Move and position individuals in accordance with their plan of care

Move and position individuals in accordance with their plan of care Page 1 of 21

Level 2 Diploma in Health and Social Care Unit HSC 2028 Tutor Name: Akua Quao Thursday 12 th September 2013 Release Date: 29/08/2013 18:53 Assignment task HSC 2028 Move and position individuals in accordance with their plan of care Unit purpose and aim This unit is aimed at those working in a wide range of settings. It provides the learner with the knowledge and skills required to move and position individuals as part of their plan of care according to their specific needs. Page 2 of 21

Task 1 Understand anatomy and physiology in relation to moving and positioning individuals Outline the anatomy and physiology of the human body in relation to the importance of correct moving and positioning of individuals Describe the impact of specific conditions on the correct movement and positioning of an individual Task 2 Understand legislation and agreed ways of working when moving and positioning individuals Information: Agreed ways of working will include policies and procedures and guidelines where these exist Describe how legislation and agreed ways of working affect working practices related to moving and positioning individuals Describe what health and safety factors need to be taken into account when moving and positioning individuals and any equipment used to do this Task 3 Be able to minimise risk before moving and positioning individuals Access up-to-date copies of risk assessment documentation Carry out preparatory checks using: the individual s care plan, and the moving and handling risk assessment Identify any immediate risks to the individual Describe actions to take in relation to identified risks Describe what action should be taken if the individual s wishes conflict with their plan of care in relation to health and safety and their risk assessment Page 3 of 21

Prepare the immediate environment ensuring; adequate space for the move in agreement with all concerned; and that potential hazards are removed Apply standard precautions for infection prevention and control Task 4 Be able to prepare individuals before moving and positioning Demonstrate effective communication with the individual to ensure that they: understand the details and reasons for the action/activity being undertaken; and agree the level of support required Obtain valid consent for the planned activity Information: Valid consent must be in line with agreed UK country definition Task 5 Be able to move and position an individual Follow the care plan to ensure that the individual is positioned: using the agreed technique, and in a way that will avoid causing undue pain or discomfort Demonstrate effective communication with any others involved in the manoeuvre Describe the aids and equipment that may be used for moving and positioning Use equipment to maintain the individual in the appropriate position Encourage the individual s active participation in the manoeuvre Information: Active participation is a way of working that recognises an individual s right to participate in the activities and relationships of everyday life as independently as possible; the individual is regarded as an active partner in their own care or support, rather than a passive recipient Page 4 of 21

Monitor the individual throughout the activity so that the procedure can be stopped if there is any adverse reaction Demonstrate how to report and record the activity noting when the next positioning manoeuvre is due Task 6 Know when to seek advice from and/or involve others when moving and positioning an individual Describe when advice and/or assistance should be sought to move or handle an individual safely Describe what sources of information are available about moving and positioning individuals Assignment task HSC 2028 Answers Task 1 Understand anatomy and physiology in relation to moving and positioning individuals Outline the anatomy and physiology of the human body in relation to the importance of correct moving and positioning of individuals Page 5 of 21

Table of the anatomy and physiology of the human body in relation to the importance of correct moving and positioning of individuals Musculoskeletal System The spinal column is made up of individual bones called vertebrae. In between the bones there are joints that connect these together. A ligament connects bone to support joints Muscles work by the fibres they contain contracting; this makes the muscle shorten. When the muscle shortens it pulls on the tendon and then on the bone to which it is attached. Muscles are connected to bones by tendons Bones in limbs are covered with tissue Moving and Positioning of Individuals Not moving an individual correctly can cause ligaments to sprain. This is why individuals must never be dragged when being moved as this can cause joints to over stretch and then sprain the ligaments When an individual is moved and positioned it is important this happens smoothly. Sudden movements or pulling in any direction of an individual s limbs or body can cause pulled muscles or tear tendons which can cause a lot of pain Putting pressure on an individual s hand or arm when they are moving from one position to another can cause a bone to fracture. Fractures can also happen if there is an accident with for example equipment like a hoist and this falls onto the individual when moving and positioning them or using the wrong sling size and the individual falls out Page 6 of 21

Describe the impact of specific conditions on the correct movement and positioning of an individual The impact of specific conditions on the correct movement and positioning of an individual is important when working with individuals with different conditions because this affects how we support them to move and change positions. For example, an individual living with dementia who is confused might not understand what we are saying during supporting the individual. It is very important to take time to show to the individual living with dementia what we will do before to do it. Individuals with arthritis have to be supported to move gently as they may be in a lot of pain and positioning or moving may be uncomfortable. An individual that has had a stroke might have one arm or leg stronger than the other so this needs to be taken into account when weight bearing or moving so as to avoid putting pressure on the weak side. Individuals who are blind might need more reassurance and speaking explanations about the move and what is around them as they cannot see. Task 2 Understand legislation and agreed ways of working when moving and positioning individuals Information: Agreed ways of working will include policies and procedures and guidelines where these exist Describe how legislation and agreed ways of working affect working practices related to moving and positioning individuals How legislation affect working practices related to moving and positioning individuals. Legislation that is relevant includes the Management of Health and Safety at Work Regulations; this introduced the requirement for risk assessment, risks when moving and positioning individuals must be assessed, acted on and reviewed; also all staff must be trained in moving and positioning individuals. The Lifting Operations and Lifting Equipment Regulations (LOLER) introduced the requirement for employers to provide lifting equipment that is safe to use and maintained; staff must also be provided with training. The Manual handling Operations Regulations for employers states that they must carry out risk assessments for all moves and reduce the risk of injuries from happening and avoid dangerous moving and handling; the employees responsibilities include using all Page 7 of 21

equipment as trained to do so, follow all health and safety working practices and avoid putting themselves or other staff, individuals or visitors at risk, reporting any hazards or risks to their employer. How agreed ways of working affect working practices related to moving and positioning individuals. Agreed ways of working mean that employers must have workplace policies and procedures for moving and handling; these must be explained to staff and staff provided with training and supervision. It is also important that all employees, read these procedures, if they do not understand ask, that they attend training, are supported with understanding all individuals needs, the moves needed and all equipment being used. Describe what health and safety factors need to be taken into account when moving and positioning individuals and any equipment used to do this Health and safety factors that need to be taken into account when moving and positioning individuals and any equipment mean; before moving and positioning individuals I have to take responsibility for the health and safety of the individuals, others and myself and while doing this adhere to the organisational policies in place and meet all health and safety obligations. I only move and positions individuals where I have had training to do so. I do this by ensuring that I am wearing appropriate clothing and foot wear when I move the individuals or when I am supporting them to change position to avoid any risk of being harmed; for example when using a hoist I must not wear open shoes or sandals, and always work with my colleague. I also make sure that I do a manual risk assessment before performing any move or reposition. I do not use any equipment that I have not been trained to use and I check that there is enough space around me to carry out the move. All equipment needs to be checked that it is working correctly, if a hoist that it is charged, and all equipment must be clean and safe to use. I look out for any obstacles, like loose rugs, clothes and move them to one side. It is important the space around me is clean and comfortable. All moving and positioning must not be rushed. Infection control is also important, washing of hands before and after and wearing of personal protective equipment according to my workplace policy. I also check with the individual their needs and preferences and check this against their plan. Page 8 of 21

I ask the individuals for their agreement before the move and make sure I am using the correct equipment, that the sling and hoist are clean and safe to use and the correct ones for the individual; these must then be stored away safely to avoid any accidents or them being used for someone else. In the plan it includes the individual s weight and the sling and hoist to use for their weight and for some individuals who are tall. For example, individuals who are tall need a much longer sling to support their head and body. Also to take into account is whether the individual will keep their arms in the sling or whether they may decide not to or may become anxious when being moved. Task 3 Be able to minimise risk before moving and positioning individuals Access up-to-date copies of risk assessment documentation To access up-to-date copies of risk assessment documentation, I need to ask to my line manager if I don't know. Usually, up-to-date copies of risk assessment documentation are kept in a separate file in the main office with a copy in the individual's care plan. Carry out preparatory checks using: the individual s care plan, and the moving and handling risk assessment To carry out preparatory checks using the individual s care plan, and the moving and handling risk assessment, mean to have access to the individual s care plan, and to have access to the moving and handing risk assessment. If I don't know where individual's care plan is, I need to ask to my line manager. Usually, individual s care plan is kept in a separate file in the main office with a copy of the up-to-date copies of risk assessment documentation. Moving and handling risk assessment is a basic tool to allow you to identify hazards, evaluate risks and decide on the safest way to do your work. Managers and principal investigators are responsible for risk assessments. Identify any immediate risks to the individual When moving and positioning an individual, it is very important to be able to minimise risk before moving and positioning the individual. Page 9 of 21

First, I will washes and dry my hands, with the full hand washing technique, before using the hoist for example. Then I will wear an apron and gloves. Before to move an individual with the hoist, I always make sure the hoist is working by checking the battery is fully charged, checking the hoist is clean and checking the correct sling size I will use to hoist the individual is also recorded in the plan and assessment of the individual, and fit the individual correctly. Of course, I will explain with my colleague, to the individual what we will do before moving and positioning the individual. For example during to transfer the individual from the bed to the wheelchair, I make sure this is what it's has been agreed with the individual and I make sure the way we will transfer the individual is written down in the individual's care plan and risk assessment. I also make sure to look around the individual s room to be sure my colleague and I have enough space before to process moving the hoist. If needed, I will ask to the individual if I can move the small table until the move with the hoist is over. I will explain this is to avoid anyone slipping or falling over and having injuries. During moving and positioning an individual with the hoist, immediate risks for the individual mean risk to fall on the floor, risk hurting an object, and risk having injuries. What is risk? Risk is the chance of harm happening to someone. Risk assessment and the prevention of harm to people is naturally an important part of providing health and social care, particularly to vulnerable people such as living with dementia. However, fear of any risk, and therefore complete prevention of risk, has become the focus in some cases. In reality we all take assessed risks every day. We take part in sports and activities; we cross busy roads and drive our cars. Life would be boring if we never did anything that had risks attached to it. Acceptable risk can bring benefits into individual s lives. Risk and individuals living with dementia In considering risk in relation to caring for individuals living with dementia, it is important that we are aware of, and assess for, risks. We need to do what we can to prevent accidents and harm to the individuals we care. However, this has to be weighted up against the individuals we care for being able to do things that are enjoyable and that promote well being and quality of life. Page 10 of 21

Sometimes things individuals living with dementia may want to do may carry some level of risk, however, preventing an individual from doing something may carry greater risks for social, emotional and physical well being. All individuals living with dementia have rights. Rights are the freedoms to which all people are entitled. Risk is a concern in providing care to individuals living with dementia. Care homes have a duty to ensure individuals are not at risk of harm. Risk of physical harm has to be balanced against risk to well being and quality of life where activity and movement is restricted because of potential risks. Individual s rights are protected by law, particularly where individual are vulnerable and do not have capacity to make decisions about their own care. Laws of individual s rights are The Human Rights Act 1998, Dignity in Care, Mental Capacity Act 2005, and Deprivation of liberty safeguards (DOLS) in England. The issue of rights and risk are not straightforward. There are often no clear answers. This is why discussion, assessment and carful thought are required. Describe actions to take in relation to identified risks Actions to take in relation to identified risks are: - First Step = identify any risk - Next Step = decide what can be done to be protected from the risk For example: There is a carpet on the floor, in an individual room, that may open chance of fall for the individual with limited mobility. Action to take: Remove the carpet. Describe what action should be taken if the individual s wishes conflict with their plan of care in relation to health and safety and their risk assessment If the individual s wishes conflict with their plan of care in relation to health and safety and their risk assessment, action should be taken. When I come across risks before moving and positioning an individual my actions will depend on what the risks are. For example, if there are risks in the environment from hazards that I can move like an item on the floor then I will do so with the individual s agreement. Page 11 of 21

If there is a risk in terms of the equipment I m using if it is faulty or from the individual it may be that I think they are unwell or I see a change in their behaviour then I would not carry out the move but first would report the risks to my manager and seek advice. The equipment if faulty is removed from the immediate area and an out of order sign placed on it until it is replaced to make others aware that it is not working or safe to use. If an individual asks me to move them in a different way than is stated in their care plan and risk assessment I will explain to the individual what their care plan and risk assessment says, the risks involved and my responsibilities to only follow the care plan. If the individual still insisted then I would explain that I would need to report this to my manager. I must also record the risks, the date and the action to take. Prepare the immediate environment ensuring; adequate space for the move in agreement with all concerned; and that potential hazards are removed Like I wrote above: I also make sure to look around the individual s room to be sure my colleague and I have enough space before to process moving the hoist. If needed, I will ask to the individual if I can move the small table until the move with the hoist is over. I will explain this is to avoid anyone slipping or falling over and having injuries. During moving and positioning an individual with the hoist, immediate risks for the individual mean risk to fall on the floor, risk hurting an object, and risk having injuries. For example, if there are risks in the environment from hazards that I can move like an item on the floor then I will do so with the individual s agreement. If there is a risk in terms of the equipment I m using if it is faulty or from the individual it may be that I think they are unwell or I see a change in their behaviour then I would not carry out the move but first would report the risks to my manager and seek advice. The equipment if faulty is removed from the immediate area and an out of order sign placed on it until it is replaced to make others aware that it is not working or safe to use. I must also record the risks, the date and the action to take. Apply standard precautions for infection prevention and control Standard precautions for infection prevention and control mean to work in a way to prevent staff exposure to blood and body fluids, and to minimise transmission of Page 12 of 21

healthcare associated infection (HCAI) including blood borne viruses, and to prevent injuries and minimise transmission of blood borne viruses. Standard precautions for infection prevention and control mean to ensure all staff is aware of safer practise, and to ensure staff is aware of and adhere to the guidance issued in the prevention of injuries policy and the actions to be taken following an exposure. Working in a way to prevent staff exposure to blood and body fluids, and to minimise transmission of blood borne viruses, mean the perfectly wash hand hygiene, washing and drying hands with the full hand washing technique, mean wearing personal protective equipment, eg an apron, mask and gloves. To apply standard precautions for infection prevention and control mean to disposed of apron, mask and gloves in the adapted clinical waste bin (yellow bin with yellow bag, and red bin with red bag), and then to wash and dry again hands thoroughly. Page 13 of 21

Standard precautions for infection and control Page 14 of 21

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Task 4 Be able to prepare individuals before moving and positioning Demonstrate effective communication with the individual to ensure that they: understand the details and reasons for the action/activity being undertaken; and agree the level of support required Effective communication with the individual to ensure that they understand the details and reasons for the action/activity being undertaken can be demonstrated with this example: An individual got one pressure sore on the bottom skin, and need a new air mattress bed that will help to remove, little by little, the pressure sore on the bottom skin of the individual. This new air mattress bed fit more for the individual's need, compared to the previous air mattress. In this example, effective communication with the individual help to ensure the individual understand the details and reasons for the action/activity being undertaken, by agreeing the new air mattress bed, that fit more for the individual's need and well being. Also in this example, the individual agree the level of support required by agreeing the new air mattress bed, that fit more for the individual's need and well being, because the individual got one pressure sore on the bottom skin, and can't sleep correctly during the night due of pain and discomfort. This new air mattress bed will help to ensure the individual well being. Obtain valid consent for the planned activity Information: Valid consent must be in line with agreed UK country definition To obtain valid consent for planned activity one must: 1 Complete the valid consent form according to local policy, procedures and protocols 2 Check the individual or relevant others clear understanding and confirm valid consent and authorization 3 Explain the reasons for the clinical option covered in the valid consent form 4 Check the individual identification details according to local guidelines before commencement of the valid consent authorization process 5 Refer to managers for advice and information when you are unable to resolve issues around the valid consent and authorization Page 16 of 21

Task 5 Be able to move and position an individual Follow the care plan to ensure that the individual is positioned: using the agreed technique, and in a way that will avoid causing undue pain or discomfort and Demonstrate effective communication with any others involved in the manoeuvre and Use equipment to maintain the individual in the appropriate position and Encourage the individual s active participation in the manoeuvre Information: Active participation is a way of working that recognises an individual s right to participate in the activities and relationships of everyday life as independently as possible; the individual is regarded as an active partner in their own care or support, rather than a passive recipient and Monitor the individual throughout the activity so that the procedure can be stopped if there is any adverse reaction and Demonstrate how to report and record the activity noting when the next positioning manoeuvre is due Example of providing help for an individual to stand up using the Turner aid and to sit on a wheelchair to go for breakfast To ensure the individual is positioned using the agreed technique, and in a way that will avoid causing undue pain or discomfort, my colleague and I will follow the care plan and risk assessment folders. Page 17 of 21

My colleague and I will discuss the care plan of the individual with the individual to have the agreement of the individual to stand, and of course my colleague to stand next to the individual to provide guidance for the individual. The individual s room door is closed and the individual is already washed and dressed. Before putting our personal protective equipment, by wearing disposable aprons and gloves, my colleague and I take time to wash and dry hands thoroughly, with the full hand washing technique. To demonstrate effective communication with my colleague and the individual involved in the manoeuvre, it is very important to explain what will happen to the individual about what my colleague and I want to provide the care by positioning the individual, using the agreed technique and in a way that will avoid causing undue pain or discomfort for the individual involved in the manoeuvre. My colleague and I will ensure the individual know what will happen, and will take time to explain to the individual the manoeuvre by count of three words; ready, steady, go! My colleague and I will use appropriate equipment to maintain the individual in the appropriate position, following the care plan and risk assessment folder, and using the agreed technique. I will place the Turner in front of the individual and then asks to the individual to place the feet on the middle part of the turning plate and checks with the individual if it is comfortable. My colleague and I will visually check that the individual understand how to position correctly the knees in the correct angle. To encourage the individual s active participation in the manoeuvre when positioning the individual in an appropriate position is essential to let know what will happen to the individual. To monitor the individual throughout the manoeuvre so that the procedure can be stopped if there is any adverse reaction from the individual during the manoeuvre is very important to avoid causing pain or discomfort. Then I will moves the handle to the correct height, places both hands on the handle and steps onto the turning plate and then asks the individual to place the hands on the handle and stand up and checks if the individual is comfortable, waiting a few moments. Then I will turns the disk round, steps onto the pedal and asks the individual to sit back down onto the wheelchair and checks if the individual is safe and comfortable. How to report and record the manoeuvre noting when the next positioning is due mean, my colleague and I will record in the individual's care plan the move of the manoeuvre and the checks we made of the individual whilst using the Turner aid and reports this to my manager. Page 18 of 21

Describe the aids and equipment that may be used for moving and positioning The aids and equipment that may be used for moving and positioning an individual, are the utilisation of the hoists and slings that are used to move individuals who cannot move by themselves from one position to another position. The slings come in different sizes and types depending on the height and weight of the individual. Slide boards are used for individuals who are quite independent and who just need a little support with moving for example from their bed to a wheelchair or from a chair back to their bed. Lifting handles are used with some individuals to can help them to sit up in bed independently; they hold onto to these to move themselves. Page 19 of 21

Handling belts are used when an individual might be a little unsteady when getting up and so by holding onto the handles on the belt you can help steadies the individuals so that they don t fall over. There also grab handles placed in individuals bathrooms for individuals to be independent when standing up, walking frames with and without wheels can also help individuals move themselves independently. Moving individuals living with dementia require the utilisation of the Oxford Advance Hoist and Oxford Elevate electric stand aid for the individuals that can't stand and can't walk due to dementia. The utilisation of the turner aid and walker provides a great help for the individual with low mobility. Task 6 Know when to seek advice from and/or involve others when moving and positioning an individual Describe when advice and/or assistance should be sought to move or handle an individual safely Advice and/or assistance should be sought to move or handle an individual safely; - when the manoeuvre is difficult and risky to the health and safety of both the individual and the carer as this is against the law and can cause injury - when the wrong equipment is available - when the equipment is faulty again against the law and can cause injuries - when the individual s care plan indicates that two carers have to assist with a specific manoeuvre and no-one is available - when the carer is not sure how to complete the tasks or use the equipment - when the individual asks you to carry out the manoeuvre that is outside of the care plan and that may harm them or the carer as we are not allowed to go outside the care plan this will be unsafe for the carers and individual Describe what sources of information are available about moving and positioning individuals There are lots of different sources of information who are available about moving and positioning individuals, on internet, in my workplace the moving and handling procedures and guidelines about the correct practices to follow, in the individuals risk assessment and care plans about their needs and practices agreed to follow. The individuals and their families can also help with what they find useful. Page 20 of 21

I can also ask my colleagues and manager for information and advice. Sometimes we can also ask other health care professionals such as physiotherapists and moving and handling specialist specific questions or advice about issues. Sources of information are available about moving and positioning individuals during training courses and on the information leaflets. Page 21 of 21