Integrating Risk Management &
Moving & Handling
Richard Hinckley
Head of Patient Safety & Risk Management, King’s
College London NHSFT
Simon Wells
Moving & Handling Manager, King’s College London
NHSFT
Systems for identifying Safety Issues
f
Complaints
Incidents
Claims
PALS
Inquests
Reactive
Proactive
Risk
Assessments &
Observational
audit
Internal benchmarking
(surveys, patient
experience)
Internal inspection &
audit
Internal
Internal
Safety Issues
External
External
Benchmarking (eg. via
inpatient surveys)
Trends from
national reporting
(NRLS)
External
inspections/
assessments
(NHSLA, CQC,
HSE)
Risk registers &
Board assurance
Framework
Safety notices
(MHRA, Rule 43
etc)
Reactive
Performance
targets
Proactive
National guidelines
(NICE), NCEPOD
reports etc.
Identifying & Managing Safety for M&H
Focus on 2 specific systems:
• Reporting & managing incidents allows
processes to be changed to stop incidents
recurring & prevent potential harm turning
into actual harm
• Observational audit permits assessment of
actual practice & real-time feedback. Training
& equipment deficits can be identified &
addressed immediately
Identifying & Managing Safety for M&H
1. Incident management
– Reporting systems
– Investigations
– Ensuring improvement
2. Observational audit
– Format of audit
– Integration of improvement into local practice
Incident Management
An effective incident management system will:
• Identify a wide range of risk issues in sufficient
detail in a timely way
• Triage risk issues according to seriousness
(prioritisation & proportionality)
• Investigate incidents in a structured way (RCA)
• Engage local teams to ensure learning is
embedded into practice
• Feed into local governance systems to ensure
learning is sustained
Incident Management: Reporting
• Online reporting form (with drop-downs):
– Easy to complete
– Provides instant reference number
– Allows emails to be auto-generated (eg. to M&H
team)
• Web-based system
– Access to system flexible – allowing designated staff to
see incidents details, investigation progress & action
plans
– As M&H team alerted to all AIs with type = M&H, can
respond immediately
Incident Management – Reporting
• A successful reporting system should consider:
– Identification of risk leads within clinical departments
(need clinical buy-in from outset)
– Staff training (need training programme & resource to
deliver it)
– Form design (must be user friendly – user testing)
– Responsiveness to departmental needs (this should be
tempered by need for minimum data)
– Feedback to staff (if not possible via system, then via
cascade from risk meetings, newsletters etc)
– Corporate focus (duty of all staff to report AIs)
Incident management – investigation
• All incidents “approved” by Risk Manager or
delegated risk lead in clinical area. Involves
assessment of seriousness
• Level of investigation determined by seriousness
– Incidents with moderate harm = investigation report
– Incidents with major harm/death = full investigation
• Use of Root Cause Analysis (RCA) helps identify
structural (rather than personal) causes
Incident Management – Investigation
Indicate whether the event directly led
to harm, did not directly lead to harm, or
whether the event was prevented from
occurring.
If harm was caused, then an additional
field will appear asking for the degree of
harm. The help icon will provide guidance
on what each option means .
Incident Management - Investigation
Effective incident investigation involves:
• Structured approach to investigations
– standard investigation templates
– use of specific RCA tools (5 whys, After Action Review,
timeline, wishbone etc)
– clear deadlines & reporting structure
• Pool of trained local clinicians that can be tapped
into (M&H link worker programme; investigations
training programme)
• Quality of investigation (& findings) reviewed at
local and Trust risk meetings (M&H input)
Incident Management – Improvement
Sustained improvement via investigation involves:
• Local ownership of action plans (clearly identified
local leads with deadlines)
• System for monitoring
–
–
–
–
Tracking of actions via local committees
Periodic review of implementation (link to NHSLA)
Scorecards
Link to Trust audit programme
• Shared learning (newsletters & reports, events to
raise awareness)
Example: M&H Incident (1)
• Sedated neuro patient fell to floor during transfer
between operating table & bed post-surgery
• No incident form completed (M&H team
informed later by theatre link worker)
• MH investigation revealed bed brakes not applied
& no patslide used during transfer, surfaces
parted & patient fell
• Outcome: bespoke training for local area reinforcement that equipment must be checked
& patslides used & AI completed. Without link
worker investigation wouldn’t have occurred
Example: M&H Incident (2)
• AI - Back injury due to carrying heavy back pack
during transfer of patient from ward to x-ray
• M&H advisor assigned investigation which
identifies as nurse (with backpack) walked
through lift entrance, doors closed trapping the
back pack and pulling the nurse backwards. Back
injury resulting in time off work & light duties
when she returned
• Incident due to lift door pressure sensors not
working properly & open doors automatically
Example: M&H Incident (2)
Investigation findings & actions:
• Pressure release locks on certain lifts not working
- problem known to Estates but never reported to
other staff groups (so not acted upon)
• Lift mechanism investigated and repaired by
Estates post-incident
• Service managers now aware of issue & workers
informed
• Review carried out of how back packs can be
carried or supported on bed during transfers
Example: M&H incidents (3)
• Issue: clinical staff experiencing back pain (esp.
theatres). Identified via AIs & feedback at training
• M&H Investigation
– Risk factors (frequency, route, cumulative strain, poor
work practices by porters)
Outcome:
• Change in training for porters
• Purchase of 4 powered bed movers for porters
• Reinforce at MH training how to move beds
M&H Observational Assessment
Back ground
• Wanted to supplement yearly audit of MH
equipment in clinical areas
• Some way of collecting ‘live info’ on what
workers really doing in practice when MH
patients
• Simple, easy to complete system
• Easy format to feedback to respective
divisions at Risk & Governance meetings
Information collected
• M&H incidents (AIs) reported in area, & of these no.
resulting in WRMSD
• No. of workers on Long Term Sickness absence due
to WRMSD
• M&H equipment available against M&H Equipment
Standard
• % workers with in date M&H training
• Assessment of Moving & Handling activities in the
workplace
– Patient handling activities
– Load handling activities
Assessment of MH activities in the workplace
A] Moving & Handling Activity: standing, sitting, hoisting
(Indicate the handling activity assessed by ticking against technique)
sit – stand from bed/chair/commode/couch to stand ( )
stand – sit on bed/chair/commode/couch ( )
repositioning in the chair ( )
walking ( )
hoisting transfer ( )
Patient RA form completed
(circle Y or N)
Y/N
Safe technique/
handling principles identified
(circle Y or N)
Y/N
General comment:
B] Moving & Handling Activity: Movement of patient in bed:
sitting forward ( )
rolling/turning ( )
proning ( )
move up bed (supine transfer – dependant patient) ( )
lateral transfer ( )
C] Moving & Handling Activity: Personal care:
transfer into bath/bathing ( )
transfer into the shower/assisted shower ( )
dressing ( )
(Comment if technique altered due to patients condition or situation)
No. of staff required correctly
identified
(circle Y or N)
Y/N
Equipment identified correctly
(circle Y or N)
Y/N
Good application of technique
(circle Y or N)
Y/N
Total Score
Findings from Neuroimaging Assessment
Findings & actions:
• Equipment available (eg. for lateral t/f) but not
used correctly (attendance at dept. to identify
better use of equip)
• Consultants had not attended MH training
(focussed M&H training session arranged)
• Equipment required to take testing equipment into
domestic environment (folding trolley identified &
procured)
• No M&H link worker (worker identified & training
booked)
Summary
• Years programme of M&H Obs. Assessments in
clinical areas
• ‘Live’ information & timely delivery to the
coalface
• Additional information for use in training room
• Feedback on impact of training in the workplace
• Additional information on level of compliance
with Trust MH Equipment Standard (2009)
• Link to incident trends