Safe moving of client

Caring for people often necessitates helping them move. The manual lifting and moving of people is a high risk activity and is a major contributor of musculoskeletal injuries to nurses, health professionals and carers.

Some practical ways to manage the risks arising from any activity that requires the use of force to lift, carry, push, pull, support, transfer, hold or restrain a client at a workplace. It also provides advice on various types of lifting equipment. This information is useful for home carers, employers and employees in hospitals, nursing homes, residences, special schools and emergency services.

Risk assessment

Tasks involving the manual handling of people should be performed in a balanced, controlled manner and should not cause discomfort or pain. Extreme ranges of joint movement should be avoided, especially when this is prolonged or repetitive.

Examples of actions and movements which may lead to injury during handling:

• using only one hand to lift a child
• moving suddenly to stop a client's fall
• lifting a client out of a bed or bath without assistance, requiring the worker to bend and twist over to one side

The nature of handling people often results in workers adopting sustained postures. Work activities should permit the worker to adopt a variety of comfortable working positions, without any one posture being awkward, prolonged or repetitive. Working heights should be adjustable to enable individual workers to perform manual handling tasks in an upright, comfortable position.

Examples of postures and positions which may lead to injury during handling:

• rescuing or retrieving people from confined areas which make them difficult to reach
• prolonged stooping to dress or support a client
• bending or twisting to push or pull wheelchairs, beds or mobile hoists

The risk of injury rises with the increasing frequency and duration of manual handling activities by a worker in a work period.

Repeating the same task over time may also lead to boredom and monotony.

Examples of task duration and frequency factors which may lead to injury during handling:

• repeated lifting of children with disabilities into and out of vehicles
• prolonged surgical operations or procedures
• repeated positioning and turning patients in bed

Risk Management

There is no one simple, safe method for lifting and moving people. The risk of manual handling injury is exacerbated by a number of unpredictable variables. These include the fluctuating nature of the client's physical and mental condition, which may, for example, result in sudden, uncontrolled movements, resistance to assistance or aggression toward staff. Each manual handling activity therefore warrants the evaluation of its specific, unique requirements and the application of risk controls which aim to meet the health and safety needs of all persons involved in the activity, including the client. Risks associated with lifting and moving people can be managed in a systematic, proactive way by applying risk management principles including:

• identification of factors likely to cause injury
• assessment of potential risks to workers and other persons affected by the work
• implementation of control measures to eliminate or reduce the risks
• monitoring and reviewing the effectiveness of the control measures

This information promotes the use of mechanical lifting equipment in all cases where the person being moved is fully dependent and/or the weight of the person being lifted is 55 kilograms or more. Where the health and safety of the person being lifted or transferred may be compromised, manual methods may be used. Where manual lifting techniques are used, they should be documented and performed by a team of four or six fit and trained/accredited lifters.

A manual handling policy should be developed and the risk management process should be documented.

Mechanical Equipment and Assist Devices

Eliminate manually lifting and moving clients who cannot fully support their own weight by using mechanical equipment and assist devices.

To facilitate the use of mechanical equipment and assist devices, they should be:

• evaluated and selected by the users
• purchased in sufficient quantities
• stored so they are visible and easily accessible at all times
• accompanied by effective training
• equipped with sufficient replacement accessories such as slings and castors
• maintained in good working order

Before purchasing any equipment or device, consider the following:

• What lifting or moving activity do you need it for?
• Know what you want the equipment to do as no single piece of equipment can do everything.
• Where is the equipment going to be used and stored?
• Know the limitations of the environment including the width of doorways, type of floor surfaces and layout.
• What are the characteristics of the clients being moved?
• The person's mobility, height, weight and special needs, and whether they are weight bearing or non-weight bearing.
• Provision should be made for the safe handling of very heavy clients who weigh more than the capacity of mechanical lifting equipment.
• Develop selection criteria in the form of a checklist for the equipment required.

Discuss your requirements with equipment suppliers and obtain the equipment for a trial period before purchase. If this is not possible, see it in operation a similar workplace. Find out whether the equipment can be improved. Some manufactures are willing to modify their equipment to suit your needs.

Training

Provide induction and ongoing training in the safe moving of people.

Training and instruction in safe manual handling principles should be based on the outcome of the risk identification, assessment and control process. Training is essential to reduce the risk of injury, but it is only one aspect of the control process.

To be effective, training should be competency based (requiring workers to demonstrate their skills in a competency evaluation) and it should:

• include practical demonstrations
• ensure that workers understand the risks associated with lifting and moving people
• allow feedback from workers
• be systematically reinforced with appropriate supervision and retraining

The training program should be conducted by a competent person who has a sound knowledge of anatomy and physiology, biomechanics, experience in lifting and transferring people, knowledge of the workplace and equipment, an understanding of client needs and good communication skills.

Training programs should be tailored to the specific needs of the group being trained. The training content should include:

• risk factors related to musculoskeletal injuries
• biomechanics and how to best use body weight, posture and teamwork
• participation in the risk management process
• client assessment
• use of mechanical equipment and assist devices
• specific manual handling techniques
• administrative procedures
• reporting of injuries and problems with work environment, equipment and/or task
• legislative requirements and responsibilities

Evaluation and Review

Evaluation and review should be an ongoing process that aims for continuous improvement in reducing the risks associated with moving clients. The effectiveness of control measures should be reviewed regularly to ensure that health and safety objectives are being achieved.

Evaluate and improve the risk management process by:

• consulting workers, maintaining awareness and encouraging feedback
• using checklists and conducting regular inspections
• responding to reports of risks and incidents
• developing performance indicators

When evaluating control measures, it is important to consider the following:

• Is the control measure working as planned?
• Are there any compliance problems?
• Have conditions changed?
• Has the control measure inadvertently introduced new risks?
• Has there been a reduction in injuries associated with moving clients?