MOVING AND HANDLING POLICY

MOVING AND HANDLING POLICY This policy and protocols have been written by the Lincolnshire Inter-Agency Group for Moving and Handling which comprises the following members: AdultsChildren and Young People Alyn Blyth Tina Craggs Risk Manager Moving and Handling Specialist Lincolnshire Ambulance Service NHS Trust Lincolnshire NHS Shared Services Wendy Cundy Alison Gibson Head of Workforce Development Strategic Back Care Advisor East Lincolnshire Primary Care Trust Lincolnshire Social Services Alison Gibson Mandy Jones Strategic Back Care Advisor School Nurse, St Francis School Lincolnshire Social Services United Lincolnshire Hospitals Trust Elizabeth Hart Abigail Storr Control Assurance Manager Senior Occupational Therapist Lincolnshire South West Primary Care Trust West Lincolnshire Primary Care Trust Shirley Kaberry Jo Thomas Health and Safety Co-ordinator Senior Practitioner Occupational Therapist Lincolnshire Ambulance Service NHS Trust Lincolnshire Social Services Malcolm King Gil Vashak Specialist Training & Advisory Services Manager Senior Physiotherapist Lincolnshire NHS Shared Services West Lincolnshire Primary Care Trust Sheila Miles Lynn Walters Primary Care Manager Senior Occupational Therapist West Lincolnshire Primary Care Trust West Lincolnshire Primary Care Trust Tobias Payne Regulation Inspector Commission for Social Care Inspection Linda Rhodes Clinical Advisor Community Healthcare Equipment East Lincolnshire Primary Care Trust Carol Stevens Homecare Manager Lincolnshire Social Services Joanne Taylor Senior Physiotherapist St Barnabas Hospice Adi Todd Moving and Handling Co-ordinator United Lincolnshire Hospitals Trust The Inter-Agency Group meets regularly and was originally formed over three years ago with the aim of promoting a consistent approach to Moving and Handling across the Lincolnshire Health and Social Care Community.

MOVING AND HANDLING POLICY CONTENTS

MOVING AND HANDLING POLICY 1. STATEMENT OF COMMITMENT As member organisations of the Lincolnshire Inter-agency Group for Moving and Handling we recognise the threat that the risks inherent in moving and handling pose to individuals, the organisations and the provision of our services. Working together with our staff, we are committed to addressing these risks in a proactive way, employing good risk management systems and ergonomic practice. As far as is reasonably practicable, we aim to eliminate moving and handling activities where there is a risk of injury. Where this is not possible, we aim to implement a range of actions to reduce the risks in the workplace to the lowest possible level. We also acknowledge the need for tangible investment in taking this policy forward and will endeavour to ensure that the necessary resources are made available in line with Risk Management Strategies. This will include the provision of the necessary equipment and safe systems of work, human resources and a safe handling environment. The organisations also accept the responsibility to monitor the implementation of the policy and to review it on at least an annual basis. We the Chief Executives and General Manager are committed to the principles of working through the Lincolnshire Inter-Agency Moving & Handling Group to ensure a consistent approach to moving and handling across Lincolnshire. Also to work collaboratively in the development of local procedures and protocols. This policy is subject to ratification and adoption by the individual member organisations. CHRIS SLAVIN ROGER PAFFARD Chief Executive Chief Executive Lincolnshire Partnership Trust United Lincolnshire Hospitals Trust MATT BUKOWSKI TIM RIDEOUT Director Chief Executive Lincolnshire Social Services West Lincolnshire Primary Care Trust DEREK BRAY JANE FROGGATT Chief Executive Chief Executive Lincolnshire Southwest Primary Care Trust East Lincolnshire Primary Care Trust KEN DAVIDSON General Manager St Barnabas Hospice Date: May 2005 The policy is also recognised and supported by the following organisations: The United Lincolnshire Hospitals NHS Trust The Lincolnshire Ambulance Services NHS Trust The Commission for Social Care Inspection revised 7 July 05

MOVING AND HANDLING POLICY 2. DEFINITION OF MOVING AND HANDLING Moving and handling is any action required as part of a person’s job that involves movement of a person or inanimate object by hands or bodily force. This includes activities such as lifting, lowering, pushing, pulling, carrying and supporting a load. It is recognised that in Musculoskeletal Disorders (MSDs) can arise from periods of being in a static position (eg being seated at a desk for long periods) or repetitive stooping or bending and that they are often the result of a cumulative effect rather than being attributable to a specific incident. It is important therefore, that any injuries or ill-heath related to moving and handling or working in static positions and poor postures is reported in accordance with local reporting procedures. 3. THE COSTS OF INJURY AND ILL-HEALTH Health and social care workers are among the highest risk occupations with injuries, caused by their work. This is an increasing trend and 54% of all accidents in the care sector are associated with moving and handling (Manual Handling Operations Regulations 1992,1998). MSDs are by far the most common form of work related ill health in Great Britain, creating a great deal of suffering and hardship to individual workers, and it is costly to their employers and health and social care providers. The Health and Safety Executive has estimated that back problems caused by work cost employers between £315 – £335 million. 4. THE SCOPE OF THE POLICY The policy covers all moving and handling activities undertaken by staff during the course of their work. It applies to all members of staff and volunteers as well as the person being moved. It also applies to agency staff, contractors, and visitors. The policy recognises that the member organisations and their staff have a duty of care under common law to the person being moved and relatives who may be involved in the moving and handling tasks. Organisations will take reasonable steps to ensure that staff from outside agencies have received the appropriate training in and information on how to perform safer moving and handling prior to commencement of duties on behalf of the organisation. revised 7 July 05

MOVING AND HANDLING POLICY 5. POLICY VALUES All the organisations are committed to the implementation of the Moving and Handling Policy based on the following values. • Handling of People • Each person who needs assistance with moving and handling will be individually assessed by a competent member of staff taking into account their individuals needs, capabilities and circumstances. A balanced approach will be followed which considers the person’s human rights as well as the need to protect staff from injury. • As part of the risk assessment the risks and benefits to the person will be balanced against the need for staff safety. The rehabilitation and developmental needs of the person will also be considered as part of this process. • The person and, where appropriate, those acting on their behalf, will be actively involved in the moving and handling assessment and decision making process. • A problem solving approach will be adopted which considers the use of a variety of handling methods and equipment to reduce the risk of injury. The independence of the person will be encouraged at all times. • The assessment will identify the number of staff that will be required to safely move the person. There will be many situations where more than one member of staff will be required. • Following assessment, a written individual handling plan will be produced which will be reviewed at appropriate intervals or when circumstances change. A copy of the person’s moving and handling assessment and handling plan should be available for staff to refer to. This applies to hospital, residential and community situations.

Handling of People contd Manual lifting of adult people will be avoided in all but exceptional or life threatening situations. Hoists, sliding aids and other specialised equipment should be used whenever possible but in some situations manual lifting may be required. In the case of children it may not be appropriate for all manual lifting to be eliminated. Methods of avoiding or reducing the risk of injury should be employed based on a full risk assessment. This should take account of the child's development needs and manual handling risk factors including the weight of the child. Moving and handling equipment may not always be required and manual handling techniques may be used based on an individual risk assessment provided that they follow safer handling principles. Load Handling A minimal lifting approach will be applied to load handling situations based on a full risk assessment, which takes account of factors such as size, shape, weight and design of the load. Mechanical aids should be utilised whenever possible. Whenever possible the risk of injury from load handling problems should be reduced by implementing measures at strategic level. Good planning and design at the workplace will often eliminate hazards at an early stage. Safe systems of transportation will be readily available for the movement of goods, supplies and equipment. MOVING AND HANDLING POLICY

MOVING AND HANDLING POLICY 6. ORGANISATIONAL RESPONSIBILITIES Chief Executives and Chief Officers retain the overall responsibility within their organisation for the implementation of the policy. This includes for example, ensuring that sufficient resources are made available for the purchase of moving and handling equipment, the provision of training for all staff and the availability of specialist staff to support the risk assessment process. Each organisation has a legal duty so far as is reasonably practicable to ensure that: • The need for hazardous moving and handling is avoided or, when it cannot be avoided, an assessment is made of the operation and where there is a risk of injury, appropriate steps taken to reduce the risk to the lowest possible level. • The assessment must follow the ergonomic approach and take into account the following factors: • - Characteristics of the load • - Physical capabilities of the individual worker • - The working environment • - The requirements of the task • Information and training is provided to staff and managers on risk assessment and basic ergonomic principles. • A safe working environment and safe systems of work are provided including the necessary aids and equipment.

MOVING AND HANDLING POLICY 7. MANAGEMENT RESPONSIBILITIES All managers have the responsibility, so far as is reasonably practicable, for ensuring that arrangements made under the policy are implemented properly. This includes: • Safe Working Practices and Systems of Work • Being aware of the moving and handling tasks that occur within their areas of responsibility and avoiding the need for employees to undertake any moving and handling tasks which involve a risk of injury. • The introduction of appropriate risk reduction measures where the handling task cannot be avoided. This may include the use of mechanical aids, redesigning the handling task or changing the environment. • Supervising staff to ensure that safe working practices are being followed and that equipment is being used where applicable. • Ensuring that adequate staffing levels are maintained to meet moving and handling requirements. • Making sure that staff wear the appropriate clothing and footwear for moving and handling. In some situations this may include personal protective equipment eg gloves and special footwear. • Risk Assessments • Performing risk assessments of hazardous moving and handling tasks or situations within the workplace. Specialist support and advice can be obtained where appropriate from the organisation’s Moving and Handling Advisor. • Making a clear, written record of the assessment and communicate its findings to all staff involved. • Reviewing risk assessments and making arrangements for the risk assessment to be repeated if they are no longer valid due to changes in the work situation. • Ensuring that in situations where risk assessments are being performed by frontline staff eg person handling assessments in hospital or community, that these are being completed and recorded where appropriate in writing. These assessments must also be available for staff involved in the moving and handling to refer to.

MOVING AND HANDLING POLICY MANAGEMENT RESPONSIBILITIES contd • Training • Making sure that all staff attend moving and handling training including updates. All new staff should attend a moving and handling course, as part of the formal induction programme, before commencement of duties in the workplace. • Attending training and acting as a role model for staff. • Equipment • Ensuring that suitableand sufficient mechanical aids are provided and that these are properly maintained and easily accessible for staff. • Making sure that equipment is only used by staff who have been properly trained in its use. • Ensuring that all moving and handling equipment and accessories are thoroughly examined, serviced and maintained in accordance with The Lifting Operations and Lifting Equipment Regulations 1998 (LOLER) and The Provision and Use of Work Equipment Regulations 1998 (PUWER) • Staff Health • Ensuring that moving and handling requirements are clearly identified when recruiting staff so that appropriate medical and Occupational Health advice can be taken as part of pre-employment health screening. • Making allowance for any known health problems which might have a bearing on an existing employee’s ability to carry out moving and handling tasks in safety. • Referral to Occupational Health Advisors if there is any good reason to suspect that an individual’s state of health might significantly increase the risk of injury from moving and handling. • Accident/Incident Reporting • Maintaining records of accident and ill-health related to moving and handling and to investigate the circumstances surrounding the accident or incident. • Reporting unresolved problems and deficiencies to senior management such as lack of equipment, unsafe working conditions or lack of trained staff.

MOVING AND HANDLING POLICY 8. EMPLOYEE RESPONSIBILITIES Employees have a legal duty to take reasonable care of their own health and safety and that of others who may be affected by what they do or do not do. Staff must therefore: • Work within their own limitations and not carry out any activity for which they are not competent • Co-operate with their line manager in performing risk assessments for moving and handling • Look out for hazards • Use equipment provided, eg hoists • Follow safe working practices • Not interfere with or misuse any equipment or aids that have been provided • Not use equipment that they have not been trained to use • Follow training and instructions provided on moving and handling eg moving and handling protocols, person handling plans and guidance from training courses • Look out for hazards and report any unsafe situation to the local manager. This includes things such as: • Faulty equipment – which should be labelled and taken out of use • Unsafe working practices • High risk handling procedures • Environmental problems • Attend moving and handling training including updates for their area of work • Report pregnancy or any medical conditions, which may affect their ability to perform moving and handling to their manager • Wear suitable work clothing and footwear for moving and handling and comply with the Dress Code for their area of work

MOVING AND HANDLING POLICY 9. DRESS CODE FOR MOVING AND HANDLING The following dress code is strongly recommended for staff who are involved in hazardous moving and handling tasks: • Flat, supportive footwear with a non-slip sole. Open-toed sandals should not be worn • Trousers or culottes for female staff instead of dresses or skirts • Tops or tunics should be non-restrictive and allow ease of movement • Personal protective equipment eg gloves and protective footwear should also be worn in accordance with local risk assessments for some groups of staff • Fingernails should be short so as not to cause any trauma to the person’s skin • Staff should not wear jewellery, which may cause harm to themselves or the person being moved. Examples of inappropriate jewellery include: • watches and rings with sharp edges • large hoop earrings • necklaces and bracelets

MOVING AND HANDLING POLICY 10. TRAINING In order to meet their statutory responsibility each organisation will ensure that suitable and sufficient training is provided for all staff, managers and senior officers. Training in risk assessment for moving and handling will be mandatory for relevant managers. All new staff will attend moving and handling training as part of their induction programme prior to the commencement of duties. A two-day foundation course is recommended for staff involved with moving people. Each organisation will ensure compliance with relevant training standards. Training programmes will be based on the ergonomic and problem solving approach to moving and handling and include the following elements as a minimum requirement: • The human, economic and legal costs of MSDs • Relevant health and safety legislation including Human Rights and the need for balanced decision-making • The anatomy and function of the spine and the causes of MSDs • 24-hour back care • Basic ergonomic and manual handling principles • Assessment skills and knowledge of the assessment process • Current moving and handling techniques • Use of relevant mechanical aids and equipment

MOVING AND HANDLING POLICY TRAINING contd It is recommended that refresher training be provided every two years for all staff and managers. More frequent training may be required in some areas depending on the findings of local risk assessments. Training must also be provided if new equipment is provided in the workplace or if there is a change in the work situation, eg changes to the environment or changes in service delivery. Accurate training records will be kept for all training courses to include: • Signature of trainer • Signature of staff attendance • Course programme and learning outcomes • Course content including details of practical work covered Each organisation will perform its own training needs analysis to identify the type of training required. This may be informed by health and safety audits and the findings of risk assessments and workplace assessments. Training programmes will be reviewed and monitored regularly to ensure that they continue to meet the needs of the organisation.

MOVING AND HANDLING POLICY 11. RISK ASSESSMENTS Risk Assessments for Moving and Handling People A written moving and handling assessment must be completed for people who need assistance to move. The assessment should cover the following areas: • Assessor’s details and signature, assessment date and review date • Personal information of the person, including height and weight • The person’s personal wishes on mobility • Details of relevant medical diagnosis/problems • Handling hazards and constraints • Details of any equipment or aids being used • A detailed handling plan for all foreseeable handling tasks including techniques and equipment to be used • Numbers of staff required to perform handling tasks Each organisation will have designated staff who will perform the initial assessment. Additional advice and support will also be available as appropriate from other specialist staff, eg Occupational Therapists and the organisation’s Moving and Handling Advisor. (Please see sample assessment forms and guidance notes in Appendix 1. These forms are intended for use mainly in the community, mental health and residential settings. Other assessment formats may be required in other areas, eg acute medical wards).

MOVING AND HANDLING POLICY RISK ASSESSMENTS contd Each organisation will adopt a collaborative approach to risk assessments in situations where employees are working within the premise of another employer, or working in the person’s own home alongside staff from another care provider. In these situations representatives of each organisation will co-operate to ensure that a moving and handling assessment and handling plan is completed and that the information is available for all staff to refer to. It will usually be the organisation with the most involvement that takes a lead in completing the assessment and co-ordinating any equipment or aids that are required. Some risk assessments will lead to using equipment or adjustments to the handling environment to reduce handling risks to the carer and/or the person being moved. The proposed changes are more likely to be acceptable to the person and their family if they have been fully involved in the assessment process and understand the purpose for which it has been carried out. Balanced Decision Making for Moving and Handling People In a minority of cases the person or their family may be reluctant to accept changes that have been recommended to address the risks identified. In these situations the assessor and, where appropriate, the Service Manager will adopt a balanced approach. They will endeavour to respect the person’s wishes for mobility and support and, as far as is possible, their independence and autonomy. It is also recognised however, that under health and safety legislation staff are not required to perform moving and handling tasks that put them at an unacceptable level of risk. In these situations it may be necessary to limit the service being provided or have the service provided in a different way. Where there is a difference of opinion over methods of moving and handling it is recommended that a meeting be held with the person, the local manager and all other relevant people. The meeting should be used to outline the findings of the risk assessment and to seek a safe solution. Specialist advice from the organisation’s Moving and Handling Advisor should also be obtained.

MOVING AND HANDLING POLICY RISK ASSESSMENTS contd Limitation of service will be the final option and will only be used after all other possible solutions have been investigated and discussed with the person and other relevant people Householders cannot be required by Health & Safety law to adapt their home or use equipment provided to reduce risks to visiting care staff. However, with their co-operation, much can be done to eliminate or reduce the risks from moving and handling, particularly by modifying the home environment to improve working postures to staff and carers. Discharge from Hospital When the person is being discharged from hospital the relevant organisations will ensure, through forward planning that arrangements have been made for environmental adaptations, equipment provision and staff training. The person will not be discharged home unless the necessary equipment is in place and a moving and handling assessment and handling plan has been completed. Risk Assessment for Load Handling Local Managers will perform the initial risk assessment. Assistance from the organisations Moving and Handling Advisor or Health and Safety Advisor may be required for complex handling situations. Staff from the work area should also be involved in the risk assessment process. Load handling risk assessments will be performed by using the standardised assessment form (See sample assessment form and guidance notes in Appendix 1). More detailed and objective assessments may be performed as necessary using recognised ergonomic assessment tools. This will normally be done with assistance from the Moving and Handling Advisor.

MOVING AND HANDLING POLICY 12. COLLABORATIVE WORKING All organisations will communicate effectively in relation to moving and handling issues in order to achieve a consistent approach and to reduce the health and safety risks of all those involved. Particular consideration should be given to the provision of information to the Ambulance Service, which is often performing moving and handling tasks in vulnerable community based situations. 13. MONITORING Each organisation will monitor the policy to ensure its successful adoption and implementation. It is recommended that the following monitoring tools be put in place: • Regular audits of people handling assessments and care plans • Workplace observations to check that handling methods are consistent with individual assessments and professional standards for the handling of people • Quarterly reports of manual handling accidents and incidents • Quarterly reports of sickness absence associated with manual handling • Inspection of manual handling accident/incident forms by the Moving and Handling Advisor or Health and Safety Advisor • The reported number of civil claims from employees • The reported number of complaints from the person/relatives associated with moving and handling • The results of workplace Health and Safety Inspections and Safety Audits • Equipment Audits to check that sufficient equipment is properly maintained readily and available for staff use. • Reports completed as part of the LOLER examination of patient lifting equipment • Quarterly reports of training attendance • Workplace supervision by managers/team leaders to ensure that safe working practices are followed

MOVING AND HANDLING POLICY 14. BIBLIOGRAPHY The following sources of information have been used in the production of this policy: • Health and Safety at Work etc Act 1974 • Management of Health and Safety at Work Regulations 1999 • Manual Handling Operations Regulations 1992 • Human Rights Act 1998 • Lifting Operations and Lifting Equipment Regulations 1998 • Provisions and Use of Work Equipment Regulations 1998 • Manual Handling in the Health Service (Health Services Advisory Commission 1998) • Guide to the Handling of People – revised 5th edition (RCN 2005) • Handling Assessment in Hospital and Community (RCN 1999) • Introducing a Safer Patient Handling Policy (RCN 1999) • RCN Code of Practice for Patient Handling (1999) • “Handling Home Care: Achieving safe, efficient and positive outcomes for care workers and clients” (HSE 2002) • Care Handling for People in Hospitals, Community and Educational Settings –A Code of Practice. Derbyshire Inter-Agency Group

MOVING AND HANDLING POLICY 15. GLOSSARY OF TERMS Person The patient, service user, client, young person, resident, child or pupil who requires assistance to be moved Competent Person Someone with sufficient training, experience and knowledge to undertake a particular task eg risk assessments Ergonomic approach Fitting handling tasks to people to make them safer, easier and more pleasant to perform Hazard The capacity for injury, damage or loss Risk The likelihood of injury, damage or loss occurring Moving and Handling Manual handling, manual handling operations Moving and Handling Advisor Back Care Advisor, Moving and Handling Specialist

MOVING AND HANDLING POLICY 16. DIRECTORY OF SPECIALIST ADVISORS FOR MOVING AND HANDLING

Appendix 1 Assessment Forms

revised 7 July 05

LINCOLNSHIRE INTER-AGENCY MOVING AND HANDLING GROUP PERSON MOVING AND HANDLING ASSESSMENT (ADULTS) PART 1 (page 1 of 6)

LINCOLNSHIRE INTER-AGENCY MOVING AND HANDLING GROUP PERSON MOVING AND HANDLING ASSESSMENT (ADULTS) PART 2 (page 2 of 6) Person’s Name: …………………………… DOB: …..………… Assessment Date: ………….…

LINCOLNSHIRE INTER-AGENCY MOVING AND HANDLING GROUP PERSON MOVING AND HANDLING ASSESSMENT (ADULTS) PART 2 contd (page 3 of 6)

LINCOLNSHIRE INTER-AGENCY MOVING AND HANDLING GROUP MOVING AND HANDLING PLAN (page 4 of 6) Assessor’s signature & date Sheet No: ………………… Review Date: ………………… Task duration & frequency No of people DOB: …………………………. Information on this form should be used as guidance and each situation must still be assessed in case there are changes with the person or handling situation. Details of movement method to be used including equipment and techniques Person’s Name: ……………………………………. Task Description

LINCOLNSHIRE INTER-AGENCY MOVING AND HANDLING GROUP PROBLEMS/DEFICIENCIES SHEET (page 5 of 6) Date Resolved (Sign & Date) Sheet No: ………………… Reported By (Sign & Date) Person Reported to DOB: …………………………. Action/Measures Needed Person’s Name: ……………………………………. Details of Remaining Problems/Deficiencies

LINCOLNSHIRE INTER-AGENCY MOVING AND HANDLING GROUP REVIEW SHEET (page 6 of 6) Assessor’s Signature Sheet No: ………………… DOB: …………………………. Outcome of Review Including Details of any Significant Changes In situations where major changes have occurred to the person or handling situation a new assessment/handling plan must be completed Reviewed By Person’s Name: ……………………………………. Date of Review

LINCOLNSHIRE INTER-AGENCY MOVING AND HANDLING GROUP PERSON MOVING AND HANDLING ASSESSMENT (CHILDREN/YOUNG PEOPLE) - PART 1 (page 1 of 6)

LINCOLNSHIRE INTER-AGENCY MOVING AND HANDLING GROUP PERSON MOVING AND HANDLING ASSESSMENT - PART 2 (page 2 of 6) Child/Young Person’s Name: ……………………… DOB: …..… Assessment Date: ………….…

LINCOLNSHIRE INTER-AGENCY MOVING AND HANDLING GROUP PERSON MOVING AND HANDLING ASSESSMENT PART 2 contd (page 3 of 6)

LINCOLNSHIRE INTER-AGENCY MOVING AND HANDLING GROUP MOVING AND HANDLING PLAN (page 4 of 6) Assessor’s signature & date Sheet No: ………………… Review Date: ………………… Task duration & frequency No of people DOB: …………………………. Information on this form should be used as guidance and each situation must still be assessed in case there are changes with the child/young person or handling situation. Details of movement method to be used including equipment and techniques Child/Young Person’s Name: …………………………………. Task Description

LINCOLNSHIRE INTER-AGENCY MOVING AND HANDLING GROUP PROBLEMS/DEFICIENCIES SHEET (page 5 of 6) Date Resolved (Sign & Date) Sheet No: ………………… Reported By (Sign & Date) Person Reported to DOB: ……………………… Action/Measures Needed Child/Young Person’s Name: ……………………………………. Details of Remaining Problems/Deficiencies

LINCOLNSHIRE INTER-AGENCY MOVING AND HANDLING GROUP REVIEW SHEET (page 6 of 6) Assessor’s Signature Sheet No: ………………… DOB: ………………. Outcome of Review Including Details of any Significant Changes In situations where major changes have occurred to the child/young person or handling situation a new assessment/handling plan must be completed Child/Young Person’s Name: ……………………………………. Reviewed By Date of Review

LINCOLNSHIRE INTER-AGENCY MOVING AND HANDLING GROUP MANUAL HANDLING OF LOADS RISK ASSESSMENT FORM SECTION A – PRELIMINARY (page 1 of 3) SECTION A – PRELIMINARY * Circle as appropriate If ‘yes’ continue. If ‘no’ the assessment need go no further. SECTION B – See over for detailed analysis SECTION C – Overall assessment of the risk of injury? Low/Med/High* SECTION D – Remedial action to be taken: TAKE ACTION ….. AND CHECK THAT IT HAS THE DESIRED EFFECT

LINCOLNSHIRE INTER-AGENCY MOVING AND HANDLING GROUP MANUAL HANDLING OF LOADS RISK ASSESSMENT FORM SECTION B – MORE DETAILED ASSESSMENT (page 2 of 3) Possible remedial action (possible changes to be made to system/task, load, workplace/space, environment. Communication that is needed. Problems occurring from the task. (Make rough notes in this column in preparation for the possible remedial action to be taken) If yes, tick appropriate level of risk Low/Med/High Yes/No SECTION B – More detailed assessment, where necessary: • The tasks - do they involve: • Holding loads away from the trunk? • Twisting? • Stooping? • Reaching upwards? • Large vertical movement? • Long carrying distances? • Strenuous pushing or pulling? • Unpredictable movement of loads? • Repetitive handling? • Insufficient rest or recovery? • A work rate imposed by a process? • The working environment - are there: • Constraints on posture? • Poor floors? • Variations in levels? • Hot/cold/humid conditions? • Strong air movement? • Poor lighting conditions? • The loads - are they: • Heavy? • Bulky/unwieldy? • Difficult to grasp? • Unstable/unpredictable? • Intrinsically harmful (eg sharp/hot)? • Individual capability - does the job: • Require unusual capability? • Hazard those with a health problem? • Hazard those who are pregnant? • Call for special information/training? Other factors: Is movement or posture hindered by clothing or personal protective equipment? Questions to consider:

HSE RISK ASSESSMENT FILTER NUMERICAL GUIDELINES (Part 3 of 3)

Appendix 2 Protocols for Moving and Handling

PROTOCOL FOR THE MANAGEMENT OF THE FALLEN PERSON IN THE COMMUNITY

This guidance is intended for Health and Social Services staff working in the community who may encounter a fallen person • The following action is recommended: • First perform a risk assessment of the situation and assess the medical condition of the person including any injuries. • If the person is uninjured and does not need to go to hospital follow Protocol A. • If the person is injured or has a medical condition which requires hospital admission follow Protocol B PROTOCOL A – UNINJURED PERSON, HOSPITAL ADMISSION NOT REQUIRED Where possible the person should be encouraged to move themselves, provided this can be done safely. Staff may give minimal assistance but must avoid lifting or taking the person’s full weight. Use of a chair or stool for the person to lean on may be appropriate in some situations. If the person is unable to get up from the floor they should be left where they are and made comfortable. Do not attempt to move or manually lift the person from the floor unless the person is in imminent danger. If available, mechanical aids such as hoists should be used to lift the person from the floor onto the bed or chair. This option should only be used if there are a sufficient number of trained people to use the equipment. If the person cannot move themselves or be moved safely from the floor, the Ambulance Service should be contacted for assistance by ringing 999. All relevant information should be given to the Ambulance Service including: • Name and address of person • Height and weight of person • Any relevant medical conditions • Details of any risks associated with the handling situation and environment AMBULANCE CONTROL MUST ALSO BE INFORMED THAT THE MANGA EMERGENCY LIFTING CUSHION IS REQUIRED. [This page updated 6.02.06]

PROTOCOL B – INJURED OR MEDICALLY UNWELL PERSON WHO REQUIRES ADMISSION TO HOSPITAL The person should be left in the position found and not moved unless they are in imminent danger. Make the person comfortable and give reassurance. Keep the person warm with a blanket if necessary. Contact the Ambulance Service immediately by ringing 999. Stay with the person and give reassurance until the Ambulance Service arrive. CPR or other first-aid procedures should be commenced as necessary, provided staff have the appropriate skills and training. The Ambulance Service will move the person in the most appropriate way once they have arrived and assessed the situation. PEOPLE WHO FALL FREQUENTLY If falls become a regular occurrence the person should be referred to their GP for a full medical review. Other professional staff including Physiotherapists and Occupational Therapists should be involved as necessary as part of a falls assessment with the aim of preventing future falls. In situations where it is foreseeable that the person may fall again, a written moving and handling plan must be produced. The plan should include details on what action is to be taken by staff and details of any equipment to be used. All necessary equipment must be available. The Ambulance Service will be very reluctant to respond to on a regular basis unless a risk assessment has been completed and falls prevention measures have been put in place. The Ambulance Service will monitor the number of calls to individuals in the community and problem areas will be reported to the appropriate person, eg GP, District Nurse or Moving and Handling Advisor. CARE HOMES The Ambulance Service will respond to calls from Care Homes where the fallen person is injured or requires admission to hospital. If the fallen person is uninjured and does not require admission to hospital, then it is the Care Home’s responsibility to manage the situation safely. This includes having a written policy, the provision of suitable aids and equipment and suitably trained staff. If the Ambulance Service is asked to attend to the uninjured person then a charge will be made to the individual home. [This page updated 6.02.06]

PROTOCOL FOR THE MOVING AND HANDLING OF THE BARIATRIC PERSON IN HOSPITAL AND THE COMMUNITY

PROTOCOL FOR THE MOVING AND HANDLING OF THE BARIATRIC PERSON IN HOSPITAL AND THE COMMUNITY This document has been written and compiled by the Bariatric Sub-group for the Lincolnshire Inter-agency Group for Moving and Handling. The group comprises the following specialist advisors: Alyn Blyth Head of Risk and Quality Management Lincolnshire Ambulance Service NHS Trust Alison Gibson Strategic Back Care Advisor Lincolnshire Social Services Shirley Kaberry Health and Safety Co-ordinator Lincolnshire Ambulance Service NHS Trust Malcolm King Specialist Training & Advisory Services Manager Lincolnshire NHS Shared Services Tobias Payne Registration Inspector Commission for Social Care Inspection Linda Rhodes Clinical Advisor Community Healthcare Equipment East Lincolnshire Primary Care Trust Adi Todd Moving and Handling Co-ordinator United Lincolnshire Hospitals Trust

1. DEFINITIONS/TERMS Bariatric A Bariatric person is defined as a person with a weight over 160kgs (and a body mass of more than 40). World Health Organisation 2000. (See Appendix 1 for weight conversion table) Person Is the Bariatric patient, client or service user who requires assistance. Moving and Handling Advisor Is the Back Care Advisor, Manual Handling Advisor, Moving and Handling Co-ordinator or Moving and Handling Specialist. 2. BACKGROUND This protocol has been produced by the Lincolnshire Inter-agency Manual Handling Group in response to the increasing incidence of Bariatric people requiring health and social care. It is recognised that there is a need for local organisations to work and communicate effectively together in order to safely meet the needs of these people particularly where their care includes a transition between hospital and community. The protocol is also written in the context of the legislative framework as set out in the Inter-agency Manual Handling Policy and it also pays due regard to the Disability Discrimination Act 2002 and the Human Rights Act 1998 including: • Article 3 – ‘No one shall be subjected to inhuman or degrading treatment or punishment’ • Article 8 – ‘Right to respect for his private and family life, his home and his correspondence’

3. RISK ASSESSMENT FOR MOVING AND HANDLING A risk assessment must be completed for the person who requires assistance to be moved and where there is risk of injury to staff from manual handling. Specialist advice will often be required from the organisation’s Moving and Handling Advisor and it is the responsibility of the named nurse or appropriate person to make this referral at the earliest possible stage. The Moving and Handling Advisor will co-ordinate the assessment and equipment provision as necessary. Postural Issues Staff involved with Bariatric people need to be aware that assisting the whole person to move may be hazardous. In addition their individual limbs can also be very heavy and that there is risk of injury to staff when performing personal care and nursing interventions. As part of the Moving and Handling Assessment staff should consider the working postures they have to adopt whilst performing these tasks. Wherever possible height adjustable equipment should be used, eg high-low beds and leg supports to help improve working postures. Working at floor level should be avoided whenever possible. Taking the weight of the person’s limb may also be avoided by using slide sheets, leg lifters and mechanical aids such as an inflatable Lifting Cushion. If possible the person should be encouraged to move or support the limb independently. Details of the risk reduction measures to be used when moving or supporting limbs should also be documented in the Moving and Handling Assessment. Further advice on how to reduce risks in relation to working postures is also available from the organisation’s Moving and Handling Advisor. The Fallen Person The fallen Bariatric person represents a very significant health and safety risk and everything possible needs to be done to prevent this situation from arising. As part of the risk assessment, consideration should be given to identifying the factors, which could cause the person to fall. These may include medical reasons and environmental hazards such as: • Cluttered environment • Uneven floor surfaces • Loose carpeting • Lack of hand-rails or mobility aids • Poor fitting footwear

Once the hazards have been identified suitable risk reduction measures need to be put in place with the aim of preventing a fall. The risk assessment should also include a handling plan for moving the person up from the floor and this should include, where appropriate, the utilisation of mechanical aids. If community staff encounter a fallen Bariatric person then the general Fallen Person Protocol should be followed. Where possible the Ambulance Service will be notified in advance of persons who are likely to be at risk. Where appropriate, hoists or inflatable lifting cushions will be provided by the Integrated Community Equipment Service (ICES). These will be kept at the home of the person and used where necessary by ambulance personnel. Acute hospitals and care homes must ensure that appropriate equipment is available for staff to safely move the fallen person and that staff have been fully trained in the use of the equipment. 4. WEIGHING ARRANGEMENTS Having an accurate weight of the person is an essential part of the assessment otherwise it will not be possible to provide the appropriate equipment and transport for the person. All organisations will ensure that suitable arrangements are in place so that the person can be weighed in a sensitive and dignified manner. This includes hospital, community and care homes. The person should be weighed within 24 hours of initial referral/admission and at regular intervals thereafter. United Lincolnshire Hospitals Trust For work areas within the United Lincolnshire Hospitals Trust (ULHT) staff should refer to the ULHT Heavier Persons Protocol. Community In the community the weighing of the person will take place in the individual’s home environment. To facilitate this process staff should contact their Moving and Handling Advisor who will make the necessary arrangements within 5 working days. Care Homes In care homes, organisations will ensure that suitable equipment is available so that the person can be weighed in a dignified and sensitive manner. Care homes should also make reference to their individual protocol.

5. ADMISSION TO HOSPITAL Involvement of the Ambulance Service In the majority of cases the Ambulance Service will be involved in the admission of the person. The Ambulance Service will already be aware of some Bariatric people and their needs. The admission process can be divided into two different types: 5.1 Emergency Admission (Usually triggered by a 999 call to Ambulance Control Ambulance crews will conduct a dynamic risk assessment of the person, which will determine an appropriate response. In certain circumstances this assessment may indicate that this person should be treated in the home environment rather than being taken to hospital. Ambulance Control will then co-ordinate the appropriate healthcare response. If the person is to be taken to hospital the ambulance crew will ensure early notification to the receiving hospital by the ambulance mobile phone via Control. The Ambulance Service have an agreed separate protocol with Lincolnshire Fire and Rescue Service to request assistance where necessary in the moving and handling of a Bariatric person. A response from Lincolnshire Fire and Rescue Service will only be activated through Ambulance Control. 5.2 Routine Admission This is usually arranged by medical or nursing staff and includes outpatient appointments. Ambulance Control call takers will require a disclosure of the person’s weight or an estimate from the member of staff requesting the ambulance journey. The person’s needs will be categorised using a traffic light system and an appropriate response will be despatched. For the person assessed in the “Red” category, transport to hospital for routine appointments, ie blood tests, outpatient clinics etc, should only be considered as a last resort. Consideration to the appropriate clinician attending the person in their own home must be given in the first instance. Individual Moving and Handling Assessments For routine admissions a copy of the person’s Moving and Handling Assessment and Handling Plan in the community or care home should be sent to the acute hospital. This is to inform the hospital staff of how the person is normally moved and what equipment is used. This may assist the hospital staff in making their own assessment and it can also be used as part of discharge planning.

6. DISCHARGE FROM HOSPITAL The discharge process should start on admission of the person and should include the following steps: • Case Conference • The case conference should include representatives from all the relevant agencies who will be involved in helping to discharge the person back into the community including: • -the Person and their family • - Community Nursing Staff • - Acute Nursing and Medical Staff • - Moving and Handling Advisors from the relevant organisations • - the Ambulance Service • - Social Worker • - Occupational Therapist • - Homecare Supervisor • - Care Home Representative Input from other specialists may also be required, eg Tissue Viability Nurse, Clinical Advisor for Community Healthcare Equipment, Physiotherapist or Dietician. • Home Visit • In most cases a home visit will be required to ensure that the person will be able to manage safely once they are back in their own home and to identify equipment, aids and services that will be required. Recommendations may also be made for adaptations to the home environment. • Information gained from the visit will be reported back to the Multi-disciplinary Team and a further case conference will be organised when necessary.

DISCHARGE FROM HOSPITAL contd • Notification of Discharge • All agencies involved in the discharge of the person should be given at least FIVE WORKING DAYS notification of the proposed discharge date. This must include notification to the Ambulance Service and the Moving and Handling Advisor(s) involved in the case. • The person will not be discharged home or to a Care Home on the proposed date unless there is full agreement by all those involved that it is safe for the discharge to proceed. Any equipment needed by the person, eg beds, hoists etc must be in place before the person is discharged. Risk Assessment for Moving and Handling As part of the discharge process a Moving and Handling Assessment of the home situation must be completed before the person returns home. The assessment will include details of moving and handling hazards and specific details of how the person is to be moved and the necessary equipment. The Moving and Handling Assessment and Handling Plan must be documented using the Inter-agency Moving and Handling Assessment Forms. (See Inter-agency Moving and Handling Policy.) Involvement of the Ambulance Service The date and time of the discharge must also be agreed in advance with the Ambulance Service. The Ambulance Service will undertake its own risk assessment in preparation for transporting the patient home. This will include an assessment of the home environment and access into the home. Special transport will be required for some persons and this may require the use of regional response vehicles.

MOVING AND HANDLING POLICY