Minimal Handling, Transportation and Client Safety

1. Minimal Handling,Transportation and Client Safety Lecturer: Michele Archdale Powerpoint revised and edited Feb 2012 Ref: C.Ramsay / C.Cross/ M.Archdale

2. What is Minimal Handling? • Any event that involves: • Lifting, • Lowering, • Pushing, • Pulling, • Carrying • Moving holding or restraining any animal, object or person!

3. Lifting Pushing Holding Pulling Carrying Throwing Striking 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:

4. Repetitive actions Sustained postures Exposure to Vibration Manual Tasks It also describes activities involving:

5. 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.

6. 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.

7. 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 clumsiness • Heaviness • Burning sensations • Stiffness • Swelling If you start to experience any of these symptoms don’t ignore them!

8. 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.

9. 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.

10. Three Steps to Reducing Injuries The three steps are: • Identifying manual task hazards • Assessing the risk of those manual task hazards identified causing injury • Eliminating the risk, or if not practicable reduce the risk to the lowest practicable level

11. Ensure the Load is not too Heavy!

12. New Technology is not always the answer

13. 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.

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

15. 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

16. 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 .

17. ELIMINATION SUBSTITUTION ENGINEERING ADMIN PPE Eliminating (or Controlling)the Risk Hierarchy of Controls

18. Common Risk Control Measures 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 • 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

19. 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...............................

20. 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.

21. 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.

22. 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.

23. 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.

24. Evaluation & Record Keeping Evaluation Check the effectiveness of control measures in place and ensure no new hazards have been introduced Record Keeping Records should be kept of hazard identification, risk assessment and control measures including training records

25. 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.

26. 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.

27. Stretches Neck & Shoulders Abdominal 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. 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.

28. Chest Upper Back Stretch Position Stand 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.

29. Overhead Arm Pull Thigh 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.

30. Hamstring Stretch Hamstring Stretch Seated 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.)

31. Groin Stretch Standing Groin 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.

32. Calf Stretches Calf Stretches 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.

33. Hip & Back Stretch Seated Hip & Back Stretch Lying Down 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.

34. Hip Stretches Arm Stretches 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

35. 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.

36. 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.

37. The Spine

38. Functions • Receive sensory impulses from the tissue and convey to brain. • Convey motor impulses from brain to body • Pathway for reflex actions.

40. Normal Structure of spinal cord and discs.

42. Protecting Your Back Your back is particularly vulnerable to manual task injuries. Suggestions to protect your back include: • 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

43. 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.

44. 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

45. 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).

46. 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.

47. 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

48. 1. Health systems have a moral imperative to ensure the safety of patients • Adverse events have a tremendous cost to the system in extended hospital stays & additional medical procedures • Adverse events expose health organizations to legal liability

49. 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.

50. 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