NHS FORTH VALLEY. Manual Handling Guidelines for Patient Handlers

Transcription

1 NHS FORTH VALLEY Manual Handling Guidelines for Patient Handlers Date of First Issue 17 / 05 / 2016 Approved 29 / 04 / 2016 Current Issue Date 17 / 05 / 2016 Review Date 17 / 05 / 2018 Version 1.2 EQIA 19 / 04 / 2016 Author / Contact Christine Wallace Health and Safety Department Group Committee NHS Forth Valley Health and Safety Committee Final Approval This document can, on request, be made available in alternative formats Version th April 2016 Page 1 of 49

2 Management of Policies Procedure control sheet (Non clinical documents only) Name of document to be loaded Area to be added to Manual Handling Guidelines for Patient Handlers Area Wide / Risk Management Type of document Priority Policy Guidance Protocol Other (specify) Immediate 2 days 7 days 30 days Questions Understanding Yes No Options Where to be published External and Internal Internal only Target audience NHSFV wide Specific Area / service Consultation and Change Record for ALL documents Contributing Authors: Consultation Process: Distribution: Risk Management Team Members Risk Management Advisory staff NHS Forth Valley Health and Safety Committee Via NHS Forth Valley StaffNet Change Record Date Author Change Version 09/12/2015 Christine Wallace 19/04/2016 Christine Wallace Following review, contribution and recommendations by the Risk Management Team, pictures added Addition of patient s communication needs on Page 5, following recommendations from Equality and Diversity Manager V 1.1 V1.2 29/08/2016 Carole Hunter Phone numbers updated throughout document V1.2 Version th April 2016 Page 2 of 49

3 Contents 1. Introduction Risk Assessment and Principles of Safer Manual Handling Controversial Manoeuvres Pushing and Pulling Equipment (Part of Module B) Patient Handling Tasks / Manoeuvres Chair Manoeuvres (Module C Manoeuvres) Bed and Trolley Manoeuvres (Module D Manoeuvres) Hoist Manoeuvres (Module E manoeuvres) Lateral Transfers (Module F Manoeuvre) Guidance for Emergency Situations Guidance for Situations which require special attention Manual Handling Equipment Purchase and Maintenance of Equipment Instruction Manuals Version th April 2016 Page 3 of 49

4 1. Introduction Manual Handling Guidelines for Core Patient Handling Tasks and Equipment. These guidelines are designed as a reminder for the principles of safer patient manual handling tasks. They are generic guidance only and are to be read as an adjunct to training, not a substitute. To reduce the risks arising from patient manual handling to the lowest level reasonable practicable: Staff must apply the principles of safer manual handling (also known as moving and handling), which are deemed as current, best and safe practice. Staff must avoid techniques that are regarded as controversial and carry a high risk of musculoskeletal disorders for staff and / or patients. These include using the: o Drag lift o Top and Tail lift; the Cradle lift; the Australian lift o Bear hug stand or giving any assistance from the front of the patient to help them stand (Where appropriate, each section of the guidelines highlights additional risks and controversial techniques relating to that particular manoeuvre) Handling equipment must be used when required for the task When performing manoeuvres, staff must encourage the patient to do as much for themselves as possible The guidelines are divided into modules to reflect the training delivered in NHS Forth Valley: Module A Theory Module B Object Handling Module C Chair Manoeuvres Module D Bed / Trolley Manoeuvres Module E Hoisting Module F Lateral Transfers Manual Handling Guidelines should be followed during emergency situations for example, fire; in water in danger of drowning; building collapse; bomb or bullet; and situations which require special attention for example, falling / collapsing person; fallen / collapsed person; patient reluctant to be hoisted; and the aggressive patient You will find a summary of the manual handling theory (Module A) information you need to complete in the e-learning modules. These modules must be completed, along with the relevant practical training, as part of the manual handling induction and as part of the mandatory refresher training. Manual handling is never undertaken in isolation and you should be aware of associated NHS Forth Valley policies: Manual Handling Policy Bariatric Policy Health and Safety Policy Infection Control Guidelines Forth Valley Royal Hospital Manual Handling Protocols Version th April 2016 Page 4 of 49

5 2. Risk Assessment and Principles of Safer Manual Handling Risk Assessment and Principles of Safer Manual Handling - all patients must have had a manual handling assessment undertaken prior to any of these generic manoeuvres being used. This is to ensure that there is no conflict between the task and any constraints placed on the patient s ability due to a medical condition, or a procedure which they have undergone. Throughout the assessment, the patient s communication needs would be considered on a 1:1 basis to ensure they fully understand actions being taken. The Manual Handling Operations Regulations (MHOR) set out a hierarchy of measures which should be followed to reduce the risks from manual handling. These are as follows: (a) avoid hazardous manual handling operations so far as reasonably practicable; (b) assess any hazardous manual handling operations that cannot be avoided; and (c) reduce the risk of injury so far as is reasonably practicable. When trying to avoid manual handling, the first questions to ask are whether the load(s) need to be handled at all, or could the work be done in a different way? For example, can a treatment be brought to a patient rather than taking the patient to the treatment? Where it is not reasonably practicable to avoid manual handling operations which involve a risk of injury, a suitable and sufficient risk assessment must be undertaken and steps must be taken to reduce the risk of injury to the lowest level reasonably practicable. Risk Assessment The MHOR state that wherever possible we should use an ergonomic approach to risk assessment. Ergonomics if sometimes described as fitting the job to the person, rather than the person to the job. This approach looks at manual handling as a whole, taking into account a range of various factors, including the Task, the Load, the Working Environment, Individual Capability and Other Factors (TILE+O) TILE+O Manual Handling Risk Assessment Factors In an attempt to reduce the risk of injury during manual handling, consideration should be given to the following examples: Task: use equipment; avoid lifting heavy loads especially from the floor or above shoulder height; reduce carrying distances; push rather than pull; avoid repetitive handling; vary the work etc. Individual Capability: take extra care of pregnant women and new mothers e.g. additional risk assessment / Occupational Health advice; provide staff with more training / information etc. Load: make it lighter; easier to manage; easier to grasp; more stable; evenly stacked to an appropriate height etc. Working Environment: remove obstructions / change flooring; reduce work at different levels; improve lighting etc. Other Factors: Is movement or posture hindered by personal protective equipment or by clothing? Version th April 2016 Page 5 of 49

6 The AAPEE System of Safer Manual Handling The following offers an approach to the manual handling tasks, which will make the process safer for you and the colleagues. Step 1: Avoid - Never manually handle unless you have no other alternative Ask yourself do I need to handle manually? Step 2: Assess - What if the handling procedure in question cannot be avoided? Perform a personal, on-the-spot assessment of the risks present Think: What needs to be done? Where will it be performed? Who is involved? How do you plan to do it? If anything should go wrong you want it to occur during the thinking stage, not the practical stage. Step 3: Plan / Prepare For example - if you cannot reach the required shelf height, appropriate equipment will need to be sourced and checked to ensure it fulfils the requirements. Step 4: Execute Carry out the manoeuvre using the principles of safe manual handling: create a mobile stable base; keep the spine in line, keep close to the load. Step 5: Evaluate Consider the success with which the task was performed on this occasion so that any mistakes, however minor, can be rectified prior to the procedure being repeated. REMEMBER! IF IN DOUBT AT ANY TIME SEEK ADVICE Version th April 2016 Page 6 of 49

7 3. Controversial Manoeuvres There are some practices which were once considered best practice in their day for moving and handling patients. They have since been condemned because their use can cause injury or harm to the patient and / or the handler. Some Controversial Manoeuvres The drag lift : placing the hand or arm under the axilla and using the shoulder as a lever to pull the person into sitting or forward, including cross arm lift; leg and arm lift; assisting between sitting and standing e.g. adjusting patient s clothing; assisting during standing and walking; and lifting a person from the floor. Considered unsafe since 1981 and can cause damage to the patient s shoulder(s) and / or cause musculoskeletal disorders (MSDs) to the handler(s). Using the bed sheet to move the patient: where the handler holds the bed sheet to move the patient up the bed or to be turned on their side. Risk of the sheet ripping; can cause friction and shearing to the patient s skin and / or MSDs to the handler(s) Top and tail : where one handler would lift the patient s upper body and the other would lift their legs e.g. from bed to chair; lift up the chair / bed. Can cause friction and shearing to patient s skin and / or MSDs to the handler(s) Cradle lift / Orthodox lift: where the handlers stood either side of the bed and stretched their arms under the patient s torso and legs to lift then up the bed. Can cause friction and shearing to patient s skin and / or MSDs to the handler(s) Australian lift / shoulder lift: where the patient would put their arms down the handlers backs, with their arms linked under the patient s legs. Can cause friction and shearing to patient s skin and / or MSDs to the handler(s) Front assisted stand and pivot transfer (axillary, bear-hug, clinging ivy, rocking-lift, elbow lift, belt holds from front, face to face): the patient is assisted into standing, or transferred using a pivot movement to another seated position by the handler standing directly in front of them. The handler may use a variety of holds, a knee or foot block may be applied and the patient encouraged to hold onto the handler e.g. patient s arms around handlers neck; considered controversial since it was found to cause MSDs to the handler(s) These controversial manoeuvres should no longer be used for planned moving and handling interventions In areas where this practice is used or known to be common practice ; staff who use or allow this practice to be used in their area of responsibility can be disciplined for breach of NHS Forth Valley policy. SAN - Controversial Patient Handling Manoeuvres Version th April 2016 Page 7 of 49

8 4. Pushing and Pulling Equipment (Part of Module B) For each manoeuvre, the handler must apply the principles of safe manual handling: create a mobile stable base; keep the spine in line, keep close to the load. These are general guidelines for pushing and pulling equipment e.g. bed / trolley / wheelchair The following should be considered for all pushing and pulling tasks: Pushing is considered better than pulling from a manual handling perspective Forces are greater upon starting and stopping, so start and finish slowly Use the powerful leg and buttock muscles to exert force, not just the arms Position the hands between hip and shoulder height for pushing and pulling Floor covering will impact on the degree of difficulty e.g. carpeted or softer impact flooring will increase the forces required to initiate a move and to keep the wheels in motion Wheelchairs A patient in a standard wheelchair is usually pushed by one person Use pushing and pulling manoeuvre as described above. Do not lift to change the position of the wheelchair, instead go backwards and forwards altering the angle of the chair each time The tyres should be correctly inflated otherwise the increased loading on pushing will be too great If the wheelchair is larger than the standard, or the patient is bariatric, and a powered wheelchair is not available; then more than one person may be required dependent on risk assessment, and, generally this would mean two handlers to push at the same time (e.g. using a handle each) Beds and Trolleys A bed or trolley with a patient must be moved with at least two handlers; and Ideally two handlers even if empty; however if assessed appropriate this may be reduced to 1 handler The bed or trolley should be pushed and steered by the handler at the foot end (the patient s head end must lead) Where 2 handlers are manoeuvring the bed, the second handler is at the patient s head end, walking at the side of the bed, guiding the head end as necessary. This person must not pull to keep the bed in motion The function of the second person is to make sure the patient is transported safely Coordination is essential so that corners and doors are negotiated safely and the pusher(s) must be aware of stopping in time if the lead person meets a shut door If the bed / trolley is larger than the standard, or the patient is bariatric, and a powered unit is not available to move the bed; then additional staff will be required dependent on risk assessment. Generally, this would mean more people to push and one person to steer Negotiating Doors The doors approached whilst moving patients should be fully opened up by the handler; if they are fire doors, they will then close slowly to allow you time to pass through without having to support them in an open position. If the door closes too quickly, please contact the fire adviser for advice prior to contacting the relevant Estates Department to request that the door is adjusted as necessary: FVRH contact Serco Helpdesk on 67888; Version th April 2016 Page 8 of 49

9 CCHC contact Robertsons Facility Management on ; All other areas, contact NHS Forth Valley Estates on If any safety aspects of the doors for the area are altered e.g. safety of patients, please advise the line manager. Wheelchairs If a door cannot be held back the handler should back through it, bringing the wheelchair through after them. Do not lean over the wheelchair to push the door open ahead. Beds or Trolleys If doors cannot be held back, during the passage through, each handler should hold back a door by standing in front of it, with their back holding the door in an open position, facing each other Each handler should then feed the bed or trolley through between them, being sure to keep their feet clear of the bed wheels There should be no twisting to effect this feed through Do not lean over or around the bed / trolley to push the doors open ahead Keep the feet clear to avoid being run over by the bed wheels Version th April 2016 Page 9 of 49

10 5. Patient Handling Tasks / Manoeuvres 5.1 Chair Manoeuvres (Module C Manoeuvres) For each manoeuvre, the handler must apply the principles of safe manual handling: create a mobile stable base; keep the spine in line, keep close to the load. The handler should also ask themselves the question: are there any unsafe practices or controversial manoeuvres which I should avoid when I undertake this task? (See Section 3) (C1a) Sit to Stand / Stand to sit from a chair Introduction This is suitable from an armchair, dining chair, wheelchair, commode or toilet, if sufficient space is available. Apply brakes on equipment as applicable. To achieve standing the patient must: Be sitting in an appropriate chair (a chair which is e.g. too low, may render an independent person unable to get up) Demonstrate sitting balance Be able to weight-bear Be able to balance If unable to judge whether the patient has these abilities then seek assistance from a senior colleague to make this assessment. Independent movement The patient should be encouraged to: Move forwards to the front edge of the chair Position their feet flat on the floor Place hand(s) on the arm(s) of the chair Lean body weight forwards with head up Push up into standing Assistance Required Sit to stand (One or more handlers are required dependent on the risk assessment) Encourage the patient to position themselves as above; if unable to do so, one handler may assist them, see section (C3) Ensure that the patient is ready to co-operate and understands that, on the command STAND, they must lean forwards with their head up and push up into standing with their hands on the chair arms A handler could assist with sliding the patient s hips to the front of the chair but if the patient cannot do this for themselves then this might indicate there will be problems with standing Handler(s) stand, to the (each) side of the patient, facing the direction of movement, with one foot in front of the other Handler(s) place the nearest arm and forearm across the patient s back, down towards the opposite hip ( posterior hold ). If the handler cannot reach down to the hip, around waist level is acceptable, (the handler(s) should not grasp the person or their clothing).the other hand is used to support the patient at the shoulder / forearm, at the front, as required One handler co-ordinates with a READY - STEADY - STAND command Version th April 2016 Page 10 of 49

11 As the patient leans forward, with head up, and pushes up with their hands, the handler(s) push gently in the patient s back / hip whilst supporting the shoulder / forearm, at the front, to ensure that the patient stands upright Whilst taking a step forward with the front foot, handler(s) transfers weight from their rear foot to front foot, utilising their own weight to guide the person forwards and upwards Patient must be standing and weight-bearing before they hold onto any equipment e.g. walking stick or frame Stand to sit Ensure the patient can feel the chair on the back of their legs Encourage them to reach backwards for the arms of chair whilst bending at the hips and knees and sitting down Precautions If the patient is unable to maintain weight on their feet or assist sufficiently to push into standing, too much strain will be placed on the handler(s) and the handler(s) should allow the person to sit onto the chair and not hold the weight of the person If the patient has weakness on one side, the handler should consider which side to stand so as not to take the full weight of the patient leaning onto them Other Options Transferring a patient from chair to commode / commode to chair One or two handlers can use the posterior hold as above or a combination hold, where one handler adopts the stance and hold as per posterior hold and the other handler faces the opposite direction, placing their arm and forearm across the front of the patient, towards the patient s opposite hip ( anterior hold). This is useful where space is limited, however must be undertaken with caution and only following careful assessment of the patient. The anterior hold must only be used as part of the combination hold. Risks and Controversial Techniques Risk of injury in standing a patient increases when consideration is not given to skin integrity there must be no gripping of the patient which can bruise soft tissue. Standing a patient who is unable to take their own weight through their legs is likely to cause injury to the patient and handler(s): Bear Hug or Pivot Transfer stances are not justifiable. Drag Lifts in any form, for example, to transfer patient from chair to commode, chair to bed, sit to stand from chair, sitting on the floor to standing etc. are not justifiable - see section 3 controversial manoeuvres: NBPA, images reproduced by kind permission of BackCare Version th April 2016 Page 11 of 49

12 Assisting by pulling on the patient s hands - the patient s arms and shoulders are vulnerable to injury and this approach can exacerbate behavioural resistance to stand; the patient leans their whole body weight against the handler in a counterbalance. The handler blocks the space the patient needs to move into, restricting independent movement. The handler could lose balance and any control of the move if the patient was to move in an unpredictable manner. NBPA, reproduced by kind permission of BackCare Version th April 2016 Page 12 of 49

13 5.2 Bed and Trolley Manoeuvres (Module D Manoeuvres) (C1b) Transfer from Chair to Bed / Trolley and Reverse Introduction Please see section (C1a) sit to stand from chair and section (D1) Sit to stand from a bed or trolley but the patient must be able to step around. Any aids e.g. walking stick or frame must be available and a member of staff must not take the patient s weight as they transfer. Apply brakes to bed / trolley. Adjust the bed / trolley height so that the patient s feet are flat on the floor when sitting on the edge of the bed / trolley. The chair should be a suitable height for the patient. Assistance Required (One or more handlers are required dependent on the risk assessment) Position the chair at a 90 degree angle to the bed / trolley, if possible Use posterior hold or combination hold to assist the patient to stand from chair or bed / trolley Walk round with the patient continuing with the same holds or change to palm to palm, avoiding thumb hold to hold the patients hand(s) Note that some patients like to transfer from the chair to the bed / trolley without fully coming up to standing. This type of independent sideways transfer generally depends on the patient having sufficient balance to achieve it safely; having a chair with arms which can be removed or lowered; and having the two surfaces at the same height. Use posterior hold or combination hold to assist the patient to sit on chair or bed / trolley If the patient requires support or cannot manage to transfer or step then equipment should be considered Using Equipment One or more handlers are required dependent on the risk assessment and the type of equipment used: Etac Turner (SWL 140kg / 22stone) / SamHall Turner; or Romedic Turner (SWL 150kg / 23 stone): Patient must be able to stand and balance but the Etac Turner or Romedic Turner substitutes the step around. NB-These are not transport aids. Sara Stedy (SWL 182kg / 28stone) used to transfer from sit to sit; room to room. Cricket (SWL 140kg / 22 stone) used to transfer from sit to sit; room to room. The patient must be cognitively aware and have some muscle tone in at least one leg and their trunk. Transfer board / Banana Board (SWL 130kg / 19 stone): The patient must have sitting balance, upper body strength and contact with the floor. This equipment is usually provided by physiotherapist or occupational therapist. Stand Aid: See section (E2) Hoist: See section (E1) Version th April 2016 Page 13 of 49

14 (C2) Walking For each manoeuvre, the handler must apply the principles of safe manual handling: create a mobile stable base; keep the spine in line, keep close to the load. The handler should also ask themselves the question: are there any unsafe practices or controversial manoeuvres which I should avoid when I undertake this task? (See Section 3) Introduction If a patient needs assistance when walking then there are many different and specific ways in which they may be supported. You should be aware of any individual requirements from e.g. a physiotherapy perspective. Assistance Required In general you should consider the following: When walking with a patient, you should not be entangled with them, i.e. ensure that you can break free if they should fall or stumble Use a palm to palm, avoiding thumb hold (see image), which provides support without entanglement, as does support under their forearm with a hand across their back to their hip NBPA, reproduced by kind permission of BackCare Do not allow the patient to hold the thumb The patient linking their arm through the handlers is also entanglement and should not be offered as a means of support The handler is not a substitute for a walking frame and should not be taking the patient s weight Equipment The patient may need the support of a walking stick, crutches or walking frame to move from one place to another The handler should be familiar with the equipment in the area and how the patient may be assessed for its use In general, physiotherapists or occupational therapists are involved in the assessment process Be aware that a patient may need to be re-assessed, once in the care, for equipment used previously at home Risks and Controversial Techniques Risk of injury in walking a person increases when there is any foreseen likelihood that the person may fall. This is the case with almost all patients using a walking aid, since it has been given to compensate for poor or compromised balance and effort. Safety measures must be put in place when walking with a patient who has a history of falls, e.g. an additional handler follows with a wheelchair, or a walking harness and hoist are used until the patient is confident and competent with the aid. Version th April 2016 Page 14 of 49

15 Palm to palm hoist with thumb hold The handler cannot release the grip quickly. The patient may grip tightly causing painful thumb joints. Assisted walking supporting at the axilla NBPA, reproduced by kind permission of BackCare The handlers inner arm is raised to support the patient which can cause strain to the handlers arms and shoulders. The handlers may end up holding the patient up and the patient may be inclined to lean on the handlers. NBPA, reproduced by kind permission of BackCare Version th April 2016 Page 15 of 49

16 (C3) Repositioning in a chair Moving to the edge of the chair Independent movement Verbally encourage the patient to move towards the edge of the chair Assistance Required If the patient cannot move forward themselves, one handler may assist. The patient must have cognitive ability to understand; follow instruction; must be able to lean their weight forward and move, with guidance and help, from side to side, without falling over; require trunk control and sitting balance The handler kneels in front of the patient, in open kneeling Handler asks the patient to hold on the arms of the chair and lean slightly forward and away from the side nearest to the handler Handler places one hand (using an open palm so as not to grasp the patient) close to the patients hip and their other hand on the front or just behind the patient s knee As the patient raises their weight off the seat, the handler exerts a forward pressure against the patients hip and to their knee, and leans back using their body weight to bring the patients hip forward in the chair Repeat for other side as above, until the patient is closer to the edge of the chair Do not use a glide sheet to bring a patient forward in the chair, as they may slide off the seat Reposition back in chair Independent Movement Encourage the patient to edge their own way back in the seat - Patient must have sitting balance Assistance Required If they cannot move back themselves, one handler may assist. The patient must have the ability to understand and follow instruction; with guidance and help, must be able to lean their weight forward and move from side to side, without falling over; requires trunk control and sitting balance The handler kneels in front of the patient, in open kneeling and places the palms of their hands (fingers facing down) on the patients shins Ask the patient to move their feet back towards the chair, until they are just on their toes Ask the patient to hold on the arms of the chair and lean slightly forward On READY, STEADY, PUSH ask the patient to push up as though going to stand and at the same time, handler transfers weight from rear knee to front knee, resulting in the patient being moved back in the seat Using Equipment A glide sheet may be inserted just underneath the patient s buttocks prior to the manoeuvre, but must NOT be close to the edge of the chair or the patient may slide off the seat One way glide Make sure you are familiar with the equipment prior to using it. The patient must have sitting balance and must be sitting on the one way glide prior to repositioning. Then reposition the patient as above Version th April 2016 Page 16 of 49

17 Risks and Controversial Techniques The patient is passive and the handler will take the full weight of the patient. The handler lifts in a stooped position as the chair restricts knee flexion NBPA, reproduced by kind permission of BackCare (C4) Managing the Falling and Fallen Patient Please see Section 7 Guidance for Situations which require special attention Version th April 2016 Page 17 of 49

18 Bed Manoeuvres (Module D manoeuvres) For each manoeuvre, the handler must apply the principles of safe manual handling: create a mobile stable base; keep the spine in line, keep close to the load. The handler should also ask themselves the question: are there any unsafe practices or controversial manoeuvres which I should avoid when I undertake this task? (See Section 3) (D1) Sit to stand / Stand to sit from a bed or trolley Lying to sitting on the side of the bed or trolley Independent Apply brakes to bed / trolley Adjust the bed height so that the patient s feet are flat on the floor when sitting on the edge of the bed To stand from a bed or trolley the patient must first get to a sitting position on the side of the bed / trolley To do this the patient must be able to raise their head from the pillow and this ability should be checked prior to commencement Encourage the patient to: Roll onto their side, near to the edge of the bed / trolley, with their legs bent to about 90º (feet still on the bed near to the edge of the mattress) and then; simultaneously push up from the mattress (with their lower elbow and with their upper hand); and drop their lower legs over the side of the bed / trolley, to come up to sitting or The backrest could be raised so that the patient is sitting up and can then move their legs over the side of the bed (a glide sheet could be folded under their bottom to avoid friction or shearing forces, but should not overlap the edge of the bed) Now see (C1a) sit to stand from chair but the patient should push up with their hands on the bed / trolley Assistance Required Sit to stand (One or more handlers dependent on the risk assessment) Prompt the patient to roll onto their side, near to the edge of the bed / trolley as described above If necessary, give some hands-on assistance to help them to either raise their shoulders or to drop their legs down over the side of the bed. However, do not assist with shoulders and legs on your own if the patient requires this amount of assistance seek help Adjust the bed height so that the patient s feet are flat on the floor when sitting on the edge of the bed Assist patient to stand, as in sit to stand from chair, except that the handler(s) may sit on the bed beside the patient and stand up with them* Stand to sit Ensure the patient can feel the bed / trolley on the back of their legs Encourage patient to reach backwards for bed / trolley surface whilst bending at the knees and hips to sit down Handlers may sit down on bed next to the patient* Version th April 2016 Page 18 of 49

19 Assisting patient s legs into bed Legs can be heavy and the patient should be encouraged to raise one leg at a time (this is generally easier than both at once) onto the mattress surface A handling sling placed under the patients lower leg(s) / heel(s) brings the weight closer to the handler s centre of gravity exerting less of a force, and the handler is not in a stooped position It is useful to place a folded glide sheet on the lower end of the bed, so that the patient can slide their legs across to the centre *If sitting down next to the patient on the bed, consider the safe working load of the bed (weight limit), and any infection control restrictions FVRH standard bed is a Huntleigh Enterprise 5000 (SWL 267kgs / 42 stone) displayed clearly on the foot end of the bed Standard bed in Community is Hillrom Avant (SWL 185kgs / 29 stone) Please note the Maximum User Weight of the beds will be less please check the beds in your areas. Version th April 2016 Page 19 of 49

20 (D2) Rolling in Bed Independent Encourage the patient to: Turn their head to face direction of movement Reach across their body towards direction of movement with far arm (the one opposite to the direction of movement) Bend their far knee (the one opposite to the direction of movement) with the foot flat to the bed surface Then a push with the far foot and a reach with the far arm will achieve the roll NB: the bed rails of a Huntleigh Enterprise 5000 bed (the standard hospital bed) are not weight tested for the patient to pull on them, neither are any of the beds unless otherwise advised by the Company Assisting a dependent patient: Two or more handlers are required dependent on the risk assessment The bed / trolley should be adjusted to so that the handler(s) avoid bent postures (forward flexion) 1 st Handler Adjust bed to full height of standard hospital bed (approximately waist height) and ensure brakes are on Adopt a stable, mobile base by placing the forward foot under the bed If the bed is fixed height at low level, adopt the stable base by placing one knee on the bed Face the patient Ask patient to turn their head in the direction they are rolling, towards you, or position their head for them, if necessary Ask the patient to reach across their body towards the direction of movement with far arm towards you, or position this arm for them Ensure that the nearest arm is not in a compromised position where it may be rolled onto Adopt a mobile stable base with flexed knees and place a hand on patient s scapula and pelvis, do not overstretch Co-ordinate the manoeuvre with a READY - STEADY - ROLL command and transfer weight from front foot to back foot so that the patient rolls towards you Step forward back to the bed 2 nd Handler Positions equipment e.g. glide sheets, or hoist sling or Handler 2 then rolls the patient as above, so that handler 1 can bring the glide sheet or hoist sling through towards them NB: If you feel you are overstretching, either one or two (or more if assessment dictates), use the bed sheet to assist with the roll. Ensure that the bed sheet is in good condition prior to using it. This manoeuvre is also used to change bed sheets, or to undertake care etc Version th April 2016 Page 20 of 49

21 (D3) Glide Sheets and extension straps Information on Use of Glide Sheets Although there are some tubular glide sheets available in NHS Forth Valley, most areas now use flat glide sheets Flat glide sheets are to be used in pairs: two slippery surfaces are required to prevent friction and shearing forces; the webbing along the edges allows them to be used in conjunction with extension straps to affect a lateral transfer from bed to trolley to bed see (F) They can be wiped down after minimal soiling and used again for the same patient They should be sent with the patient wherever they go (e.g. to x-ray) so that they are available for all staff to use Types of Glide Sheets Blue with webbing along the edges are washable standard size (200cm x 90cm) Extra large Blue with webbing along the edges are washable and much larger (200cm x 140cm) making them suitable for a bariatric patient, particularly when a wider bed has been brought in Red with webbing along the edges are patient-specific, standard size and disposable (i.e. used for one patient only and disposed of when soiled, damaged or no longer required) Availability of glide sheets: FVRH - Contact the helpdesk to request washable glide sheets from Linen Room, FVRH. Please do not hold additional glide sheets in the ward / department as they may be needed elsewhere. There is an adequate supply of glide sheets in the FVRH pool for this to run successfully. Each area should routinely order glide sheets to maintain the level of stock in FVRH. Please make sure you send any new glide sheets to the sewing room, Falkirk Community Hospital (FCH) where they can be marked as appropriate. In general, washable glide sheets can be used provided they are fit for purpose e.g. still slippery. If no longer slippery, please dispose of them and order new glide sheets. On average, glide sheets can be used up to 50 washes meaning they need to be replaced at least every 15 months. If on request, there are no glide sheets available, you may be able to obtain emergency equipment from the Manual Handling Equipment Library (MHEL). The MHEL is a top-up service which stocks patient specific glide sheets and hoist slings. Equipment is requested via the Manual Handling Team and is on a named patient basis ; you will have to sign for any equipment requested with the Ward / Dept meeting the cost of replacing equipment used. Extension straps These are available in the ward / department and are packed in pairs. They are clearly marked for use with flat glide sheets. You will require two pairs to affect a lateral transfer see (F). They are wipeable and reusable. Extension straps are used to prevent you from Version th April 2016 Page 21 of 49

22 having to bend or overstretch when you are using glide sheets to move a patient. They attach to the loops on the blue or red glide sheets. Manoeuvres for insertion of glide sheets At least 2 handlers are required and they should apply the principles of safe manual handling: (shown in all manoeuvres) for these tasks Rolling from side to side Glide sheets can be inserted by rolling the patient to one side and then back to the other side (manoeuvres). The sheets can be rolled, folded or scrunched together and positioned under the patient using the same manoeuvre as for changing a bed sheet They need to be fully under any part of the patient which they cannot move independently (e.g. from up and under the pillow, to down and under the heels for moving a dependent patient up the bed) so that no friction or shearing forces are exerted on the patient, and you do not take the weight. Unfurling or unfolding Glide sheets can be positioned under the full length of the patient without the patient rolling from side to side Place the two glide sheets on a level surface Starting at the top end (i.e. across the width) make large folds, of approximately 15cms or 6ins Continue these folds down the length of the glide sheets ensuring that the two layers stay together. Neat, flat folds will make this manoeuvre easier Turn the glide sheets so that the folds are downwards and the two free ends are uppermost The patient should be lying flat (either supine or on their side) Place the folded glide sheets underneath the patient s pillow and introduce under their shoulders Handlers will face the head of the bed on either side and place their nearest hand, palm uppermost, up and under the fold and grasp the top edge of the fold The handlers outer hand can hold the top two free layers to keep them in place, or lower down, press the mattress down so that the unfolding is easier On the command READY STEADY PULL the handlers bring their nearside hand down to unfold one fold at a time all the way down to the patient s feet The patient will now be lying fully on the two glide sheets This technique can also be done by inserting the glide sheets under the feet and legs and unfolding the glide sheets up to the patients head They can also be folded to mid point and inserted at waist level on the patient, unfolding top sections of folds up towards the patients head and lower sections of folds down towards the patients feet Manoeuvres for removal of glide sheets Each glide sheet is removed by folding a corner under itself and then pulling this lead edge (it forms a triangle shape) so that the glide sheet is withdrawn in easy stages, but with no friction or shearing forces against the patient s skin. This is most easily started by passing the under-folded corner under the patient s ankles to the handling partner; or They can be removed by rolling the patient from side to side (a reversal of the insertion manoeuvre) Version th April 2016 Page 22 of 49

23 (D4) Movement up the Bed or Trolley Independent To achieve this independently the patient must be able to: Sit unaided Push down onto the mattress surface with both hands Coordinate the movement by pushing with their feet Encourage the patient to: Sit up and balance with their hands on the mattress surface Raise their knees so that their feet are flat on the mattress surface Push down with hands and feet, to raise their bottom clear of the bed / trolley surface and push up towards the head end of the bed / trolley. Use of hand blocks can assist if assessed appropriate Alternatively, they could sit balanced with their hands on the bed and walk or shuffle their bottom towards the head of the bed, or; A folded glide sheet could be placed under their bottom so a self slide can take place Alternatively, a very able patient could: stand, move up towards the head of the bed / trolley and get back in nearer to the head end of the bed / trolley or the bed / trolley could be moved down behind them, whilst they are standing, for them to sit back down higher up the bed If the above independent movement compromises their tissue viability then glide sheets should be used, as below, to prevent friction and shearing forces Assisting a dependent patient, using two flat glide sheets Two or more handlers are required dependent on the risk assessment The bed / trolley should be adjusted to so that the handler(s) avoid bent postures (forward flexion) Insert glide sheets, from underneath the pillows, down to, and under, the feet of the patient see (D3) Handlers 1 and 2 Move the bed / trolley away from the top of the wall Make sure the brakes are on the bed / trolley Adjust the bed / trolley height to approximately waist height Stand either side of the bed One at a time, gently raise the patient s shoulder to allow you to position the hand closet to the patient, palm up, on top of the glide sheet, under the patient s upper thorax. The patient s head supported on the pillow. The elbow and forearm remain in contact with the bed. Facing the foot end of the bed, adopt the mobile stable base and with the other hand take hold of the top glide sheet at approximately hip level of the patient do not overstretch One handler co-ordinates with a READY - STEADY - SLIDE command Transfer the weight from the front foot to the back foot whilst holding the glide sheet Repeat this so that the patient is moved up in small stages Version th April 2016 Page 23 of 49

24 Each glide sheet is removed by folding a corner under itself and then pulling this lead edge see (D3) More than 2 handlers Additional staff position themselves at either side of the bed, facing the foot end of the bed, adopt mobile stable base and take hold of the top glide sheet Then as above from one handler co-ordinates with a READY - STEADY - SLIDE command Version th April 2016 Page 24 of 49

25 (D5a) Turning in Bed or Trolley Independent Encourage the patient to: Turn their head to face direction of movement Reach across their body towards direction of movement with far arm (the one opposite to the direction of movement) Bend their far knee (the one opposite to the direction of movement) with the foot flat to the bed surface Then a push with the far foot and a reach with the far arm will achieve the roll Re-position the shoulders and hips to achieve side-lying in the centre of the bed In reality all of the above is generally achieved in a coordinated, simultaneous movement Assisting a dependent patient, using two standard size flat glide sheets: Two or more handlers are required dependent on the risk assessment The bed / trolley should be adjusted to so that the handler(s) avoid bent postures (forward flexion) Inserting the glide sheets 1 st Handler Adjust bed to approximately approx waist height and ensure brakes are on Roll the patient as per rolling in bed 2 nd Handler Place the 2 glide sheets lengthways underneath the full length of the patient Turning the patient with 2 flat glide sheets to maintain a central position in the bed: 1 st Handler Adopt a mobile, stable base Encourage the patient to turn towards you so that as much normal movement as possible is achieved and during the turning you will be in place to reassure the patient 2 nd Handler Adopt a mobile, stable base by placing the forward foot under the bed If the bed is at low level, adopt a stable base by placing one knee on the bed With palms facing up, hold the top glide sheet, level with the patient s shoulder and hip One handler coordinates the manoeuvres with a READY STEADY - TURN command Transfer weight from front foot to back foot, causing the glide sheet to be pulled in a backwards and upwards movement easing the patient across the bed before or as he / she rolls This will turn the patient towards handler 1 Each glide sheet is removed by folding a corner under itself and then pulling the lead edge. In general, patients with a high BMI will find it difficult to lie on their side and will probably only manage a 30 tilt at best (D5b) Rolling and Turning Push and Receive Manoeuvre Turning the patient using two large (bariatric) flat glide sheets, using the push and receive manoeuvre is useful for bariatric patients Four or more handlers may be required dependant on the risk assessment Version th April 2016 Page 25 of 49

26 The bed / trolley should be adjusted to so that the handler(s) avoid bent postures (forward flexion) Inserting the bariatric glide sheets: 1 st Two (or more) Handlers Encourage the patient to do as much for themselves as in Independent section above Adopt a mobile, stable base, by placing the forward foot under the bed With palms of hands, push gently at patient s shoulder and hip 2 nd Two (or more) Handlers Adopt a mobile, stable base by placing the forward foot under the bed Place the hands in similar places on the patient to receive the patient towards you Or Tilt the patient towards you by grasping the bottom sheet up and over the patient (if the sheet is in good condition with no weak areas, rips or tears) 1 st Two (or more) Handlers Place the 2 glide sheets lengthways underneath the full length of the patient and roll them back into supine. It is generally easier if the glide sheets are placed under the bottom sheet Then roll the patient in the opposite direction, as above, so that the glide sheets can be gently unravelled centrally under the patient who is then returned to a supine position Turning the patient using two bariatric flat glide sheets to maintain a central position in the bed: 1 st Two (or more) Handlers Hold the top glide sheet to laterally slide the patient across the bed towards them. This will create space in front of the patient for them to roll towards and into 2 nd Two (or more) Handlers Place the hands at the patient s shoulder and hip, as above, to tilt the patient towards you, or grasp the bottom sheet up and over the patient, as above, ready to tilt the patient towards you 1 st Two (or more) Handlers With both hands, palms facing up, hold the top glide sheet, level with the patient s shoulder and hip One handler coordinates the manoeuvre with a READY STEADY - TURN command Transfer the weight from front foot to back foot, causing the glide sheet to be pulled towards you SIMULTANEOUSLY the other two (or more) handlers tilt the patient towards them This will turn the patient towards the 2 nd handlers Each glide sheet is removed by folding a corner under itself and then pulling the lead edge NB: this manoeuvre can be used for non-bariatric patients, in which case only 2 staff may be required, see (D2, D5a) and is particularly useful for staff who cannot reach over the patient to roll the patient towards them. Version th April 2016 Page 26 of 49

27 (D6) Lying to Sitting in Bed / Trolley Independent Patient will be lying in supine, Encourage the patient to Bend their knees with feet flat on bed surface Bend elbows at each side ready to push into mattress Raise their head to look towards feet Push up with elbows against the bed and raise up onto hands Once sitting up, place arms behind torso to prop and support in sitting posture Some patients may be able to sit up using a bed ladder. This should be firmly attached to the bed frame. The patient must not have had recent abdominal surgery / problems or have had a recent cardiac problem. The patient must be able to use both arms Manoeuvre to assist a less able patient: In general a profile bed with powered positioning will be available and should be used to assist a patient to sitting who cannot manage to achieve it independently The patient should be in the correct position in the bed / trolley and may have to be moved up to achieve this see (E) Most beds will profile with a bend at the knee and a raise of the backrest and the Huntleigh Enterprise 5000 bed has a yellow auto-contour function button on the patient handset which does both at once. This is the preferred option for a profiled position. If the profile functions are operated separately then the knee bend must be performed first to a) prevent friction/shearing to the patient s skin, which would otherwise occur if the back rest is raised alone and; b) to better replicate normal movement A bed with a trendelenberg tilt function can also be tilted foot-down to achieve a chair sitting position once the bed has been profiled Manoeuvre where no powered assistance is available: Use of handling sling / with pillow for head support Two or more handlers are required dependent on the risk assessment: Make sure the patient has head control and is able to bring their chin towards their chest Handlers at either side of the bed, facing the head end of the bed Place handling sling under patient s shoulders with a gentle tilt of shoulders towards one handler then the other Bend patient s knees slightly to reduce hamstring pull Bed in low position: Stand in walking stance with the inside knee on the bed then Take hold of the handling sling with the inner arm and take hold of the pillow with the outer arm One handler co-ordinates with a READY - STEADY - SIT command On SIT - both handlers move their knee back on the bed and sit down, as they do so the patient comes up to a sitting position between them Folding back rest or pillows can now be placed behind the patient to maintain their position and this will require a 3 rd handler Bed in higher position: Adjust the bed height to an appropriate level at the end of the move the patient s shoulders should not be higher that the handler s shoulder Stand in walking stance with both feet flat on the floor Version th April 2016 Page 27 of 49