Moving and handling

No-one should routinely manually lift patients. Hoists, sliding aids, electric profiling beds and other specialised equipment are now available as substitutes for manual lifting. Patient manual handling should only continue in cases which do not involve lifting most or all of a patient's weight. This rules out for example, the shoulder or Australian lift. The Health and Safety Executive advise a balanced approach to managing the risks from patient handling. These include:

• care workers are not required to perform tasks that put them and their clients at risk unreasonably
• client's personal wishes on mobility are respected wherever possible
• client's independence and autonomy is supported as fully as possible.

A patient-centred care plan should include information on immobility and detail any handling risks and/or needs. For more information see the section for back pain on the Health and Safety Executive (HSE) website.

Legally, employers are obliged to provide a safe working environment for their staff. Under the Manual Handling Operations Regulations 1992 (as amended) employers are required to:

• assess the risk of back injury at work
• reduce the risk to the lowest level reasonably practicable
• provide training for staff on safe and healthy practice
• supervise staff to ensure compliance with the regulations.

Risk assessment should be generic and individual.  A generic risk assessment would cover the workplace/environment e.g. the equipment needed, safe staffing levels, emergency procedures and the suitability of the physical environment.  Individual risk assessments consider the specific moving and handling needs (e.g. help needed, specific equipment needs and number of staff needed to support the patient) to ensure the safety of staff and the patient/service user.

Employers also need to assess the risks of back and musculoskeletal disorders from a wide range of activities such as those which could involve bending or stooping for periods of time e.g. leg ulcer dressings - or handling part of a patient e.g. a limb being prepared for surgery in a theatre environment.

There is a requirement for a ‘competent person’ to conduct risk assessments. Competency is a mixture of skills, knowledge and qualifications to carry out the role.  For further information see National Back Exchange website.

The NHS Employers website has various guidance including employer responsibilities. 

Additional laws require employers to ensure that moving and handling equipment is maintained and safe to use. Staff should be trained in the safe use of equipment and safe moving and handling.

Further information on the Manual Handling Operations Regulations 1992 is available on the Health and Safety Executive (HSE) website. From the HSE website please also search for ‘moving and handling in health and social care’. Members based in Northern Ireland should check the Health and Safety Executive Northern Ireland (HSENI) website.

In summary, employers should have:

• safer patient handling policies
• risk management processes
• regular staff training.

If you have any concerns that any of these are not in place, contact us for advice and support.

Hoists

Hoists are in common use in the health and social care sector and can reduce the risk of injury to staff, however if not used safety they can present a serious risk to patients and the user.  See the Health and Safety Executive website for more. 

The Manual Handling Operations Regulations 1992 set no specific requirements such as weight limits. An ergonomic approach based on a range of relevant factors should determine the risks. The Health and Safety Executive (HSE) website contains further guidance on this in their FAQs section. Those based in Northern Ireland should check the Health and Safety Executive Northern Ireland (HSENI) website.

Health and safety law requires employees to:

• take reasonable care of their own health and safety and that of other people
• cooperate with their employer on health and safety matters and,
• report any problems.

If you suffer an injury whilst moving a patient you may be able to make a personal injury claim. However, under the Manual Handling Operations Regulations 1992 you also have an obligation to make full and proper use of any system of work provided by your employer.

See our advice guide on making a personal injury claim.

For staff working with children, it may not be possible to eliminate all lifting. It is still important to avoid the risk of injury to carers and minimise lifting at all times.

By law employers must ensure that risk assessments have been carried out using appropriate guidelines which assess all factors. The design of a cot, for example, may be more of a risk factor than the weight of the baby in it. Poor posture is a greater risk to carers of babies and children than actual lifting.

Another example is the neonate with complex care needs. This baby may have many pieces of equipment attached to them. Each of these require consideration when developing a safe plan for mobility.

In each situation a risk assessment must be carried out and an individual plan of care devised by all involved in the care, for example parents, health visitors, teachers. The day to day needs of children vary. Flexibility can ensure optimum independence of the baby/child whilst minimising carer risk. If you have any concerns then contact us to discuss arrangements for local support.

Health and Safety Executive (HSE) - where you can find lots of information about the legal framework as well as case studies around nurse-led innovations to reduce risk.

Health and Safety Executive Northern Ireland (HSENI).