identify hazards and develop control measures that eliminate, reduce or control risk in order to produce safer worker conditions for staff and/or patients.


4.5.1 Hazard A Hazard is anything with the potential to cause harm, injury, damage or loss.

4.5.2 Risk Risk is the combination of the likelihood of harm, injury, damage or loss occurring and the consequences should it occur.

4.5.3 Likelihood The chance of an incident recurring

4.5.4 Consequence The harm expected should an incident occur

4.5.5 Control Measures Actions, procedures, protocols, physical controls etc designed to eliminate, reduce or control risk presented by exposure to the hazard.

5. Duties / Responsibilities: Individuals

5.1 Chief Executive

The Chief Executive has overall responsibility for ensuring that Wirral Community NHS Trust is meeting its legal responsibilities with regards to Health and Safety, including Moving and Handling.

5.2 Director of Quality and Governance

The Director of Quality and Governance is responsible for ensuring that Serious Untoward Incidents associated with moving and handling are appropriately escalated both internally within the Organisation, and externally as appropriate, for example via the Strategic Executive Information System (StEIS); and are appropriately investigated.

5.3 Head of Quality and Governance

The Head of Quality and Governance is responsible for supporting Wirral Community NHS Trust in relation to risk management issues associated with moving and handling, and promoting best practice. The Head of Quality and Governance is responsible for ensuring that moving and handling incidents are appropriately managed and investigated; with any lessons learned being appropriately disseminated throughout the Organisation.

5.4 Health and Safety Advisor

The Health and Safety Advisor has a duty to ensure that that all staff incidents which meet the RIDDOR reporting criteria, will be RIDDOR reported, when the member of staff has been absent from work, due to the reported incident, for a period of seven days (not including date of injury occurrence).


The Health and Safety Advisor will investigate all RIDDOR reportable injuries as per the incident reporting policy (GP8), and will provide advice and support to staff during the investigation process.

5.5 Divisional Managers / Heads of Service

Divisional Managers / Heads of Service are responsible for ensuring that this policy is implemented throughout their Division / Service; and that unmitigated moving and handling risks are escalated as per the Procedure for Risk Identification and Management Policy (GP45).

Divisional Mangers / Heads of Service will ensure that appropriate systems are in place for staff to comply with their mandatory training requirements

5.6 Service Leads

Service Leads are responsible for:

Ensuring that all moving and handling incidents are appropriately reported via the Datix incident reporting system; and for ensuring that the incident review process commences within 48 hours from date of incident reporting.

Ensuring Moving and Handling risk assessments are conducted and reviewed within their area of service responsibilities. Reviewing attendance of training within their area of service responsibility. Alerting the Divisional Manager if staff are not attending mandatory training.

5.7 Moving and Handling Advice Team

The Moving and Handling Advice Team will provide advice and support to staff regarding moving and handling risk assessments and for the development of patient specific action plans.

The team will provide moving and handling training to clinical staff via the Clinical Essential Learning Programme, and delegate responsibility to appropriately trained staff, to deliver moving and handling training to non-clinical staff via the Non-Clinical Essential Learning Programme.

5.8 Community Equipment Service Manager

The Community Equipment Service Manger has a duty to ensure the following:

The timely delivery of moving and handling equipment to patients. The management and monitoring of the service maintenance and inspection contract for all mechanical lifting equipment ensuring compliance with the Lifting Operations and Lifting Equipment Regulations (1998) and with Medical Devices Management Policy (GP48).

Ensuring an up-to-date equipment inventory, including mechanical handling equipment.


5.9 Team Leaders In addition to the responsibilities documented in point 5.10, Team Leaders are responsible for:

Ensuring the appropriate completion of moving and handling risk assessment and action plans.

Disseminating the results of any completed moving and handling risk assessments and action plans to all team members.

Raising any moving and handling concerns that cannot be sufficiently managed through the available resources to the Service Lead.

Team Leaders working within clinical services are responsible for ensuring staff within the team appropriately order equipment for patients in accordance with their agreed competencies.

Reviewing incidents.

5.10 Staff

All staff are responsible for: Following current best practice evidence in both inanimate load and people

handling. Taking care of their own health and safety and that of others who may be

affected by their acts or omissions. Co-operating with their managers in the implementation of safer moving and

handling practice. Risk assessing moving and handling tasks and completing the relevant documentation where required.

Ensuring the appropriate ordering of equipment for patients, in accordance with the competencies agreed with their line manager.

Ensuring they do not use handling aids or equipment unless they have receive appropriate instruction or training.

Reporting to their line manager or senior member of staff on duty if they are unsure of any handling procedure or any task they consider to pose a risk of serious or imminent danger to themselves or other.

Ensuring all mechanical and smaller handling aids are inspected prior to every use to check for obvious signs of defects, ensuring safety and mechanical lifting equipment has been serviced / inspected within a six monthly period, to ensure compliance with the Lifting Operations and Lifting Equipment Regulations (1998) LOLER.

Attend moving and handling training as per the Trust’s mandatory training matrix.

Report any incidents or near misses or unsafe practice to their line manager, and via the Datix incident reporting system.

Wearing appropriate clothing and footwear when working in a clinical area or delivering direct patient care.

Reporting any disability, ill health, or if they are a new or expectant mother to their line manger.


6. Duties / Responsibilities – Committees 6.1 Trust Board

The Trust Board have overall responsibility for ensuring that the Trust delivers high quality services that are efficient and effective.

The Trust Board is made up of the Chairman, Chief Executive, Executive Directors, Medical Director and Non-Executive Directors. The Trust Board oversee the running of the Trust, make the decisions that shape future direction, monitor performance and ensure accountability.

The Trust Board will:

Review moving and handling risks and associated action plans that have been escalated by the Quality and Governance Committee.

Review moving and handling risk and associate action plans for mitigation or reduction in the level of risk which score 15 or above using the Trust risk scoring matrix, as per the Procedure for Risk Identification and Management (GP45).

6.2 Quality and Governance Committee

The Quality Governance Committee will advise Wirral Community NHS Trust Board of all significant moving and handling risks which have been escalated to the Trust Risk Register.

6.3 Quality, Patient Experience and Risk Group

The Quality, Patient Experience and Risk Group will:

Review and monitor any service level risks and escalate risk which score 15 or above to the Quality and Governance Committee, as per the Procedure for Risk Identification and Management (GP45).

Review and monitor any National Institute for Health and Clinical Excellence (NICE) guidance which is relevant to the Trust and escalate, when appropriate, to the Quality and Governance Committee.

Review and monitor any action plans which are developed as a result of National Patient Safety Agency (NPSA) alerts or from complex Root Cause Analysis (RCA) investigations and escalate, when appropriate to the Quality and Governance Committee.

6.4 Health Safety Wellbeing Group

The Health Safety Wellbeing Group will:

Raise awareness of any significant risks within the organisation and ensure these are included on business or corporate risk registers as appropriate.

Receive regular performance assurance reports from all services including evidence of compliance against policies and standards.

Review and monitor reported incidents of falls to staff, public and visitors, and moving and handling incidents and injuries.


Escalate incidents to the Quality and Governance Committee, as per the Procedure for Risk Identification and Management (GP45).

6.5 Divisional Governance Meetings

Each Division will have a Divisional Governance Meeting which will:

Discuss, agree and monitor action plans for risks belonging to their Division. Ensure significant risks are recorded using the Divisional risk register. Escalate risk issues which score 12 or above using the Trust risk matrix to the Quality, Patient Experience and Risk Group. Review incidents, complaints and claims which occur in the Division. Discuss audit findings and implementation of action plans.

7 People and Patient Moving and Handling

7.1 How the Organisation risk assesses the moving and handling of patients

7.1.1 When must a patient moving and handling risk assessment be completed?

An individual manual handling risk assessment must be carried out on any patient receiving intervention by Wirral Community NHS Trust staff, in circumstances where the member of staff has to assist the patient with moving and handling as part of the required clinical intervention.

Completion of a manual handling risk assessment must always be considered on the first clinical contact the patient has with a Wirral Community NHS Trust Service.

The risk assessment and any resulting action plans developed by Wirral Community NHS Trust staff are only to be used by the Organisation’s staff, as per the definition of ‘staff’ on page 6 of this policy.

Wirral Community NHS Trust staff must not complete moving and handling risk assessments for staff employed by or within any other organisation, for example Care Home staff, or domiciliary care staff.

7.1.2 Documentation to be used to risk assesses the moving and handling of patients

Where Wirral Community NHS Trust staff identify that a patient referred to their employing Service requires assistance with moving and handling as part of the required clinical intervention, a manual handling risk assessment form must be completed.

All staff completing a patient moving and handling risk assessment form, must have attended moving and handling training as per the Trust’s mandatory training needs matrix.


A copy of the patient moving and handling risk assessment can be found in Appendix 2.

The risk assessment form is designed to identify the characteristics of the patient concerned, and to give each aspect a numerical value. Where there is a variable figure given, a decision needs to be made as to the degree of severity of that aspect and the total score represents a measure of the level of risk. Any comments can be made for each aspect to help clarify the individual patient’s requirements or needs, providing the clinical evidence for variable scores awarded. A completed copy of the moving and handling risk assessment must be retained within the patient’s Health Care Record, accessible to any members of Wirral Community NHS Trust staff involved in the patient’s care.

The outcome of the patient moving and handling risk assessment must be communicated to the team leader. The team leader is responsible for communicating the outcome of the risk assessment to all team members.

Where clinical services retain documentation in both the patient’s home and at the office base, the outcome of the risk assessment must be clearly recorded in both sets of notes.

Where a total score of 10 or more is obtained on completion of the patient moving and handling risk assessment a specific handling action plan must be completed.

Where a total score of 10 is not reached there is not a requirement for staff to complete a moving and handling specific handling action plan.

Irrespective of the initial risk score, all risk assessments must be reviewed as a minimum six monthly, or on identification of clinical changes in the patient’s condition which directly impact on their moving and handling requirements.

7.2 How action plans are developed as a result of risk assessments

Once the moving and handling risk assessment has been completed, a total will be given. If the score is ten or more, a specific individual patient handling action plan must be completed by the member of staff who has completed the risk assessment.

The purpose of the action plan is to detail actions, techniques or equipment to be used, to reduce or control the risks identified with the required level of patient moving and handling to deliver clinical care. The action plan should support safe systems of work for staff, whilst promoting patient safety.

Where complex patient moving and handling risk have been identified, staff should contact Wirral Community NHS Trust’s Manual Handling Advice Team for guidance and support when completing the risk assessment and action plan. The contact details for the Team can be found in section 9 of this policy.

All staff completing a specific individual patient moving and handling action plan, must have attended moving and handling training as per the Trust’s mandatory training needs matrix.


A copy of the specific individual patient moving and handling action plan can be found in Appendix 3.

The action plan will identify the requirements for each type of activity where there is staff involvement. It should include the number of staff required to deliver that aspect of care, as well as any equipment that should be used. Where hoisting equipment is to be used, the make and model of the equipment must be documented once it has been delivered to the patient.

A completed copy of the specific patient moving and handling action plan must be retained within the patient’s Health Care Record, accessible to any members of Wirral Community NHS Trust staff involved in the patient’s care.

The outcome of the specific patient moving and handling action plan must be communicated to the team leader.

The Team Leader is responsible for communicating the outcome of the action plan to all team members. The Team Leader is responsible for ensuring that staff conducting clinical intervention with the patient, have the required skills and competency to follow the action plan. This can be conducted by the deputy Team Leader or senior staff on duty, in the absence of the Team Leader.

Staff who require additional support or guidance with any techniques or equipment detailed in the specific patient moving and handling action plan, must in the first instance report this to their immediate line manager. Where resolution within the team is not possible, the Manual Handling Advice Team must be contacted for additional guidance, support and training.

Where clinical services retain documentation in both the patient’s home and at the office base, the outcome of the specific moving and handling action plan must be clearly recorded in both sets of notes.

The patient specific moving and handling action plan must be communicated to the patient, with the aim of maximising patient engagement with the documented plan of care.

7.3 How moving and handling action plans are followed up

Patient specific moving and handling action plans will be consulted by each member of staff prior to moving and handling a patient.

The patient specific moving and handling action plan must be reviewed as a minimum six monthly, or on identification of clinical changes in the patient’s condition which directly impact on their moving and handling requirements.

Any changes to the patient specific moving and handling action plan must be clearly documented in the patient’s Health Care Record, and where appropriate the patient records held with the office base.


Any changes to the moving and handling action plan must be communicated to the patient, with the aim of maximising patient engagement with the documented plan of care.

7.4 Techniques to be used in the moving and handling of patients, including the use of appropriate equipment

Patients should be encouraged to mobilise and assist in their own transfers where possible.

Wirral Community NHS Trust staff must only use the approved technique as outlined below, following a risk assessment; no other technique is to be used.

Staff must always encourage patients to remain as independent as possible and use the following agreed techniques for the moving and handling of patients:

Sit to stand transfer: One / two staff with or without the use of a handling belt or other equipment

Assisted walking: One / two staff with or without the use of a handling belt

Sitting to sitting transfer: One / two staff with or without a transfer board handling belt, rota stand, stand aid, mobile hoist or ceiling track hoist

Lying to sitting: Use of a profiling bed should be considered if appropriate, two staff with or without a handling sheet, slide sheet or hoisting equipment

Repositioning in bed: Two staff using a slide sheet or hoist

Lateral transfer from bed to stretcher trolley: A minimum of four staff and the use of a hard transfer board (Pat slide) and two slide sheets must be used

Emergency handling (Falling Person): Where the patient falls towards the staff, they may be able to support the patient and lower them to the floor - taking into consideration their own Health and Safety

Assisting from the floor: Staff must encourage the patient to get up by using the backward chaining method if they are capable and there is no clinical reason for staff to assist. If assistance is required, equipment must be used, for example a hoist

A front assisted stand may only be used by appropriately trained physiotherapists in therapeutic handling and as part of therapeutic handling treatment, following an appropriate risk assessment – not as a standard transfer technique.

Staff must not use the following transfer techniques which are considered unsafe both to the staff and the patient:

a. Drag lift (underarm lift) b. Orthodox lift (cradle lift) c. Through arm lift


d. Australian lift (shoulder lift) e. Front assisted stand and pivot transfer.

7.5 Ordering equipment for moving and handling from the Community Equipment Service

Following a patient moving and handling risk assessment, the assessing Clinician may be required to order equipment to assist with patient moving and handling. This must be clearly documented in the patient specific moving and handling action plan.

Only staff who are Ordering Officers are able to order equipment from the Community Equipment Service. To become an Ordering Officer staff must have had the equipment ordering system fully explained to them, during a visit to the Community Equipment Service. Once this visit has been conducted, the member of staff will be added to the equipment ordering system. This visit can be conducted at any time during the staff member’s employment, as determined by their direct line manager.

To order equipment, the ordering officer must complete an equipment requisition form. The appropriate requisition form must be used, depending on whether the equipment is a stock item (Appendix 4) or a non stock item (Appendix 5).

Completed requisition forms can be faxed or e-mailed to the Community Equipment Service in and out of hours, using the following contact details:

Fax Number: 0151 334 9139

E-mail: [email protected] Orders will be inputted on the ordering system by Community Equipment Service staff as they are received, or during the Community Equipment Services next working day, which are as follows, Monday – Friday (excluding Bank Holidays):

Monday / Wednesday / Friday 08:00hrs – 16:30hrs

Tuesday / Thursday: 08:00hrs – 18:30hrs

The Community Equipment Service aim to deliver all stock equipment items within seven working days from date of entry on to the Community Equipment Service ordering system.

Delivery for non-stock equipment items will vary depending on the supplier.

It is the responsibility of the ordering officer to contact the patient to establish when the equipment has been successfully delivered; and to contact the Community Equipment Service where delays in equipment delivery have been identified.

Once delivery of equipment has been confirmed with the patient, the ordering officer must ensure that a home visit is conducted to the patient to confirm the suitability of the equipment with the patient.

mailto:[email protected]


Equipment checks can be delegated to another ordering officer within the team, by the initial ordering officer or team leader / nurse in charge for staff working within the Community Nursing Service.

The patient specific action plan will identify the requirements for each type of activity where there is staff involvement. It should include the number of staff required to deliver that aspect of care, as well as any equipment that should be used. Where hoisting equipment is to be used, the make and model of the equipment must be documented once it has been delivered to the patient.

The patient specific moving and handling action plan including the use of equipment, must be communicated to the patient, with the aim of maximising patient engagement with the documented plan of care.

7.5.1 Provision of Moving and Handling equipment outside of the Community Equipment working hours

Delivery of equipment will occur during the Community Equipment Service hours of operation, as per section 7.5 of this policy. Outside of these hours, Community Nursing staff are able to access slide sheets from out of hours stores located at Field Road, Eastham Clinic and Port Causeway, to assist with patient moving and handling.

Provision of slide sheets directly from the out of hours stores must be supported by a completed patient specific risk assessment (Appendix 2) and action plan (Appendix 3).

7.5.2 Equipment Problems Out of hours

Errors and malfunctioning Moving and Handling and Handling equipment which are identified by staff during the Out of hours periods, must be reported to the on-call service engineers, via the G.P. Out of Hours Service, contactable via telephone number: 0151 678 8496.

The G.P. Out of Hours Service is operation during the following hours:

Monday – Friday: 18:30hrs – 08:00hrs

Saturday, Sunday and Bank Holidays: 24hr Service is available (08:00hrs – 08:00hrs).

This telephone number can also be used by members of the public, for example patients, relatives and carers, to report malfunctioning equipment identified out of hours.

The Service and Call Out Procedure for equipment is detailed in the Incident Reporting Policy (GP8). This includes arrangements for the out of hours repairs to dynamic mattresses, which is provided by Direct Healthcare Services on telephone number 0845 459 9836, accessible via the Community Nursing Service.


7.6 Stand aid Hoists Stand aid hoists enable patients to participate during transfers; however, there is a risk of the patient falling through the sling if inappropriately assessed. Due to the additional considerations required when assessing a patient for a stand aid hoist, only staff who have received specific training in stand aid risk assessment, action planning and ordering, via a Manual Handling Advisor, can order a stand aid hoist via the Community Equipment Service.

Where there is any doubt regarding the knowledge level of the ordering officer with regards to patient specific stand aid hoist risk assessments, action plans or ordering authorisation, the Moving and Handling Advice Team must be contacted.

In addition to a patient specific Moving and Handling Risk Assessment (Appendix 2) a Stand aid Assessment Record (Appendix 6) must be completed by the assessing Clinician who has received the required level of stand aid hoist training.

The stand aid assessment must consider the following:

Is the patient able to bear some weight through their feet Is the patient able to maintain head and trunk / upper body control and weight bear for the duration of the equipment use? Is the patient able to follow instructions and co-operate with the task? Is the equipment required for regular and frequent use? Is the patient free from uncontrolled / unpredictable behaviour and / or movements Is the patient able to tolerate the sling without risk of shoulder subluxation? Does the carer have the physical and cognitive ability to operate the equipment?

Is the patient’s weight compatible with the 19 stone safe working load of the stock stand aid equipment provided by the Community Equipment Service?

The ordering officer must conduct an equipment review as a minimum three monthly; this can only be delegated by the ordering officer, to a member of staff who is also an ordering officer for stand aid hoists, having received specific training in stand aid risk assessment, action plans and ordering via a Manual Handling Advisor.

The Moving and Handling Advice Team can be contacted for advice and support regarding stand aid training, risk assessments, action plans and the ordering process.

7.7 Therapeutic Handling

Patient moving and handling should be distinguished from therapeutic handling which involves physiotherapy, occupational therapy massage and manipulation. Therapeutic handling may involve the use of techniques to facilitate normal movement with which the patient is required to participate. These techniques may seem contrary to safe patient handling practice ie. transfers, but will require specific training and competency to carry out.


The service specific training matrix details specific training needs that are in addition to the Trust wide mandatory training matrix, this will include training for Therapeutic handling for relevant staff.

7.8 Patient Handling Assessment in an Emergency

The manual handling of patients should be avoided, so far as reasonably practicable in all but exceptional life threatening situations, such as:

A person is in water in immediate danger of drowning A person is in an area that is on fire or is filling with smoke A person is in danger from bombs or bullets A person is in danger from a collapsing building or other structure Any perceived life threatening situation

7.9 Very Heavy Patients (bariatric)

A patient who weighs at least 25 stone or more than 120% of their ideal body weight is classed as a Bariatric patient.

When a Bariatric patient is being discharged from one Organisation following an episode of care, for example an Acute Hospital Trust or a Hospice, to the care of Wirral Community NHS Trust Community Nursing staff; the discharging organisation and receiving clinical team must work collaboratively to ensure that all equipment is in place prior to the patient’s discharge.

It is best practice for the discharging organisation to arrange a case conference, to include representation from Wirral Community NHS Trust to discuss complex patient discharges which require the provision of specialist equipment.

It is the responsibility of the receiving Clinical Team to conduct a patient moving and handling risk assessment (Appendix 2) and patient specific action plan (Appendix 3) for use by Wirral Community NHS Trust staff.

The Moving and Handling Advice Team can be contacted via the contact details in section 9 of this policy, if clinical teams require advice and support with any bariatric moving and handling enquiries.

7.9.1 Equipment for very heavy patients (bariatric)

The Community Equipment Service stock a range of equipment which can accommodate patients who weight in excess of 25 stone.

As a guide, the following equipment considerations should be made when assessing very heavy patients:

Safe working load Adequate internal proportion (width and depth) so as to accommodate the patient


Suitable height The breaking wheel locking mechanism Robust construction Compatibility with the environment, for example strength of floor Compatibility with any other piece of equipment to be used

The Following should also be considered:

Does the equipment have integral weighing scales? Is the equipment power assisted? Can the equipment be adjusted? Do the arms / sides detach? Does the equipment profile? Can the patient operate the equipment if required?

The Moving and Handling Advice Team can be contacted to support staff when ordering equipment for bariatric patients.

7.10 Moving and Handling following a patient fall

Following a witnessed fall, or when a patient is found on the floor (fall un-witnessed) and there are signs and symptoms of, or suspected fractures, spinal injuries and head injuries, then staff must not move the patient by hand or hoist. Staff must keep the patient comfortable and as still as possible and seek urgent medical advice from a doctor or paramedic service via 999.

If staff have any doubt as to possible injury, they must not move the patient.

8. Inanimate Load Manual Handling

8.1 Inanimate Loads (objects)

Inanimate loads are any load that is not a person or an animal. Loads can be almost anything, common examples include:

Something that is heavy and/or awkward Furniture Cleaning, office or ward equipment Laundry Equipment Patient Health Care Records

8.2 How the Organisation risk assesses the moving and handling of inanimate loads (objects)

All moving and handling related activities that cannot be reasonably avoided should be risk assessed, in accordance with the Procedure for Risk Identification and Management (GP45).


All inanimate load (objects) moving and handling risk assessments must be documented on the Trust’s generic risk assessment form (Appendix 7).

The manual handling risk assessment process identifies the hazards and risks associated with a particular activity and the control measures required to reduce the risk to its lowest acceptable level. The risk assessment process includes looking at the Load, Individual, Task and Environment (LITE).

Risk Assessment should always be readily available for reference by all staff, and must be produced when requested by the Divisional Manager / Head of Service, Service Lead, Health and Safety Advisor and Governance Team.

The risk assessment will:

Be completed prior to undertaking any new significant task or using new

equipment. Be current. Contain sufficient detail to anticipate and record all the reasonably foreseeable hazards and other factors that relate to the complete handling task. Identify long and short term risk reduction solutions. Be updated at least every six months, or more frequently should significant elements of the risk assessment change, or if there is reason to believe that the existing control measures are inadequate.

Staff need to be informed of the findings and controls put in place All service manual handling risk assessments must be held by the Team Leader/ Service Lead / Head of Service within the office base, and should be reviewed as a minimum on a six monthly basis; the time scales for review must be followed in accordance with the Procedure for Risk Identification and Management (GP45).

8.3 How action plans are developed as a result of risk assessments

Action plans are developed where further action is identified following completion of the Risk Assessment to reduce risk, an action plan is required to be developed in accordance with the Procedure for Risk Identification and Management (GP45).

The purpose of the action plan is to detail actions, techniques or equipment to be used, to reduce or control the risks identified with the required level or inanimate load moving and handling. The action plan should support safe systems of work for staff.

A copy of the generic action plan, which should be completed for inanimate load moving and handling can be found in Appendix 8 of this policy.

8.4 How action plans are followed up

Action plans should be followed up and reviewed by the relevant Service Leads / Head of Service as a minimum six monthly, or on identification of changes to the original risk assessment and action plan.


The developed action plan must be monitored in line with the Risk Assessment, and reviewed at the appropriate Governance / Divisional Governance meeting in accordance with the Procedure for Risk Identification and Management Policy GP45.

8.5 Techniques to be used in the moving and handling of inanimate loads (objects), including the use of appropriate equipment

Staff must follow the advice and guidance for the handling of loads or objects:

Loads must be handled at waist height and close to the body wherever possible Use of equipment must be considered to assist with the transporting of loads, such as ‘sack’ trolleys

Staff must keep their head upright, spine in line (no twisting) and bend at their hips and knees when lifting a load to maintain a correct posture Staff must ensure they have a safe, secure grip when handling a load Staff must not handle loads where they have uncertainty concerning their ability Do not adopt a stooped static posture for extended periods.

9. Arrangement for access to appropriate specialist advice

All members of staff can obtain Moving and Handling advice and support from Wirral Community NHS Trust Moving and Handling Advice Team. The advice team are contactable via the Quality and Governance Service during weekly working hours: Monday – Friday 09:00hrs – 17:00hrs, excluding bank holidays.

Telephone Number: 0151 514 2202 E-mail: Q&[email protected]

The Moving and Handling Advice Team can provide support with risk assessments and the development of action plans.

9.1 Out of Hours

Moving and Handling advice and support which is required outside of the days and hours covered by the Moving and handling Advice Team, can be sought from the on- call Duty Manager.

Full details of the on call arrangements including reporting pathways can be found in the On Call Managers Pack provided to on call duty managers, as per Wirral Community NHS Trust’s Incident Reporting Policy (GP8).

10. How Wirral Community NHS Trust records that all permanent staff complete moving and handling training in line with the training needs analysis

Manual handling training (Non-people moving) is a mandatory requirement for both clinical and non clinical staff as detailed in the Trust’s core mandatory training Matrices.

Staff required to attend people moving handling training are identified in the Trust’s core mandatory training matrices.

mailto:Q%[email protected]


All core mandatory training is recorded centrally by the Quality and Governance service. Quarterly monitoring reports are prepared for the Learning and Development Group and Divisional managers to monitor attendance rates. Full details of the processes in place for managing and monitoring attendance are set out in the Policy for Learning and Development GP46.

Staff attendance at mandatory training is also monitored at Divisional Governance Group meetings.

11. How Wirral Community NHS Trust follows up staff who do not complete moving and handling training

The process for following up staff who do not complete mandatory moving and handling training in line with the Trust training matrices, is detailed in the Learning and Development Policy (GP46).

12. Action to be taken in the event of persistent non-attendance

Action to be taken in the event of persistent non-attendance of mandatory moving and handling training in line with the Trust training matrices, is detailed in the Learning and Development Policy (GP46).

13. Incident Reporting

Staff must ensure prompt reporting of any incident relating to Moving and Handling to facilitate timely investigation where appropriate, maximise Organisation learning, with the aim of reducing incident reoccurrence.

All Moving and Handling incidents must be reported via the Datix incident reporting system. In addition to this, staff must report the incident to their line manger / team leader on duty.

In accordance with General Policy 8: Incident Reporting, all serious Moving and Handling incidents which occur out of hours, must be reported to the on-call Trust Manager.

14. How Wirral Community NHS Trust monitors policy compliance with the following sections:

Wirral Community NHS Trust monitors compliance of the following sections, as per the processes outlined in Appendix 9.

Duties Techniques to be used in the moving and handling of patients, including the use of appropriate equipment

Techniques to be used in the moving and handling of objects, including the use of appropriate equipment Arrangements for access to appropriate specialist advice How the organisation risk asses the moving and handling of patients and objects


How action plans are developed as a result of risk assessments How action plans are followed up How Wirral Community NHS Trust records that all permanent staff complete moving and handling training, in line with the training needs analysis

How Wirral Community NHS Trust follows up those who do not complete moving and handling training Action to be taken in the event of persistent non-attendance

15. Equality Impact Assessment

In line with the Trust’s Equality Scheme, each procedural document should be screened using the Policy Equality Impact Assessment Screening Tool by the manager responsible for its development, to consider whether there is an equality dimension or whether it is applicable to the Trust’s duty to promote equality. The equality screening process and any wider impact assessment should be forwarded with the policy when approved to the Compliance Officer.

As part of its development, this policy and its impact on equality have been reviewed as described above. The purpose of the assessment is to minimise and if possible remove any disproportionate impact on employees on the grounds of race, sex, disability, age, sexual orientation or religious belief. No detriment was identified.

16. Associated documents

General Policy 8: Incident Reporting Policy General Policy 45: Procedure for Risk Identification and Management Policy. General Policy 46: Learning and Development Policy. General Policy 48: Medical Devices Management Policy

17. References

Manual Handling Operations Regulations 1992, Health & Safety Executive Lifting Operations & Lifting Equipment Regulations 1998, Health & Safety Executive,

18. Appendices

Appendix 1: Manual Handling Operations Regulations 1992 (as amended) Guideline figures for loads

Appendix 2: People Moving and Handling Risk Assessment

Appendix 3: People Moving and Handling Action Plan

Appendix 4: Stock equipment order form

Appendix 5: Non-stock equipment order form Appendix 6: Stand aid assessment record


Appendix 7: Risk Assessment for inanimate load Moving and Handling Appendix 8: Action Plan for inanimate load Moving and Handling

Appendix 9: Monitoring Tool


Appendix 1 Manual Handling Operations Regulations 1992

(as amended) Guideline figures for loads Safe guidelines on maximum weight limits in the workplace and how the weight a person can hold will alter when held at different heights and distances from the body. These are guides only and individual capability should be considered.


Appendix 2






Mr/Mrs/Miss/Master

Appendix 4 Stock Equipment Ordering form

COMMUNITY EQUIPMENT SERVICE Tel: 0151 334 9139

STANDARD STOCK ORDER FORM Instructions

for the completion of this form:

Use Block Capitals and FAX copy to (0151) 482 8610. All information is mandatory. Failure to complete will result in your order being returned.

ORDERING OFFICER CLIENT DETAILS

Full Name Title Department Surname Tel No: First Name Dept Fax No: DOB Assessment Date Address Decision to Supply Date Signature GP Practice Postcode

Tel No: Hospital Discharge Y N Alternative Tel No: Discharge Date Ethnicity Code

STANDARD STOCK ITEMS ONLY

Quantity Stock Code Description Driver fit required

NB: Store staff do not fit bed rails, bed leavers and PRE mattresses. All other equipment will be fitted unless you indicate ‘N’ in the end column above.

INSTRUCTIONS/OTHER RELEVANT INFORMATION

Instruction leaflet required in: Language Format:

NB: Please include any relevant information that may affect delivery of the above items, e.g. access problems, sensory problems or other risk information. Please indicate all fitting heights in the instruction box above


Mr/Mrs/Miss/Master

Appendix 5 NON STOCK EQUIPMENT ORDER FORM

COMMUNITY EQUIPMENT SERVICE Tel: 0151 334 9139

NON STANDARD STOCK ORDER FORM

Use Block Capitals and FAX copy to (0151) 482 8610. All information is mandatory for all items you are ordering. You must include Quantity, Supplier stock code, supplier item description, price and Supplier’s details. One form must be submitted per Supplier

ORDERING OFFICER CLIENT DETAILS Full Name Title Department Surname Tel No: First Name Dept Fax No: DOB Assessment Date Address Signature Non Stock Q’naire attached

AUTHORISING OFFICER Postcode

Full Name Tel No: Title Alternative Tel No: Tel No: GP Decision to Supply Date Practice Signature Ethnicity Code

NON STOCK EQUIPMENT TO BE ORDERED Quantity Supplier Stock Code Supplier Item Description Price (exc. VAT)

SUPPLIER’S INFORMATION Name Address

Tel No

INSTRUCTIONS/OTHER RELEVANT INFORMATION

Instruction leaflet required in: Language Format: NB: Please include any relevant information that may affect delivery of the above items, e.g. access problems, sensory problems or other risk information.

CONTINUING HEALTH/COMPLEX CARE APPROVAL ONLY _

Decision to Supply Date

Signature of Director

Appendix 6

Standaid Assessment Record

Name of Patient Date of Birth

Address

INITIAL ASSESSMENT REVIEW ASSESSMENT Date Date Date Date Date

Is patient unable to stand independently? Yes No Yes No Yes No Yes No Yes No

Is patient able to maintain head and trunk/ upper body control and weight bear for the duration of the equipment use?

Yes No Yes No Yes No Yes No Yes No

Is patient able to follow instructions and co-operate with task?


Is equipment required for regular and frequent use? Yes No Yes No Yes No Yes No Yes No

Is the patient free from uncontrolled/unpredictable behaviour and/or movements?


Is the patient able to tolerate sling without risk of shoulder subluxation?


Does the carer have the physical and cognitive ability to operate the equipment?


Is the client’s weight compatible with the 19 stone SWL of the stock standaid equipment?


Note: If any answer to the above questions is NO, then Standaid provision is not appropriate

RECOMMENDATIONS: Patient fulfils criteria for Standaid provision Yes No Yes No Yes No Yes No Yes No

Assessor

Signature

Designation

Date

HANDOVER CHECKLIST Yes No Yes No Yes No Yes No Yes No Maintenance of safe environment for equipment use explained

Safe use of equipment demonstrated to client and/or carer

Action to take in event of change in client’s/carer’s abilities

Action to take in event of equipment failure/other emergency with equipment

Emergency contingency plan agreed

3 MONTHLY MINIMUM equipment review arrangements/ implications discussed

Handover Officer

Signature

Designation

Date


Risk Assessment Form

Appendix 7 Risk Assessment for inanimate load Moving and Handling

Location/Activity: Assessment date:

Assessor: Signature: Review date:

Ref

Hazards

Risks

People at risk

Current Control Measures

L x C = R

Is further action required (Y/N)

If applicable

Patient’s Name:

Patient’s DOB:

Male Female Tick as appropriate


Appendix 8

Action Plan for inanimate load Moving and Handling

Risk Assessment Action Plan

Location/Activity: Assessment date:

Assessor: Signature: Review date:

Ref

Further Actions to be Implemented

Responsible Person

Revised Risk rating

L x C = R

Are further assessments required if so list.

e.g. COSHH, DSE

Short Term

Medium Term

Long Term


Appendix 9

Process for Monitoring Compliance with the Procedure for Moving & Handling

Minimum requirement to be monitored

Process for monitoring (e.g. audit)

Responsible individual / group/ committee

Frequency of monitoring

Evidence

Responsible individual for development of action plan

Responsible committee for monitoring of action plan and Implementation

Duties

Staff Performance Development Reviews

Review of Policy

Service Leads / H.R.

QPER Group

Once annually during a financial year.

H.R. exception reports.

Policy Review

Head of H.R.

Manual Handling Team

Education and Workforce Committee


How the organisation records that all permanent staff complete moving and handling training, in line with the training needs analysis.

Quarterly learning and development monitoring reports.

Learning and Development Group.

Quarterly

Quarterly Reports.

Quality and Development Manager


How the organisation follows up those who do not complete moving



Quarterly

Quarterly Reports.








Evidence



and handling training.

Action to be taken in the event of persistent non- attendance.



Quarterly

Quarterly Reports.



Techniques to be used in the moving and handling of patients and objects, including the use of appropriate equipment.

Trend analysis of reported moving and handling incidents.

Quality, Patient Experience and Risk Group.

Monthly

Quality Report

Head of Nursing, Quality and Governance


Arrangement for access to appropriate specialist advice.

Report of referrals to the Moving and Handling Team.


A minimum of once per financial year

Copy of Report

Patient Safety Advisor


How the organisation risk assesses the moving and handling of

Audit of completed risk assessments.

Quality, Patient Experience

Once annually during a

Copy of Audit Report








Evidence



patients and objects. and Risk Group.

financial year.

How action plans are developed as a result of risk assessments.

Audit of developed action plans.






How action plans are followed up.

Review of minutes of Divisional Governance Meetings.

Compliance Audit.



Minutes of monthly Divisional Governance group meetings




Documents

MOVING AND HANDLING POLICY GENERAL … Moving...7.4 Techniques to be used in the Moving and Handling of patients, 15 including the use of appropriate equipment 7.5 Ordering equipment