Minimal Handling,Transportation and

Client Safety

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Lecturer: Michele Archdale

Powerpoint revised and edited Feb 2012Ref: C.Ramsay / C.Cross/ M.Archdale

What is Minimal Handling?

• Any event that involves:– Lifting,– Lowering,– Pushing,– Pulling,– Carrying– Moving holding or restraining any animal, object or

person!

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Manual Tasks

A manual task refers to any activity

requiring a person to use any part of their

muscular or skeletal system in their

interactions with their work environment.

It includes the following activities:

Carrying

Lifting

Pushing

Pulling

Holding

ThrowingStriking

Manual Tasks

It also describes activities

involving:

Exposure to

Vibration

Repetitive actions Sustained postures

Manual Task Injuries

Manual tasks can lead to injury through the development of Musculoskeletal Disorders (MSD).

An MSD is an injury affecting the bones or soft tissue structure (other than organs) of the body that is caused by manual handling at work.

Examples include sprains of ligaments; strains of muscles or tendons; injuries to the spine, joints, bones or nerves and abdominal hernias.

Possible injuries• Sprains and strains most common• Contusion, lacerations, and fractures.• Sites of injury

– Back injuries most common– Arms and legs next.– Other injuries include neck and shoulder.

• The main patient handling tasks associated with low back pain in nurses are: – Manually moving patients in bed – Manually transferring patients between bed and chair– Manually lifting patients from the floor– Sustained postures such as stooping Eg. when taking

observations or when supporting limbs in theatre.

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Symptoms

• Back or neck pain• Pain in wrists shoulder or

arms• Stabbing pains in arms or

legs• Painful joints• Pain, tingling or

numbness in hands or feet

Weakness or clumsinessHeavinessBurning sensationsStiffnessSwelling

If you start to experience any of these symptoms don’t ignore

them!

Why it’s important• Injuries from manual handling have a big impact on nurses,

nursing and the health system in general.• Manual handling injuries can have many outcomes.

– Minor - very serious injuries. • Can result in the nurse being unable to continue working.• Workplace injury can also have impact on family, social or

recreational pursuits. • Injuries to nurses also affect colleagues:

– Significant impact in the workplace through the loss of experienced and skilled staff.

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• Evidence that patients can be injured through poor minimal handling practice: – Skin tears– Fractures, – Dislocations.

• Relevant Legislation and codes of practice in S.A.– Occupational Health, Safety and Welfare

Regulations 1995. Division 2.9—Manual handling.

– South Australian Occupational Health and Safety Commission—Approved Code of Practice for

Manual Handling.

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Three Steps to Reducing Injuries

The three steps are: 1) Identifying manual task hazards2) Assessing the risk of those manual

task hazards identified causing injury 3) Eliminating the risk, or if not

practicable reduce the risk to the lowest practicable level

Ensure the Load is not too Heavy!

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New Technology is not always the answer

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Minimal handling risks• Risks involved:

– Sudden jerky movement– Hard to control movement.– Bending reaching or twisting– Prolonged static posture or position.– Frequent repetitive and prolonged tasks.– Moving loads from below thigh to above shoulder– Heavy bulky or awkward loads– Excessive force to push , pull, or hold objects.– Poor lighting– Slip or trip hazards– Untrained or inexperienced staff.

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Assessing the Risks

• Body posture

• Force

• Repetition of

movements

• Speed of

movements

• Vibration

• Duration

• Workplace or

workstation layout

• Other work

conditions

• Characteristics of

the item

• Location of objects

and distances moved

• Work organisation

and systems of work

The next step is to assess which factors are contributing to the risk of injury. Risk factors to be considered:

Assessing the Risks

• Type of work - some tasks

require fixed postures for long

periods of time

• Layout of the work space - a

poorly designed workspace may

force people to maintain awkward

postures, such as bending or

twisting repetitively

• Handling time - the more often

an object has to be handled, the

greater the chance of injury

• Weight of the object - heavy

objects that have to be lifted

awkwardly, such as from ground

level are more likely to cause

injury than objects lifted from

waist level

• Equipment - more effort may be

required to manipulate badly

designed or poorly maintained

equipment

• The degree of effort - simply

restraining an object such as an

animal, can cause sprains and

other injuries

Further information on assessing manual task risks and forms can be found on the manual task website

Patient risk assessment

• Every patient should be assessed for risk. Are they able to:– Move in bed– Move in and out of bed – Get into and out of chairs – Move to and from toilets and

bathrooms– Commode chairs – Walk.

• A patient handling assessment should be carried out on admission and continually reassessed .

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Eliminating (or Controlling)the Risk

Hierarchy of Controls

ELIMINATION

SUBSTITUTION

ENGINEERING

ADMIN

PPE

Common Risk Control Measures

• Change the task - does this task need to be carried out? If so, does it have to be done this way?

• Change the object - for example, repack a heavy load into smaller, more manageable parcels

• Use mechanical aids - like wheelbarrows, trolleys, conveyor belts, cranes or forklifts

Change the workspace - for example, use ergonomic furniture and make sure work benches are at optimum heights to limit bending or stretching

Change the nature of the work - offer frequent breaks or multi-task

Seek proper training - inexperienced workers are more likely to be injured

Risk management...employer responsibilities

• If a minimal handling task is assessed as being a risk to health and safety, the employer must take such steps as are reasonably practicable to control the risk.

• the employer must—– redesign the manual handling task to eliminate or control

the risk factors – ensure that the employees involved in the manual

handling task receive appropriate training, (including training in safe manual handling techniques)

– Provide appropriate supervision...............................

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• where redesign is not reasonably practicable, or as a short-term or temporary measure, the employer must take one, or a combination of two or more, of the following measures as may be appropriate:– provide mechanical aids – provide personal protective equipment– arrange for team lifting

• Ensure that the employees receive appropriate training, supervision in:– Correct use or application of any mechanical aids– Personal protective equipment.– Team lifting procedures.

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Duties of employees

• An employee must so far as is reasonable (but without derogating from any common law right) apply any training provided for the purposes of this Division.

• Comply with any instruction given in supervision of the manual handling task.

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Risk control strategies• Work through the problem and find solutions.• Ask; Can we eliminate the need to lift?

– Eg. Use pressure mattresses to reduce turning requirements.

• Can we reduce the number of times the patient is handled?– Eg. May involve coordinating with other departments or

health care workers. Physio or x-ray • Can we get the patient to move themselves?

– Eg. Patient teaching or equipment – monkey rings/self help poles, electric beds, rope ladders

and walking appliances.

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• Do we have an appliance that can help us?– Slide sheets and slide boards for bed moving

activities– Standing hoists for bed to chair– General hoists should always be used for any total

body lifting including lifting patients from the floor.

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Evaluation & Record Keeping

EvaluationCheck the effectiveness of control measures in place and ensure no new hazards have been introduced

Record KeepingRecords should be kept of hazard identification, risk assessment and control measures including training records

Patient Co-operation and Nurses rights

• Patient and relatives should be informed that certain pieces of equipment will be used to move them.

• For their own safety and the safety of the staff.

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Simple stretches to reduce the risk of suffering an injury

By completing the following stretches prior to undertaking any minimal handling task, you are

reducing the risk of injury.

If any of the following stretches cause you pain or discomfort, STOP the stretch immediately.

Stretches

Position

Stand with the feet shoulder width apart

and the arms behind the body

Action

Grasp the left wrist with the right hand.

Pull the left arm down and to the right.

Tilt the head to the right. Hold this

position for 10-15 seconds. Repeat the

action with the right wrist, pulling the

right arm down and to the left. Tilt the

head to the left.

Neck & Shoulders

Position

Stand and extend the arms upward and over

the head. Interlace the fingers with the

palms turned upward.

Action

Stretch the arms up and slightly back. Hold

this position for 10-15 seconds.

Variation

This stretches the rectus abdominous

muscles. Stretch to one side, then the other.

Return to the starting position.

Abdominal

PositionStand and interlace the fingers behind the back.

Action

Lift the arms behind the back so that

they move outward and away from the

body. Lean forward from the waist. Hold

this position for 10-15 seconds. Bend

the knees before moving to the upright

position. Return to the starting position.

Position

Stand with the arms extended to the

front at shoulder height with the fingers

interlaced and palms facing outward.

Action

Extend the arms and shoulders forward.

Hold this position for 10-15 seconds.

Return to the starting position.

Chest Upper Back Stretch

Position

Stand with the feet shoulder width

apart. Raise the right arm, bending the

right elbow and touching the right hand

to the back of the neck.

Action

Grab the right elbow with the left hand,

and pull to the left. Hold this position

for 10-15 seconds. Return to the

starting position. Do the same stretch,

and pull the left elbow with the right

hand for 10-15 seconds.

Position

Stand. (For variation, lie on the stomach.)

Action

Bend the left leg up toward the buttocks.

Grasp the toes of the left foot with the right

hand, and pull the heel to the left buttock.

Extend the left arm to the side for balance.

Hold this position for 10-15 seconds.

Return to the starting position. Repeat with

the right leg. Extend the right arm for

balance. Hold this position for 10-15

seconds. Return to the starting position.

Overhead Arm Pull

Thigh Stretch

Position

Stand with the knees slightly bent.

Action

Bend forward keeping the head up, and

reach toward the toes. Straighten the

legs, and hold this position for 10-15

seconds.

Position

Sit on the ground with both legs straight

and extended forward with the feet

upright about 15cm (6”) apart. Put the

hands on the ankles or toes.

Action

Bend from the hips, keeping the back

and head in a comfortable, straight line.

Hold this position for 10-15 seconds.

(Variation for greater stretch: Stretch

and pull back on the toes.)

Hamstring Stretch

Hamstring Stretch Seated

Position

Lunge slowly to the left while keeping

the right leg straight, the right foot

facing straight ahead and entirely on

the floor.

Action

Lean over the left leg while stretching

the right groin muscles. Hold this

position for 10-15 seconds. Repeat

with the opposite leg.

Position

Sit on the ground with the soles

together. Place the hands on or near

the feet.

Action

Bend forward from the hips, keeping

the head up. Hold this position for

10-15 seconds.

Groin Stretch

Standing

Groin Stretch

Seated

Position

Stand straight with the feet together, arms

extended downward, elbows locked, palms

facing backward, fingers extended and

joined, and head and eyes facing front.

Action

Move the right foot to the rear about two

feet, and place the ball of the foot on the

ground. Slowly press the right heel to the

ground. Slowly bend the left knee while

pushing the hips forward and arching the

back slightly. Hold for 10-15 seconds.

Return to the starting position. Repeat with

the left foot. Return to the starting position.

Position

Stand with the feet shoulder width apart

and the left foot slightly forward.

Action

Bend forward at the waist. Slightly bend

the right knee, and fully extend the left

leg. Reach down and pull the toes of the

left foot toward the left shin. Hold this

position for 10-15 seconds. Return to

the starting position. In a similar

manner, pull the toes of the right foot

toward the right shin, and hold for

10-15 seconds.

Calf Stretches Calf Stretches

Position

Sit on the ground with the right leg forward

and straight. Cross the left leg over the right

while sitting erect. Keep the heels of both

feet in contact with the ground.

Action

Slowly rotate the upper body to the left and

look over the left shoulder. Reach across the

left leg with the right arm, and push the left

leg to your right. Use the left hand for

support by placing it on the ground. Hold this

position for 10-15 seconds. Repeat this

stretch for the other side by crossing and

turning in the opposite direction.

Position

Lie on the back with the arms straight beside

the body. Keep the legs straight and the

knees and feet together.

Action 1- Bring the left leg straight back

toward the head, leaving the right leg in the

starting position. Bring the head and arms

up. Grab the bent left leg below the knee,

and pull it gradually to the chest. Hold this

position for 10-15 seconds. Gradually

return to the starting position. Repeat these

motions with the opposite leg.

Action 2 - Pull both knees to the chest. Pull

the head up to the knees. Hold for 10-15

seconds. Return to starting position.

Hip & Back Stretch

Seated

Hip & Back Stretch

Lying Down

Position

Stand with the back straight and feet

shoulder width apart. Extend the arms

outward to shoulder height.

Action

Rotate the shoulders forward, and make a

large circular motion with the arms. Repeat

the action in the opposite direction. Do this

three times in each direction.

Position

Stand with your feet shoulder width

apart and hands on your hips.

Action

Rotate the hips clockwise while keeping

the back straight. Repeat the action in a

counterclockwise direction. Do this

three times in each direction

Arm StretchesHip Stretches

Remember:

Prevention is better than cure! You can do just a few of the

stretches anytime during the day. Try some of them before you

get stiff and sore.

Stretch prior to doing any manual handling tasks.

Exercise and take short breaks frequently

Cool down after any heavy lifting/manual handling.

Exercise is one of the best ways you can improve your posture.

Include a variety of movements in your workday.

To improve flexibility, strength and endurance, try holding each

stretch a little longer or doing more repetitions.

When stretching, you will feel a slight pull on the muscle. If this

becomes mildly uncomfortable (especially if you feel radiating

pain), ease off or stop the stretch.

The Spinal Cord

• Part of the C.N.S.• Approx. 46cm in length.• 31 spinal nerves originate from the spinal cord.

– 8 Cervical– 12 thoracic– 5 lumbar– 5 sacral and coccyx.

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The Spine

• Functions– Receive sensory impulses from the tissue and

convey to brain.– Convey motor impulses from brain to body– Pathway for reflex actions.

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Normal Structure of spinal cord and discs.

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Protecting Your Back

• Warm up cold muscles thoroughly before engaging in any manual work

• Lift and carry heavy loads correctly, by keeping the load close to the body and lifting with the thigh muscles

• Never attempt to carry or lift loads in excess of the recommended maximum limit for one person

• Maintain correct posture and the natural curves of the spine

• Take frequent breaks

• Organise the work area to reduce the amount of bending, twisting and stretching required

• Get help to lift or carry a heavy load whenever possible, using another worker or appropriate mechanical aids

• Cool down after heavy work with gentle, sustained stretches

• Exercise regularly to strengthen muscles & ligaments

• Lose any excess body fat

Your back is particularly vulnerable to manual task injuries.

Suggestions to protect your back include:

Safe Lifting Technique

Minimal HANDLING PRINCIPLES

• Plan the lift• Keep the load close to your

body• Maintain the natural curves of

your spine – Don’t stoop.• Lean forward from the hips &

knees• Keep feet apart in line with your

shoulders.• Swivel the feet thus turning the

whole body as one.

Safe Lifting• Use your leg muscles to push up with.

• Keep your elbows in, reducing the risk of increasing the potential

for strain on the neck and shoulder muscles.

• Palms up and use your bicep muscles, rather than shoulders and

neck.

• Always have patients’ cooperation.

• Ensure you have spoken to the patient and they are fully informed

of the lifting plan you intend to use and you have their consent.

• Assess the patients’ overall condition, – Can they help you?

– Do you need extra help?

• Ensure the work area is hazard free

Avoiding injury

• Avoid manual handling!• If unavoidable then do correctly with the

correct equipment and appropriate amount of assistance.

• Avoid repetitive tasks.• Carry out stretches and Spinal exercises (Back

Exercises).

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Patient Safety #1

• A client’s health and wellness depend upon safety. Safety is the number 1 priority in all aspects of care.

• Nurses need to be aware of safety. The hospital setting is complex, potentially dangerous & unfamiliar to clients.

Ensuring Client safety:

• Reduces length of stay & cost of treatment

• Reduces frequency of treatment

• Reduces potential for law suits

• Reduces the number of work-related injuries to personnel

1. Health systems have a moral imperative to ensure the safety of patients

2. Adverse events have a tremendous cost to the system in extended hospital stays & additional medical procedures

3. Adverse events expose health organizations to legal liability

A safe environment is one in which basic needs are met, physical hazards

are reduced or eliminated, transmission of organisms are reduced and sanitary measures are carried out.

Strategies to help reduce falls: Physical environment

• Appropriate furniture and lighting

• Call bell easily accessible/personal items within reach

• Traffic areas free from obstruction

• Secure/remove loose carpets or runners

• Eliminate clutter

Grab bars in appropriate areas in washroom

Handrails in the halls

Keep bed in a low position – lock bed/wheelchairs/stretcher

Identify clients at risk for falls.

–If a client experienced falls at home, they will likely continue to be at risk for falls in the hospital setting. Place them close to nurses station.

Strategies to help reduce falls: (Communication/Assessment)

• Orientate client to physical surroundings• Explain use of call bell• Assess client’s risk for falling• Alert all personnel to the client’s risk for falling

• Instruct client and family to seek assistance when getting up

• Maintain client’s toileting schedule • Observe/assess client frequently• Encourage family participation in client’s care

Dangers in patient transfer / repositioning

• Failure to support the head adequately–A pillow unsupported by the stretcher mattress may fall away & can cause whiplash injury to the neck.–Uncoordinated movement of assistants when turning the pt may damage the neck.

• Failure to support the whole pt

– Torn stretcher MATTRESS– Accidents where 2 stretchers / barouche are not adjacent

while transferring patient– Failure to apply the brakes on transfer barouche allows

the pt to fall btw the operating table & trolley– Inadequate physique of lifting attendants relative to the

weight of the pt– Failure to raise the side guard-rails on narrow transfer

trolleys

• Failure to prevent localised damage

– Finger can be injured /amputated by hinged sections of the operating table / barouche

– Fractures may result due inappropriate safety– Careless stretcher transfers can cause skin abrasions /

tears– Accidental traction on infusion lines, drainage tubes &

urethral catethers can cause internal damage

Minimal Handling – Assessment

• Before any patient movement or manual handling exercise you should go through the following steps;– Inform patient and obtain consent– Assess patients current condition– Review care plan and deal with any inconsistencies– Ensure work area is hazard free

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Minimal Handling – preparation• Prepare patient for activity. (Explain)• Privacy• Bed height• Brakes - item of origin• Brakes - item of destination• Appropriate space• Need for assistance?• Obtain equipment. (Ensure correct operation)• Space, pillows, bed linen etc.

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Minimal Handling – implementation• Apply key principles of manual handling.• Know own limits• Keep load close• Smooth movements• Use lunge or squat.• Maintain balance• Wrist position• Avoid twisting movements• Use body to steer not arms• Perform procedure according to training.• Communicate with patient and assistant• Document and report as appropriate.• Restore environment.• Terminate the activity. (Ensure patient comfort)• Evaluate the movement. (How did it go?)

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Assistive Devices for Positioning, Transfers,

Ambulation• Footboards /

Slideboards• Trochanter rolls• Pillows• Hoyer Lift / Lifting

Machine

Transfer Techniques

• Lock Wheels of bed and Wheelchair• Plan exactly what to do• Make Sure Patient understands• Use the Hoyer / Lifting Machine if necessary!

Use of A Wheelchair

• Be Sure to inspect for defects before using• Put the Foot rests up.• Lock the bed and the wheelchair• If paralyzed, position chair on patient’s

unaffected side!

Minimal Handling - Approved Client Movements. (ANF Manual

Handling Guidelines)– Turn client using a slide sheet– Move client up a bed with slide sheet– Getting client off a bed (one carer)– Getting Client out of Bed (2 carers)– Getting client out of bed (Stand Hoist)– Getting client bed to chair (Sling Hoist)– Standing client (2 Carers)– Assisting client to walk ( 1 or 2 carers)– Assist client form floor to Chair (Verbal Instruction)– Assisting client from floor (Sling hoist)– Moving a Box.

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GENERAL HOIST• General hoist is a mobile device for moving patients. • Vary in safe working load (SWL) • Hoists can be manual (hydraulic) or electric (battery

powered). • Sling is used for attaching the patient to the hoist. • Coded for size (S, M, L, XL) and load capacity• Two main types of sling:

– Total body sling with head support – Toileting sling.

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• Hoists can also be fitted with a variety of attachments.

• Used for moving a patient who is incapable of weight bearing for the duration of the task.– Repositioning the patient in bed

• Transferring the patient between the items of origin and destination – E.g. Bed/stretcher, Bed/chair,

Chair/chair – Toileting – Lifting the patient from the floor.

• For further information you will be attending a Hoist workshop at The Independent Living Centre.63

ROLLING

• Rolling over is used for a number of activities. – Changing the bed ,– Patients positioning for pressure care,– Position slings, slide sheets, slide boards.– Preparation for getting out of bed

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• Ensure the brakes are on. • Take all but one pillow out from behind the head .• Back rest down.• Patient to bend up knees or bend one or both up for them. • Patient to move arm in the direction of the rolling or place it

for them.• Patient to turn head in the direction they are rolling.• One nurse stands on destination side and holds the patient • Nurse on origin side pushes on the patient’s legs, then uses

the hip and shoulder to roll the patient.

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Precautions – rolling

• If one nurse technique.– Ensure that the bedrail is up on the side that the

patient is rolling to.

• Some conditions require a patient rolled without twisting.

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Slidesheet

• A rectangle of thin slippery fabric that can either be used singly or in combination with a second slide sheet or slide board.

• The slide sheet/s is placed under the patient to facilitate moving them in the bed.

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• Roll the patient onto their side and place the partially rolled up sheet under the patient.

• Position the open side of the slide sheet on the same side as the pulling action is to occur: – for rolling – your side – towards the shoulders of the patient for pulling up the

bed.

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• Ensure the slide sheet covers the heaviest part of the patient (Shoulders to past the hips.)

• Bed brakes on.• Moving the patient up the bed:

– Encourage them to assist by bending their legs up and pushing down with their feet.

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• One handler – stands on the side of the movement. (Open end of slide sheet)

• One Handler – stand on other side of the bed. (Direction patient will face.)

• Maintain arms straight but with elbows relaxed and pull on the top layer of the slide sheet, shifting weight on to the back foot.

• Adopt a lunge position.• 1st handler pulls top of slide sheet.• 2nd handler assists by pushing patient through movement.

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Precautions - Slide Sheet

• A single slide sheet is unidirectional.• Two slide sheets can be multidirectional -

used to move across, up, down the bed.• Variation in slipperiness of the fabric, which

can impact on both noise and forces required to use.

• Bed sliding devices can be unpredictably slippery (Be aware of force required!)

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Sit to stand – single person • Technique. (walk belts can be used here.)• Patient’s feet should be positioned under the chair ie behind

their knees. • Patient should slide forwards on the chair.• Position your feet and knees outside the patients – you can

block one of the patient’s knees with your own. • When the patient is ready get them to push down on the

armrests as you lean back pulling the patient towards you. • Standing slightly to the side to avoid obstructing their head. • Step back as patient approaches the upright position.

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Sit to stand – two persons

• Walk belts can be used here.• Patient’s feet should be positioned under the chair ie behind their knees.• Patient should slide forwards on the chair. • Patient should move their shoulders forward and position their hands on

the armrest.• Each nurse stands either side of the patient• Can block the patient’s foot with your own if this is comfortable and does

not compromise your balance. • Squat (lunge) and each grasp one handle at the front and one handle at

the back of the walkbelt. (If using)• When the patient is ready and in accordance with your ‘lifting command’,

guide the patient forwards and upwards.

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Getting up from the floor. (Able bodied patients)

• Patient should roll onto their side and flex their knees. • Patient then places one hand on the floor and rolls onto their knees.• As the other hand frees, the patient should place that on the floor so they

assume a crawl position. • Place a chair in front of them.• Patient should grab the chair with each arm in turn, then place one foot

on the ground. • Instruct the patient to push down (or pull up) on the chair and raise

themselves.• Bring another chair in behind patient.• Patient raises self just enough to allow second chair to be place under

buttocks.• Patient then sits onto second chair

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Transfers:Seat-to-Seat, Toilet to Bed, etc.

CK/00

Crutch Walking

• Proper Measurement of Crutches• Proper position of Handgrips• Rubber tips must be in good shape• Patient need adequate muscle strength of

upper extremity

WALKING AIDS

Thank you for your attention

RememberClient safetyYour safety

Policy and procedure

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References• WorkCover NSWHead office phone: 13 10 50Fax: (02) 4325 4145• www.workcover.nsw.gov.au• (visited17/02/09)• Further Information • NSW Nurses’ AssociationPhone: 1300 367 962www.nswnurses.asn.au• WorkCover SAwww.workcover.com• National Occupational Health and Safety Commissionwww.nohsc-eu.gov.au• Design4 Healthwww2.dir.qld.gov.au/design4health/• http://vetvirtual.external.utas.edu.au/csh/assets/manualhan

dling/index.htm• http://vetvirtual.external.utas.edu.au/csh/assets/ma

nualhandling/index.htm

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