Managing Health at Work Partnership Information Network (PIN) Guideline

MANAGING HEALTH AT WORK

APPENDIX 4.B
Model manual handling policy

1 Introduction

1.1 In [Name of organisation], we recognise the risk of musculo-skeletal injury faced by staff from manual-handling operations. This policy has been developed in accordance with the relevant legislation, in particular:

• Health and Safety at Work Act 1974;

• Management of Health and Safety at Work Regulations (1992);

• Manual Handling Operations Regulations (1992); and

• Lifting Operations and Lifting Equipment Regulations (1998).

1.2 Although an organisation-wide approach has been established, detailed arrangements for controlling manual-handling risks remain the responsibility of Directors, Heads of Service and operational managers. All departmental health and safety policies should deal with the manual-handling risks arising in the course of the work of the department.

1.3 This policy and its procedures have been developed and agreed through the local Partnership Forum.

2 Principles

2.1 [Name of organisation] is committed to applying a safe system of work to all manual-handling situations as defined in the Manual Handling Operations Regulations (1992), that is: any lifting, putting down, pushing, pulling, carrying or moving of a load by hand or by bodily force.

2.2 We are committed to a policy of minimal lifting - in other words, promoting the elimination of all whole- or near whole-body when lifting patients.

2.3 We are committed to eliminating, so far as is reasonably practicable, manual-handling operations which incur a significant risk of injury, or otherwise reduce the level of risk to the lowest level reasonably practicable. To facilitate this we are committed to providing:

• risk assessment;

• adequate manual-handling training;

• manual-handling equipment; and

• guidance on site.

2.4 This policy will be reviewed annually, and registered holders of the Health and Safety Control Book / Health and Safety Manual will be notified of amendments.

3 Policy aims

This policy aims to:

• meet the general commitments to the health and safety of staff described in the Risk Management and Health and Safety policy;

• get rid of manual-handling operations which could cause injury, wherever this is reasonably practicable, and reduce risks to the lowest level reasonably possible;

• get rid of the manual lifting of patients in all but exceptional or life-threatening situations;

• reduce the risk of unnecessary manual handling by making sure that risk assessments are carried out and that equipment is used wherever appropriate;

• make arrangements for putting the policy into practice and make sure we make improvements in controlling the risks created by manual handling;

• contribute to helping staff who have musculo-skeletal symptoms;

• reinforce the responsibilities of general or directorate managers and heads of departments for manual-handling activities within their areas of responsibility; and

• keep to the Manual Handling Operations Regulations 1992 and all other legislative and professional guidance ( see Annex 1).

4 General strategy

4.1 Our strategy for manual handling reflects the scale of the problems in this respect. Responsibility for risk assessments and implementing control measures rests with line managers with advisory input from the Manual Handling Co-ordinator, as appropriate.

4.2 The strategy for reducing manual handling risks is as follows.

• A multi-disciplinary Manual-Handling Group needs to work with the Risk Management and Health and Safety steering group to review and oversee how the policy is put into practice.

• A competent Manual-Handling Advisor or Co-ordinator needs to develop and oversee strategies, to provide staff training and expert advice on manual-handling issues.

• Wide-ranging risk assessments must be carried out by line managers, heads of department and identified key-workers of all manual-handling operations if there may be a significant risk of injury.

• There needs to be a plan for putting any action into place. The plan will aim to reduce the risk of injury within manual-handling operations by:

  • identifying priority risk areas;

  • helping staff use mechanical and patient-handling equipment correctly;

  • encouraging safe-handling practices;

  • adapting the working environment; or

  • reorganising work practices.

• Priority staff groups for training programmes must be established, and refresher training provided as appropriate.

• Manual-handling Key Workers need to be identified. Additional training should also be provided for these staff to increase their knowledge and practical skill base, in order to facilitate implementation of ongoing risk assessment, risk control measures and good handling practices, at a local level.

• Data which is collected should be used to monitor the policy's implementation.

5 Responsibilities

5.1 The Chief Executive will include a review of progress in controlling the risks from manual handling, and aims for the coming year, in the annual health and safety report for the organisation's Board.

5.2 The Health and Safety Policy and Planning Committee and /or nominated Executive Director will act on behalf of the Chief Executive in overseeing how the policy is put into practice and meeting the aims set.

5.3 The Manual Handling Advisor and Manual Handling Co-ordinators are our main source of expertise in manual handling.

5.3.1 The Manual Handling Advisor will lead, co-ordinate and develop the Manual Handling Department and the Staff Injuries Physiotherapy Service in line with this policy. S/he will advise on strategic developments necessary to reduce musculo-skeletal disorders to meet legislation and best practice.

5.3.2 The Manual Handling Co-ordinators are responsible for:

• delivering the Manual Handling Education Programme and maintaining a record of all staff who receive training;

• providing advice to the Manual Handling Key Workers and other staff on manual-handling risk assessment and risk control when necessary;

• carrying out on-site visits to reinforce the manual-handling education;

• providing advice on manual-handling issues and on new projects and buying equipment;

• developing systems to audit how effective the Manual Handling policy is and report to our Manual Handling Advisor (or other identified individual or committee) regularly; and

• investigating IR1 incident forms relating to manual-handling issues.

5.4 The Patient Service Directors and operational managers are responsible for:

• noting the initial risk assessments carried out and any amendments or additions made by Manual Handling Key Workers;

• putting the recommendations for eliminating or reducing risk into practice as far as is reasonably practicable, following the initial assessment or annual review;

• recording details in their departmental health and safety policies of their arrangements for manual-handling risks, outlining appropriate responsibilities, channels of communication and monitoring;

• making sure that appropriate measurements of fitness criteria are set for new staff and that these are used effectively by OHS when carrying out pre-employment screening;

• making sure that they have enough staff trained as Manual Handling Key Workers (as recommended by the Manual Handling Department), who will have refresher training each year with the Manual Handling Department;

• taking account of risks created by manual handling in the design of new facilities, buying of equipment or new work practices and take advice from the Manual Handing Department; and

• maintaining monthly statistics on all manual-handling incidents and the extent of any sickness absence which may be caused as a result.

5.5 Line managers are responsible for:

• identifying manual-handling risks within their department and, as appropriate, working with the Manual Handling Co-ordinator to identify measures to reduce risk;

• making sure that the incident forms are filled in for all injuries or near misses involving manual handling, and keep up-to-date details of all manual-handling incidents which occur in their area of responsibility, particularly during periods of absence;

• making sure that manual-handling risk assessments are carried out, updated as necessary, reviewed every year, and details kept;

• being fully aware of the issues highlighted within current manual-handling risk assessments carried out for their areas;

• putting into practice, as far as reasonably practicable, with the resources available, any control measures identified through risk assessments or required under this policy;

• recording details of action plans for reducing risk and passing information to general managers to make sure they prioritise risk control measures;

• taking account of the risks created by manual handling in the design of new facilities or work practices, and taking advice when necessary;

• appointing members of staff to receive further education as Manual Handling Key Workers;

• working with the Manual Handling Key Workers to make sure that all staff receive the relevant education before starting their jobs and that they are updated regularly;

• maintaining local records of staff who receive training, both at induction and for update sessions;

• recommending referral to the Staff Injuries Physiotherapist when appropriate, and taking advice on changing tasks or a phased return to work when necessary; and

• making sure that new members of staff in their ward or department have been passed by the Occupational Health Service (OHS) as fit for the job.

5.6 Manual Handling Key Workers are responsible for:

• encouraging people to use safe systems of work on a day-to-day basis;

• being responsible, with the Ward Manager or Head of Department, for making sure that the risk assessments are completed, updated each year and that safe working practices are maintained in the ward or department;

• consulting with their Ward Manager or Head of Department and taking appropriate steps to make sure individual staff members who face increased risk because of existing injury, pregnancy or other factors get the advice of OHS, the Manual Handling Co-ordinators, or the Staff Injuries Physiotherapist where necessary;

• making sure that staff go on an appropriate manual-handling course at induction and that they receive regular updates;

• making sure, along with the Ward Manager or Head of Department, that staff keep a record of their attendance at these courses;

• encouraging staff to promptly report musculo-skeletal injuries which might be made worse in the course of work and adapting work patterns or tasks to prevent placing these individuals at further risk of injury;

• monitoring poor practice within the ward or department and referring any concerns to the Ward Manager or Head of Department or Manual Handling Department as appropriate;

• making sure that the staff have enough slings, sliding sheets and other manual-handling equipment, and make the Ward Manager and Head of Department and Manual Handling Department aware of any shortages; and

• going on regular refresher training provided by the Manual Handling Co-ordinator, to allow skills to develop.

5.8 All staff are responsible for:

• taking reasonable care for their own safety and that of colleagues and patients;

• making full and proper use of equipment provided;

• following safe systems of work shown in the risk assessments;

• following the precautions and procedures set up for avoiding or reducing the risk of musculo-skeletal injury created by manual-handling work and following the safe system of work, and in particular those carrying out patient handling will note the method of transfer shown in the care plan or mobility chart for identified patients;

• going on the manual-handling course provided by the Manual Handling Department at induction and further updates, following safe working practices for manual handling and asking for extra training if they feel that they need it;

• assessing the task before carrying out any manual-handling activity to make sure enough precautions are taken, and for ward staff, making sure that there is a mobility chart or an individual mobility assessment completed for every patient, which must be updated at appropriate intervals;

• following the large-patient or bariatric-patient procedure if involved in handling a patient who weighs more than 28 stone/175 kg (or other identified weight limit);

• reporting to their Key Worker or Head of Department any risks which they think have not been handled effectively;

• avoiding manually lifting patients in all but exceptional or life-threatening situations and report any injury or significant pain which may have been caused by manual work and any personal factor (such as musculo-skeletal injury, illness, or pregnancy), which might increase the risk;

• making sure that incident forms (IR1) are promptly reported and completed by following the procedure for all incidents involving manual handling; and

• reporting any problems or shortcomings in the risk assessment or safe system to their line manager.

5.9 Health and Safety staff are responsible for:

• reviewing and updating, as necessary, the guidance given in the Health and Safety Manual on assessing risk for manual handling;

• providing statistics on the incidence of manual-handling injuries within the organisation; and

• providing technical and organisational help to the Manual Handling Co-ordinator and other members of staff when necessary.

5.10 The Staff Injuries Physiotherapist is responsible for:

• providing a service to all staff within the organisation;

• providing assessment and treatment for staff with musculo-skeletal injuries;

• carrying out workplace assessments so staff can gradually return to work if they have been on sick leave;

• carrying out on-site assessments for those staff that are concerned about their workplace, or referring these staff onto the Manual Handling Department;

• giving advice to relevant line managers following a detailed workplace assessment, to prevent injuries becoming worse;

• advising on manual-handling issues and on buying equipment; and

• auditing the effectiveness of the Staff Injuries Physiotherapy Service and reporting to the Manual-Handling Policy Committee.

5.11 The OHS is responsible for carrying out pre-employment screening and making sure that new staff are fit for the duties involved in their post.

They will discuss with the Ward or Department Head, the Staff Injuries Physiotherapist, the Manual Handling Department or Health and Safety staff any manual-handing risk which they consider to be significant.

All staff can consult the service, confidentially, on any aspect of health and safety while at work.

6 Training

6.1 The best way of reducing the risk of musculo-skeletal injury is by putting measures in place which reduce:

• the amount of manual-handling work performed; and

• the risk factors in the manual-handling tasks that remain.

[Name of organisation] will provide training which:

• teaches the principles of:

  • legislation and local policy;

  • ergonomics;

  • risk assessment;

  • back care;

  • details of injuries;

  • fitness;

  • safe-handling principles;

  • safe manual-handling principles, manoeuvres and efficient movement;

  • using manual-handling equipment; and

  • the condemned manoeuvres;

• emphasises the practical application of these principles;

• gives guidance in the correct use of appropriate mechanical aids and patient transfer equipment; and

• teaches the principles of safe moving and handling (an ergonomic approach), to reduce the likelihood of injury from the manual work which cannot be avoided. Training is based on risk assessment.

6.2 All staff will receive initial training before working in the clinical area. The length of the training at induction will vary according to the tasks in which staff are involved.

6.3 All staff will also receive refresher training.

Manual Handling Key Workers will receive extended and refresher training so they can increase and develop their level of knowledge and practical skills. This will allow them to carry out their extended role.

Line managers will identify further training needs and appropriate training will be provided in consultation with the Manual Handling Co-ordinator.

7 Moving patients

7.1 Statistics show that most nurses experience musculo-skeletal injury in the course of their careers. This risk stems largely from the requirement to move patients who have difficulty moving themselves.

7.2 The provision of lifting aids in [Name of organisation] is now such that the following can be made formal organisational policy.

• Staff must use the manual-handling equipment available on the wards.

• Unless there is an emergency (needing immediate action to avoid serious harm to a patient's health) the following must not be carried out ( see Annex 2):

  • drag lifts;

  • Australian or shoulder lifts;

  • orthodox or cradle lifts;

  • other manoeuvres involving the patient's hands around the handler's neck; or

  • any other procedure to lift most of or the entire body weight of a patient, without a mechanical lifting aid.

• Action may be taken under the 'Management of Employee Conduct' policy where there is evidence that staff are repeatedly carrying out the above manoeuvres without due cause.

• All staff should carry out a manual-handling risk assessment before handling a patient.

8 Rehabilitation and assessment

Managers, with the staff member's permission, will refer to the Staff Injuries Physiotherapist or OHS any staff who suffer musculo-skeletal injury and who may need temporary changes made to their normal duties.

The Staff Injuries Physiotherapist will assess the staff member's fitness in relation to the demands of their job and will make recommendations to the relevant head of department. They, in turn, will make all reasonable efforts to accommodate these recommendations.

If the relevant manager judges the recommendations to be impractical, they must discuss the recommendations with the next appropriate level of management.

9 Monitoring and reviewing

5.1 Outcome and indicators which may be used to evaluate this policy include:

• Is the policy effectively as of widely communicated?

• Are staff aware of the policy and its implications?

• Is the policy addressed in local and organisational induction programmes?

5.2 This policy will be reviewed one year from its effective date and annually thereafter by the steering group, reporting to [Name of Organisation] Board.

Annex 1 Legislative and Professional Guidance Documents

Health & Safety at Work etc Act (1974), Chapter 27, HMSO 1974 ISBN 0 10 543774 3

Management of Health & Safety at Work Regulations (1992) SI 1992 No2051 HMSO 1992 ISBN 0 11 025051 6

Manual Handling Operations Regulations (1992) HMSO ISBN 0717624153. Guidance on the Regulations, HSE Books, updated 1998

Health Service Advisory Committee (1992), Guidance on the Manual Handling of loads in the Health Service

Lifting Operations and Lifting Equipment Regulations (1998), SI 1998, No2307 TSO 1998 ISBN 0 11 079598 9

NBPA & RCN (1997), The guide to the handling of patients, 4th edition, NBPA, Middlesex

RCN (1999), Manual handling assessments in hospital and the community, London

RCN (1999), RCN Code of Practice for patient handling, London

RCN (1999), Introducing a safer patient handling policy, London

Annex 2 Condemned Lifts

1 The drag lift

This was condemned by the RCN in 1981 (NBPA / RCN, 1997). It relies on the nurse placing a hand or arm under the patient's armpits. It has been used to:

• move a patient up the bed;

• sit a patient up from lying in bed;

• bring a patient to stand from sitting; and

• move a patient from one seated position to another.

2 Orthodox or cradle lift

This was condemned by the RCN in 1987 (NBPA / RCN, 1997). Any modification of this lift using handling slings is also banned. Using two blue plastic handling slings (one under the patient's back and one under the patient's thighs) is still an orthodox lift and must not be used. It was the original method used to lift a patient where a handler stood on either side, clasped their wrists under the patient's thighs and behind their back. It is very, very dangerous.

3 Bear hug, stroke lift or 'clinging ivy' lift

This lift involves moving or supporting a patient with their arms or hands around the handler's neck. This is particularly dangerous because if the patient does not stand, or collapses when his or her arms are around the handler's neck, all their weight is hung around the neck, obviously causing too much strain and probable injury. Also, if the patient falls backwards, their instinct will be to remain clamped around the handler's neck, so causing them to fall. This is obviously a high-risk manoeuvre with a high risk of injury. The site of injury ranges from upper neck to lower back.

Moving a patient with their hands on the handler's shoulders is also not a safe alternative for similar reasons.

4 Australian or shoulder lift

This was condemned by the RCN in 1996 (NBPA / RCN, 1997).

All manual lifts are dangerous, so even though the shoulder or Australian lift was considered one of the safer lifts, it still has risks (Scholey, 1982; Ergonomics Research Unit, 1986; Pheasant, Holmes, Stubbs, 1992).

4.1 Negative effects for the patient

• The force of the handler's shoulder against the chest wall can cause breathing problems.

• Certain conditions, for example hip replacements, prevent the amount of hip flexion required.

• Leaning forwards can be painful or uncomfortable.

• Lifts can be uncomfortable and dangerous for patients with shoulder problems or pain.

• These lifts are not suitable for most amputees.

4.2 Negative effects for staff

• Handlers are in a 'top-heavy' position.

• The handler lifts the load on one shoulder resulting in uneven loading and strain.

• The arm under the patient's thighs is twisted and at risk of injury.

• The handhold with the other handler is uncomfortable and means they need to grip.

• Communication between handlers is difficult.

• Handlers cannot see the patient's face.

• Tall handlers have difficulty getting into position.

• It is difficult to get the patient into position.

5 Any move where staff lift the whole or a large part of the weight of a patient, including:

• manually lifting patients up off the floor;

• manually lifting patients in and out of the bath;

• manually straight-lifting patients; and

• using canvas and poles.

APPENDIX 4.C
References

The Nuffield Trust	Improving the Health of the NHS Workforce, Sian Williams, Susan Michie, Shriti Pattani
Health & Safety at Work Act	HMSO, London, 1974, ISBN 0 10543774 3
Management of Health & Safety at Work Regulations (1992)	SI 1992 No2051, HMSO, London, 1992, ISBN 0 11 025051 6
Lifting Operations and Lifting	SI 1998, No2307, TSO 1998,
Equipment Regulations (1998)	ISBN 0 11 079598 9
Manual Handling Operations Regulations	HMSO London 1992, ISBN 0717624153

Recommended further reading

National Back Pain Association and Royal College of Nursing	The guide to the handling of patients, NBPA, Middlesex, 1998, 4th Edition
RCN	Manual handling assessments in hospital and the community, London, 1999
RCN	RCN Code of Practice for Patient Handling, London 1999
RCN	Introducing a safer patient handling policy,London 1999
RCM	Midwifery Guidelines on Manual Handling,1998
Chartered Society of Physiotherapy	Guidelines on Manual Handling, CSP, 2002
Resuscitation Counsel	Guidance on Manual Handling
Association of Chartered Physiotherapists in Neurology	Guidance on Manual Handling and PhysiotherapyTreatments, ACPIN
Scottish Healthcare Supplier Safety Action Notice System
Medical Devices Agency	Advice on the Use of Equipment (MDA)