BARNET AND CHASE FARM HOSPITALS NHS TRUST
Title of policy
Policy version number
Status
Policy author
Policy consultees
Negotiated through
Accountable director
Manual Handling Policy
HR 36/04
Final Version
Julie Dixon, Manual Handling and
Ergonomics Advisor
Health and Safety Committee, Risk
Committee & HR Policy Sub-Group
Joint Staff Side Committee
Director of Organisational Development and
Human Resources
Risk Committee & Joint Staff Committee
Joint Staff Committee
Wednesday 15th June 2011
Approved by:
Ratified by
Date of ratification and
implementation:
Review date:
June 2015
Equality impact assessment
Policy equality impact assessed and neutral
completed and impact
impact.
Document location
Trust Intranet
Distribution and dissemination
All staff via intranet
Principal target audience
All employees (including temporary workers)
Responsibility for dissemination of All managers responsible for policy
policy to new staff
implementation
NHSLA/Care Quality
Compliant
Commission/ALE impact
LITERATURE SEARCH AND EVALUATION
NHSLA standards; internet search to locate good practice
REVISION HISTORY
Version
Summary of Changes
Date
01
June 2004
Initial version of policy
02
November 2007
Incorporates CNST
requirements
03
26 May 2010
Format and layout changed to
meet NHSLA requirements.
th
04
15 June 2011
Clarification of responsibilities
RATIFICATION HISTORY
Ratifying body
Version
Date of ratification
rd
Health and Safety
23 January 2008
02
Committee
Joint Staff Committee
26th May 2010
03
Joint Staff Committee
15th June 2011
04
This policy has been ratified by Joint Staff Committee. Circumstances may arise or
there may be a change in guidance or legislation that requires the policy to be
updated between now and the review date. The responsibility to ensure the policy
review process is activated lies with the policy author. All policies remain in force
until notification of an amended policy is circulated and posted on the Trust intranet.
1
MONITORING THE EFFECTIVENESS OF POLICY IMPLEMENTATION
Key Performance Indicators:
Annual audit, review of incidents and risk
assessments
Date of Audit Report:
May 2011
Location of Audit Report:
OH Department
BARNET AND CHASE FARM HOSPITALS NHS TRUST
Manual Handling Policy
Approved on Wednesday 15th June 2011
Signed on behalf of the Trust
Director of OD and HR
Raj Chana
Signed on behalf of the Joint Staff Side
Chair of Staff Side
Noeleen Behan
2
Contents
1.
Policy Statement
4
2.
Scope
4
3.
Aim
4
4.
Responsibilities
4.1
4.2
4.3
4.4
4.5
4.6
4.7
Responsibility of the Trust Board
Responsibilities of the Accountable Director
Responsibility of the Manual Handling & Ergonomics
Advisor
Responsibilities of General Managers/HOD
Responsibility of Line Managers
Responsibility of Manual Handling Representatives
Responsibility of all employees
5.
Definitions
6.
Policy Development
6.1
6.2
7.
Identification and consultation with stakeholders
Equality impact screening
5
5
5
6
6
7
7
8
8
9
Headings Relevant to Policy
7.1
7.2
7.3
7.4
7.5
7.6
7.7
Occupational Health
Training Department
Training
Purchasing of manual handling equipment
Reporting incidents and accidents
Risk assessment
Organisational action plan
9
9
9
10
10
10
11
8.
Standards / Key Performance Indicators
12
9.
References
15
10.
Associated Documentation
15
Appendices
Appendix 1 – Manual (non-patient and patient loads)
Appendix 2 – Inanimate Load Handling Risk Assessment
Appendix 3 – Patient Handling Risk Assessment
Appendix 4 – Patient handling protocols
Appendix 5 – NHSLA Checklist
Appendix 6 – Policy Launch Plan
16
30
31
33
56
58
3
1. Policy Statement
1.1
This policy lays down the objectives of Barnet and Chase Farm
Hospitals NHS Trust (hereinafter referred to as the Trust) in the
important area of moving and handling of people and loads.
1.2
The Trust undertakes to comply with current legislative requirements;
the Health and Safety at Work Act (1974), The Manual Handling
Operations Regulations (1992), and the Management of Health and
Safety at Work Regulations (1999) as well as the Human Rights Act
(1998).
1.3
Additionally the Trust undertakes to comply with national
recommendations and the systems of safer manual handling advocated
by the Health &Safety Executive (HSE). The Trust also recognises staff
need to comply with best practice requirements of state registration and
membership of professional bodies.
1.4
Compliance requires an effective management system to be in place to
prevent or reduce to an acceptable level the exposure of staff, patients
or visitors to injury through use of manual handling techniques or
equipment.
2. Scope
2.1
This policy covers both the moving and handling of people and the of
objects. It applies to all substantive staff, agency and bank staff, visitors,
sub-contracted workers and students on clinical placement. The Policy
also applies to employees working off site.
2.2
The Trust will take reasonable steps to ensure that staffs from outside
agencies have received the appropriate training and information in
relation to manual handling.
3. Aims
3.1
To provide a comprehensive policy for the Trust and its staff that
promotes a safe working environment with regards to the manual
handling of patients and loads. This will assist in the long-term reduction
of work related musculoskeletal disorders, back injuries and the
associated financial and personal costs.
3.2
To develop safe systems of work where hazardous manual activities are
avoided, assessed and the risk of harm is controlled and reviewed, so
as to eliminate as far as is reasonably practicable the risk of injury to
staff and patients.
4
4. Responsibilities
4.1
Responsibility of the Trust Board
The Chief Executive has overall responsibility and accountability for the
management of this policy.
4.2
Responsibility of Accountable Director
The Director of Organisational Development and Human Resources is
responsible for ensuring this policy is given sufficient resources to be
implemented effectively and that management complies with the
requirements of the policy.
4.3
Responsibility of Manual Handling and Ergonomics Consultant
The Manual Handling and Ergonomics Consultant is based within the
Occupational Health Department at Chase Farm Hospital and has the
following responsibilities:

To assist Departmental / Ward Managers with the Manual
Handling Risk Assessment Process where requested

To apply an ‘ergonomic approach’ to risk reduction, addressing the
issues of task re-design, equipment provision and environmental
adaptation

To provide appropriate and specific Back Care Awareness /
Manual Handling Training Programmes to all clinical and non
clinical staff

To provide specialist and specific back care advice, consultation
and assistance where requested

To investigate reported incidents or accidents involving
musculoskeletal injury and discomfort in consultation with
Occupational Health and the Risk Management Department

To assist with providing information to the ward/department in the
purchasing of manual handling aids and equipment

To liaise with the Trust’s Health and Safety Committee Group

To monitor and advise staff post-injury, during the rehabilitation
process and during their return to work

Where requested assist with the planning of new buildings and / or
systems of work thereby promoting safer handling environments
5

4.4
4.5
To centrally establish, maintain and update records of Risk
Assessments and Audit reports undertaken
Responsibility of General Managers/Heads of Department

The General Manager(GM) of each Directorate should send a
summary of all inanimate load risk assessments performed every 6
months together with any action plans to the Manual Handling and
Ergonomics Service

General Managers will be required to provide evidence to the Manual
Handling and Ergonomics Service that action plans have been
completed/ monitored or re-assessed
Responsibility of Line Manager
General Managers, Service Managers, Ward and Department
Managers are responsible for implementing the manual handling policy
and procedures at local levels. Specifically, the duties of line
managers are to:

Formally assess inanimate load manual handling operations within
their area(s) of responsibility and record the findings. Sending a
copy of the risk assessment to their General Manager.
Communicate the findings to staff and monitor and review the
assessment if there is reason to suppose it is no longer valid,

Ensure that the staff they are responsible for, complete patient
handling risk assessments where appropriate,

Avoid the need for staff to undertake manual handling operations
which involve a risk of injury. Where a risk is identified they may
contact the Manual Handling and Ergonomics Service for
assistance in determining what reasonably practicable measures
can be introduced to reduce the level of risk to an acceptable level.
Managers are responsible for the implementation of agreed
strategies and should report back to the Manual Handling and
Ergonomics Service, via the General Manager about the progress
of their actions.

Provide information and ensure all staff attend appropriate manual
handling training,

Make allowances for any known health problem which might have
a bearing on an existing employee’s ability to carry out manual
handling in safety, by conducting a risk assessment on that staff
member. If appropriate liaise with Occupational Health and the
Manual Handling and Ergonomics Advisor.
6
4.6

Maintain records of accident and ill-health related to manual
handling operations.

To ensure that if they are responsible for a clinical area that if
appropriate they have a Manual Handling Representative.
The Role of the Manual Handling Representatives
Back care representatives are departmental link persons who hold an
appropriate certificate in moving and handling, having attended an
approved workshop for representatives, covering inanimate and people
handling techniques.

They will promote compliance and good practice within their area of
work. They will work with staff to ensure confidence and
competence in techniques / equipment.

Sufficient time should be allocated to them in order that this role is
fulfilled. This is dependent upon the needs of wards and
departments.

Act as a representative for the ward / Department on matters of
equipment selection

Assist in preparing reports and recommendations regarding Risk
Assessments and other moving and handling topics in liaison with
their line manager / Clinical Manager.

To assist managers in monitoring the effectiveness of the policy in
their work area.

Should participate in Manual Handling Representatives meetings to
discuss / disseminate good ideas and practice.
4.7 The Role of All Employees
It is the sole responsibility of all employees to ensure that they follow
the Trust’s Manual Handling Policy at all times.
Safer manual handling is a participatory activity within the Trust, with all
employees having a stake in how safer work practices are identified
and implemented.
Responsibilities of employees under Health & Safety legislation
include:

taking reasonable care of their own health and safety and that of
others who might be affected by their activities when involved in
manual handling operations
7

co-operating with their manager in identifying and assessing
hazardous manual handling tasks, observing safe systems of work
and reporting any difficulties to their line manager.

Any staff involved with the moving of patients should complete
patient handling risk assessment documentation (Appendix 3) as
required

participating in any training given in manual handling principles.
Staff who require training must bring this to the attention of their
line manager.

reporting any medical condition which might affect their ability to
handle loads safely (refer to Occupational Health services).

Reporting any accident or injury that occurs as a result of manual
handling activities.
Individual staff members are required to report working conditions,
which give rise to an unacceptable level of risk of injury to themselves,
to colleagues and to patients or visitors. Staff are encouraged to
discuss manual handling issues with their Health & Safety
Representatives if they are hesitant to raise issues themselves.
Staff may also have to comply with safer manual handling practice in
accordance with membership of professional associations or state
registration. Hence staff who undertake condemned techniques may
not only have to justify their actions to the Trust but also to their
professional body.
5. Definitions
Manual Handling: “any transporting or supporting of a load (including the
lifting, putting down, pushing, pulling, carrying or moving
thereof) by hand or by bodily force”
Hazard:
“Something that has the potential to cause harm”
Risk:
“The likelihood harm will occur and the severity of the harm”
6. Policy Development
6.1
Identification and Consultation with Stakeholders
The Trust’s policy development process involves consultation with
stakeholders i.e. managers, trade union representatives, health and
safety representatives and staff. The final policy is signed off at the
Joint Staff Committee for implementation.
8
6.2
Equality Impact Screening/Assessment
The Trust recognises the diversity of its workforce and aims to provide
a safe working environment free from discrimination where individuals
are treated fairly with dignity and appropriately to their needs. The
Trust accepts that equality impacts on all aspects of its day to day
operations and has equality impact assessed this policy in accordance
with the Trust’s Equality Screening / Assessment toolkit, a neutral
impact was identified.
7. Headings Relevant to the Policy
7.1
Occupational Health
Staff should seek advice from Occupational Health (OH) if injured or if
they are concerned they might be injured during a manual handling
task due to an existing medical condition (or pregnancy). Line
Managers may also contact OH for advice on how to support an
injured, sick or pregnant member of staff who would normally be
expected to participate in manual handling. Where appropriate,
Occupational Health will refer any staff to the Manual Handling and
Ergonomics Service for an individual assessment.
7.2
Training Department
The Training Department is responsible for advertising training courses
available and maintaining records relating to staff attendance and nonattendance. DNA letters or emails are also sent to Managers by the
training department for those that do not attend.
7.3
Training
7.3.1 The Training Process
The following process ensures all permanent staff has access to the
training program and attend training:

The training needs of staff are discussed at appraisal in line with the
statutory and mandatory training matrix.

Managers have access to course dates available through the intranet
and are responsible for booking on their staff. These courses may be
occupationally specific and directed to both clinical and non-clinical
staff

Training is provided at Chase Farm Hospital site where a specifically
designated and fully equipped training room is provided. Where
appropriate some training is held within a department if suitable
facilities are available
9

Arrangements for checking that all permanent staff attends relevant
moving and handling training and arrangements for following up those
who fail to attend the training lies with the training department as per
the Statutory and Mandatory Training Policy.

Record of attendance is maintained by the Training Department who
provide a monthly report to the Manual Handling and Ergonomics
Service.

Rates of attendance at Manual Handling Training will be reported in the
Manual Handling and Ergonomics Service Annual Report to the Health
and Safety Committee which feeds in to the Risk Committee. This
information also appears in the bi-annual HR Report which gets
reported to the Performance and Business Executive.
7.3.2 Training Effectiveness
The effectiveness of any training provided will be monitored using
evaluation forms immediately after training, evaluation forms to a
random selection of staff 3 months post training and by the observation
of practice within working environments.
The evaluation of the training will be reported to the Statutory and
Mandatory Training Committee via a report every 6 months.
7.3.3 Minimum Trust Standards for Training
Please refer to the Trust Training Matrix.
7.4
Purchasing of Manual Handling Equipment.
The Medical Devices Group will purchase Capital items, Revenue
items will be funded by the Directorates. No purchasing of manual
handling equipment will be made by anyone in the Trust without first
consulting the Manual Handling and Ergonomics Advisor to ensure the
item chosen is suitable for the task.
7.5
Reporting Incidents and Accidents
Staff and management are reminded that any manual handling incident
or accident must be recorded on an IR1 form in accordance with Trust
Policy and Health & Safety Legislation. Near misses should also be
reported.
7.6
Risk Assessments
It is the responsibility of all Ward/Departmental Managers to complete
their own generic risk assessments and action plans. A copy of this
should be forwarded to their General Manager/Head of Department
10
who should forward a risk assessment report to the Manual Handling
and Ergonomics Advisor every 6 months.
Any risks identified need to be placed on the appropriate risk register,
(local, directorate, corporate) according to the Trust Risk Policy.
The Manual Handling and Ergonomics Advisor can be contacted to
assist where specific manual handling problems have been identified
and advice is needed to formulate solutions.
7.7
Organisational Action Plan
Actions generated from the training process, observation of practice,
individual staff risk assessments and generic risk assessments will
inform an organisational action plan. These risks may be reflected on
individual directorate risk registers and the corporate risk register if
appropriate.
The Manual Handling and Ergonomics Advisor will ensure that the
action plan is reviewed on a quarterly basis by the Health and Safety
Committee. The annual report and the HR OD report will also include
the organisational action plan and a report on progress regarding its
Implementation.
11
8. Monitoring Compliance
Element to be
monitored
Lead
Tool
Frequency
Reporting
Arrangements
Acting on
Change in
recommendations practice and
and Lead(s)
lessons to be
shared
Requirement to
undertake appropriate
risk assessments for
the moving and
handling of patients
and objects
General
Managers
Inanimate load risk
assessment forms
(Appendix 2)
6 months
MHES reports to Health
and Safety Committee any
deficiencies against the
minimum NHSLA
requirements.
Health and Safety will
report to the JSC and to
the risk committee where
further action to address
deficiencies is required.
Agreements and actions to
be outlined in the minutes.
The relevant committee
will then disseminate
the actions to the
relevant service lead(s)
for their subsequent
action within a specified
timeframe
Manual Handling
and Ergonomic
Service (MHES)
Audit of Patient
moving and handling
risk assessment
forms (Appendix 3)
Annual
Clinical Leadership Forum
Required changes will
be monitored by the
MHES, reported to
the Health and Safety
committee by means
of the annual,
quarterly or monthly
MHES report
(depending on the
level of risk), revised
in line with H&S/Risk
committee
guidance/approval
and shared with
relevant services via
committee minutes
and policy
amendments
General
Managers
Action Plans
(Appendix 2)
6 monthly
MHES (for action
plans that the
MHES have
supported
MHES Risk
Assessment
monitoring tool
Ongoing
MHES reports to Health
and Safety Committee any
deficiencies against the
minimum NHSLA
requirements.
Health and Safety will
report to the JSC and the
risk committee where
The relevant committee
will then disseminate
the actions to the
relevant service lead(s)
for their subsequent
action within a specified
timeframe
Required changes will
be monitored by the
MHES, reported to
the Health and Safety
committee by means
of the annual,
quarterly or monthly
MHES report
Arrangements for
ensuring that action is
taken as a result of
risk assessments
12
Action plans resulting
from deficiencies
identified in training
update
Effectiveness of
training will be
monitored
Identification of any
trends in manual
handling incidents
managers in
drafting)
Spot checks in
clinical and nonclinical areas
MHES
Training report given
by Education,
Training and
Development
Department
Monthly report
Training evaluations
forms
Conducted and
monitored
immediately posttraining and a
random selection 3
months post training
MHES
MHES
further action to address
deficiencies is required.
Agreements and actions to
be outlined in the minutes.
Health and Safety
Committee – quarterly
report
HR Indicator Report – 6
monthly
Observation
Conducted /
monitored ongoing
Incident reports
Conducted and
monitored monthly
Statutory and Mandatory
Training Committee
receive a report every 6
months from MHES.
Health and Safety
forward to Risk
Committee if required.
The relevant committee
will then disseminate
the actions to the
relevant service lead(s)
for their subsequent
action within a specified
timeframe
Statutory and
Mandatory Training
Committee
Health and Safety
Committee
Line/Departmental/General
Managers
Health and Safety
Committee
(depending on the
level of risk), revised
in line with H&S/Risk
committee
guidance/approval
and shared with
relevant services via
committee minutes
and policy
amendments
MHES can arrange
specific staff group
training if required to
improve attendance
within specific
departments. Actions
when completed will
be documented in the
relevant committee
minutes
MHES can change
and adapt training
methods and reevaluate training
effectiveness. This
will be shared with the
relevant services such
as the Training
Department and
Statutory and
Mandatory Committee
via committee
minutes and policy
amendments.
Service lead(s)
responsible for initiating
subsequent actions
within a specified
timeframe
13
Action plan formulated
identifying key areas
for improvement and
actions necessary
MHES
All of the above
Annual
Health and Safety
Committee are expected to
read and interrogate the
report and subsequently
coordinate a response that
prioritises the
organisational approach.
The organisational action
plan is located within the
annual report in the Health
and Safety Committee
minutes.
Required actions will be
identified via the Health
and Safety Committee
who can forward it to
the Risk Committee if
they deem necessary.
The relevant committee
will then disseminate
the actions to the
relevant service lead(s)
for their subsequent
action within a specified
timeframe
14
9. References
1. Manual Handling Operations Regulations 1992 (as amended).
Guidance on Regulation L23 (Third Edition). HSE Books 2004 ISBN
978 07176 2823 0
2. Five steps to risk assessment HSE Books 1998 ISBN 0 7176 1565 0
3. Management of health and safety at work. Management of Health and
safety at Work Regulations 1999. Approved Code of Practice and
Guidance L21 (Second Edition) HSE Books 2000 ISBN 07176 2488 9
4. Safe use of work equipment. Provision and Use of Work Equipment
Regulations 1998. Approved Code of Practice and Guidance L22
(Second edition) HSE Books 1998 ISBN 0 7176 1626 6
5. Getting to grips with manual handling. A short guide, free leaflet.
INDG143(Rev2), revised 03/04
6. Safe use of Lifting Equipment. Lifting Operations and Lifting Equipment
Regulations (1998). Approved Code of Practice and Guidance L113
HSE Books 1998 ISBN 07176 1628 2
10. Associated Documentation
The following is a list of policies that are related to this Manual
Handling Policy:
 Trust’s Training Matrix - Statutory & mandatory training Policy
 Equality and Diversity Policy
 Health and Safety Policy
 Risk Assessment Policy
 Slips, Trips and Falls Clinical Guidelines
 Resuscitation Policy
 Pressure Ulcers – Clinical guidelines for the Prevention and
Treatment
15
Appendix 1
Manual
Safer Manual Handling of Non-Patient Loads
(For Non-Clinical and Clinical Staff)
10.1
Manual Handling Injuries
Definitions :
Manual Handling: moving or supporting a load by bodily force.
Hazard: Something that has the potential to cause harm
Risk: the likelihood harm will occur and the severity of the harm.
Manual Handling actions include;

Pushing and Pulling

Lifting and Lowering

Holding a load
Primary causes of injury are:

Handling too heavy a load,

Repeatedly handling loads,

Adopting poor postures when handling loads.
These causes of injury may have their roots in insufficient staff training,
inadequate equipment or staffing levels, poor work organisation, the
lack of risk assessment or an individuals’ own susceptibility to injury.
Lower back pain accounts for half the reported manual handling
injuries in the UK (Health & Safety Executive (HSE) 1998). Whilst back
injuries are often the most debilitating injuries, staff must be equally
careful to avoid injuries to the other parts of their body such as their
hands, fingers, shoulders and knees.
Examples of sources of non-patient handling injuries in healthcare
include;

Pushing trolleys,

Reaching for items on low or high shelving,

Handling X-Ray cassettes,

Preparing vacutainers for laboratory analysis of contents.
16
10.2
The Manual Handling Risk Assessment Process
There are five basic steps in performing a risk assessment as
recommended by the Health & Safety Executive:
1.
Identify the hazards
2.
Decide who might be harmed and how
3.
Evaluate the risks and decide whether existing precautions
are adequate or more should be done.
4.
Record your findings.
5.
Review your assessment from time to time and revise as
necessary.
The Health and Safety Executive (HSE) advocate an ergonomic
approach to assessing the risks associated with manual handling
tasks. This approach takes into account the nature of the posture
adopted when handling the task, the repetitive nature of the task, the
load being handled, the working environment and the capabilities of the
individuals asked to complete the task. This approach is generally
referred to by it’s acronym, TILE or LITE. The complete list of
questions asked under each section is listed in Table 3 below.
Table 3 – Making an assessment
Problems to look for when making Ways of reducing the risk of
an assessment
injury
The tasks, do they involve:
Can you:
 holding loads away from the body? 
use a lifting aid?
 twisting, stooping
upwards?
reaching 
improve workplace layout to
improve efficiency?

reduce the amount of twisting
and stooping?

avoid lifting from floor level or
above
shoulder
height,
especially heavy loads?

reduce carrying distances?
or
 large vertical movements?
 long carrying distances?
 strenuous pushing or pulling?
 repetitive handling?
 insufficient rest or recovery time?
 a work rate imposed by a process? 

vary the work?
push rather than pull?
The loads, are they:
Can you make the load:

heavy, bulky or unwieldy?

lighter or less bulky?

difficult to grasp?

easier to grasp?

unstable or likely
unpredictably?
to
move 

more stable?
less damaging to hold?
17

harmful, e.g. sharp or hot?

awkwardly stacked?

too large for handler to see over?
If the load comes from elsewhere,
have you asked the supplier to
help, e.g. provide handles or
smaller packages?
The working environment, are there:
Can you:

constraints on posture?


bumpy, obstructed or slippery
floors?

remove obstructions
movement?
to
free
provide better flooring?

variations in levels?

avoid steps and steep ramps?

hot/cold/humid/ conditions?


gusts of wind or other strong air
movements?

prevent extremes of hot and
cold?

poor lighting conditions?

restrictions on movements or
posture from clothes or personal 
protective equipment (PPE)?
Individual capacity, does the job:

improve lighting?
provide PPE
restricted?
that
is
less
ensure clothing and footwear is
suitable for their work?
Can you:

require unusual capability, e.g. 
above average strength or agility?
pay particular attention to those
who have a physical weakness?

endanger those with a health 
problem or learning / physical
disability?
take extra care of pregnant
workers or those who have a
musculoskeletal condition?

endanger pregnant women?

call for special training?

provide more training?
Handling aids and equipment:
Can you:

is the device correct for the job?


is it well maintained?
provide equipment that is more
suitable for the task?

are the wheels on the device
suited to the floor surface?


carry out planned preventative
maintenance
to
prevent
problems?
do the wheels run freely?


is the handle height between the
waist and shoulders?
change the wheels, tyres and/or
flooring so that equipment
moves easily?

are the handle grips in good order 
and comfortable?
provide better
handle grips?

are there any brakes? If so, do 
they work?
make the brakes easier to use,
reliable and effective?
handles
and
REMEMBER IF INTRODUCING CONTROL MEASURES CANNOT REDUCE THE
LEVEL OF RISK TO AN ACCEPTABLE LEVEL THEN DON’T DO THE TASK
18
The risk assessment of inanimate loads should be documented. A form
given in Appendix * can be used for this purpose.
The HSE recognise that completing written risk assessments for every
task completed would be time consuming.
To help employers and staff identify where a more detailed (i.e written)
risk assessment is necessary, the HSE has developed a filter to screen
out straightforward cases. The filter (Diagram1) is based on a set of
numerical guidelines developed from published scientific data that offer
a reasonable level of protection to around 95% of working men and
women.
Diagram 1. HSE lifting guidelines
The number in each box in Diagram 1 represents a weight above which
the weakest members of staff may be at risk of injury. If the lifter’s
hands enter more than one box during the operation, the assessor
must refer to the smallest weight. If the handling takes place with the
hands beyond the boxes, or if the weight of a particular load exceeds
the guidelines then a more detailed assessment is required using the
LITE principle.
Assessors must note:

the weights assume that the load is readily grasped with both
hands with no twisting. If there is twisting the guideline weights
must be reduced by 10% if the handler twists beyond 45°, and by
20% if the handler twists beyond 90°.

the operation takes place in reasonable working conditions with
the lifter in a stable body position.

the guideline weights are for infrequent operations ( up to about 30
operations per hour) and the load is not supported for any length
of time. As a rough guide, the weights should be reduced by 30%
19
if the operation is repeated once or twice a minute, by 50% where
the operation is repeated five to eight times a minute; and by 80%
where the operation is repeated more than 12 times a minute.

the weight should be revised downwards if the load is carried more
than 10 metres and / or carried on stairs or ramps.

team lifting can be hazardous if staff do not coordinate their lifts
correctly (using ‘ready..brace..lift instead of 1..2..3). As an
approximate guide the capability of a two person team is two-thirds
the sum of their individual capacity, for three or more half the sum
of their individual capacities.

In sitting, the guideline weights are 3kg for female staff, 5kg for
males providing the load is kept close to the chest
There are guideline figures for pushing and pulling though they are of
little practical value unless staff have access to strain gauges. There is
no specific limit to the distance over which a load is pushed or pulled
provided there are adequate opportunities for rest or recovery.
The risk assessment guidelines are not safe limits for lifting. But
working outside the guidelines is likely to increase the risk of injury;
therefore staff must avoid handling loads exceeding the guidelines so
far as is reasonably practicable. If staff feel compelled to handle loads
which they would not normally choose to under normal circumstances
because of a lack of equipment, colleagues or knowledge of alternative
methods they must not proceed.
If one member of staff decides they are not at undue risk from handling
a load, which exceeds the guideline figures it is essential the same is
not expected of their colleagues.
Staff are reminded that they can also be injured by handling loads well
below the guideline weights.
10.3 Safer Handling Practices
10.3.1
Lifting
NB. Some staff will have difficulty completing a deep squat as
this may either place too much stress on their knees or may lack
the power in their leg muscles to come back into standing whilst
supporting the load. If you do not feel able to do the technique
below DON’T DO IT.

Stop and think
Plan the lift. Where is the load to be placed? Use appropriate
handling aids if possible. Do you need help with the load?
Remove obstructions such as discarded wrapping materials. For a
long lift, such as floor to shoulder height, consider resting the load
mid-way on a table or bench to change grip.
20

Position the feet
Feet apart, giving a balanced and stable base for lifting (tight
skirts and unsuitable footwear make this difficult). Leading leg as
far forward as is comfortable and if possible, pointing in the
direction you intend to go.

Adopt a good posture
When lifting from a low level, bend the knees. Keeping the spine
in line, i.e maintaining its natural curve (tucking in the chin helps).
Lean forward a little over the load if necessary to get a good grip.
Keep shoulders level and facing in the same direction as the hips.

Get a firm grip
Try to keep the arms within the boundary formed by the legs. The
best position and type of grip depends on the circumstances and
individual preference; but must be secure. A hook grip is less
tiring than keeping the fingers straight. If you need to vary the grip
as the lift proceeds, do it as smoothly as possible. Here are some
important points, using a basic lifting operation as an example.

Keep close to the load
Keep the load close to the trunk for as long as possible. Keep
heaviest side of the load next to the trunk. If a close approach to
the load is not possible, slide it towards you before trying to lift.

Don’t jerk
Lift smoothly; raise the chin as lift begins, keep control of the load.

Move the feet
Don’t twist the trunk when turning to the side.

Put down, then adjust
If precise positioning of the load is necessary, put it down first,
then slide it into the desired position.
10.3.2
Pushing and Pulling
It may be easier to push or pull rather than lift and carry an object. It is
generally easier or better to push rather than pull a load.
Pushing

Inspect the work surface. Remove objects that you may trip on. Check
that the surface is clean and dry. There should be no oil spills, grease
spots, or water on floors. Clean the floor as needed.

Evaluate the load you will push. Is the weight of the object evenly
distributed or is it off-centre? Will the weight shift during the push? If yes,
consider other ways of moving it such as lifting it and putting it on a trolley
for transport.
21

Check your hands. Be sure your hands do not slip. If there are rough or
sharp edges to the load, wear appropriate gloves.

Adjust the load so you can see over it. Do not move a load that is so large
it blocks your vision. Ask someone to guide you if your vision is blocked.

Establish a stable base so you can maintain your balance. Spread your
feet apart and put one foot slightly in front of the other.

Bend your knees, lower your hips, and brace your hands against the load
to push it. Use your legs to move the load across the floor.

Avoid twisting from side to side. Continue to face the object when pushing
the load.

If the load is too heavy, too large, or unevenly weighted, ask for help.
Agree on commands with your helper to coordinate the push and
transport before pushing up the load.

Take time to plan your push. Take a deep breath to relax. An unplanned
push under tense conditions may lead to injury.

Change postures to relieve stress. Bend, stretch, sit down, or take other
actions to avoid staying in any one position too long.
Pulling
This is generally more hazardous than pushing because you have to twist to
see where you are going. You also tend to grasp the load at arms’ length so
that you don’t run over your feet and you are unable to use your body weight
as safely and effectively as for pushing.
10.3.3
Provision of Equipment
If a load has to be moved, can it be moved mechanically, this will enable
the risk of injury to be reduced significantly. Examples of some equipment
which can assist are listed below.
Task

Equipment
Carriage of bag, sack or boxes
e.g. Truck with hydraulic lift
22

Carriage of large goods up and
down stairs

Movement of goods stored at
variable heights
e.g. Stair Climber/Star-Wheeled Truck
e.g. Platform Truck

Domestic activities
e.g.Mop bucket on wheels

Maintenance work and carriage of
tools
e.g. Wheeled Tool Box
23
Task


Equipment
Moving large boxes, sheet materials
e.g. Powered/manual pallet Truck
e.g. Powered bed / trolley mover
Moving beds and trolleys
Allows a bed or trolley to moved by only
one operator.
Patient Handling
(For Clinical Staff Only)
Important
The intent of the Manual Handling Operation Regulations 1992 has been
interpreted differently by the various professional bodies who represent staff
who handle patients.
As a result the Trust has elected to have an additional version specific to Trust
employed Physiotherapists which focuses specifically on therapeutic handling
and can be sourced directly from the Physiotherapy Department on both sites.
*(All clinical staff not directly employed by the Trust are welcome to refer to
this manual however they must consult their own employer’s documentation
for definitive guidance on their professional practice).
A good standard of care can be achieved through a balance between the
needs of the patient and the safety of staff. This policy is designed to achieve
this balance.
10.4
Causes of Injury
The following identifies the factors, which predispose clinical staff to injury:

Lifting patients

Lifting loads at arms length

Lifting with a starting (or finishing) position near the floor, or overhead or at
arms length.
24

Lifting an uneven load with the weight mainly on one side

Handling an uncooperative or falling patient (a careful assessment made in
advance can minimise risks).

Working in awkward, unstable or crouched position including bending
forward, sideways or twisting the body.
The patient is also at risk from inappropriate manual handling. These include:

Damage to skin.

Damage to joints and ligaments.

Damage to bones.

Un-siting drips and drains.
Injury may occur due to poor planning of the task or as the result of staff using
traditional techniques now recognised as harmful to the patient (Section 10.6).
10.5
Optimising a Patient’s independence.
After a period of illness patients may forget their normal movement patterns.
Certain patients readily assume a level of helplessness disproportionate to
their clinical condition. Staff may feel it is quicker and easier to give a lot of
assistance to the patient rather than instructing the patient and waiting for the
patient to do it for themselves.
The principles of normal movement are for staff to encourage patients to
follow simple ways of moving themselves. Even though the patient may not
be able to achieve these movements independently they should form the
basis of any assistance given. It is essential therefore that the staff’s action
does not undermine the patient's own efforts.
As well as normal movement, patients' usual ways of moving should be
considered. They may have found a way of moving over months or years of
disability, which though unorthodox is successful, and staff should be ready to
go along with it, as long as it is not stressful to either the staff member or the
patient. Simple tasks are discussed and practiced during induction and
update training.
10.6 Condemned Techniques
The following techniques have been condemned by the Royal College of
Nursing (RCN) because assessing the manual handling risk to staff (in
accordance with the Manual Handling Operation Regulations 1992) and
balancing these risks with the potential for physical injury to the patient have
determined them to be unsafe.

Australian or Shoulder Lift.
Shoulder / Australian Lift with/out sliding sheet
25

The Orthodox/Cradle Lift.

The Use of Canvas and Poles.

The Pivot/bear hug/stroke transfer with one member of staff in front.

The Drag Lift / underarm lift.

Top and Tail.

The Draw sheet lift.

Any lift with the patient’s arms around the carer’s neck

Use of bed sheets and pillow cases to move patients.
Pivot transfer
The Provision and Use of Work Regulations (PUWER) 1998 state that any
equipment used must have been designed for that purpose. In 2001 the
Health & Safety Executive condemned the use of bed sheets and / or pillow
cases for sitting up patients in bed or during lateral transfers. The Trust is
making electric profiling beds available for patients who would otherwise need
assistance into sitting.
10.7
Assessing Patient Handling Tasks
A patient handling assessment (Appendix 3 – Patient handling risk
assessment) must be completed prior to handling the patient and is
incorporated into the patient’s nursing notes and should be reviewed should
any changes occur with the patient’s condition, the environment, tasks being
undertaken and individuals performing the tasks.
The flowchart on the next page is the decision process staff should follow prior
to handling patients in order to determine what risks exist, whether the level of
risk is acceptable and if not what alternative methods might be adopted.
The flowchart is supported by five sections labelled A-E. The tables list the
types of questions staff should be asking themselves prior to the move.
26
IDENTIFYING RISK ASSOCIATED WITH PATIENT HANDLING TASKS
Identify Task To Be
Completed
Determine abilities of patient
(Table A)
Select Preferred Technique
(ensure it is accepted
practice) (Table B)
No
Is All Required Equipment to
Hand?
Yes
Are there any organisational
(Table C) or environmental
issues (Table D) which could Yes
increase the level of risk to
an unacceptable level?
No
Identify Whether Chosen
Technique poses too great a
risk to you and / or
Yes
colleagues (Table E)
No
Complete Task
Evaluate Outcome
Record as appropriate
27
A
The Patient

How much of their own weight are they liable to take during the move?

Are there any drips or drains liable to impede the transfer / move?

Are their movements predictable?

Are they confused or unduly anxious?

Are there any language, cultural or gender considerations?

Does the patient have any hearing difficulties?

Will any medication assist or hinder their ability to assist?

Do we know how they ‘normally’ complete the task?


B
Is their skin liable to damage or they in pain / liable to suffer pain during
the transfer / movement?
Do they suffer from restricted joint mobility?
Preferred technique.
Staff will refer to local handling protocols created (See Appendix 4).
C
Organisational Factors
There are also organisational factors, which can directly influence the risk of
injury to staff and patients. These factors can also cause staff to have to
compromise what they established was best for their patient whilst
maintaining staff safety. These factors include:

Lack of appropriate equipment

Long working hours and insufficient rest periods throughout the day

Lack of sufficient staff numbers to be able to complete the technique,
which would most benefit the patient.
D The Environment
The surroundings or make and model of equipment may lead to increased
risk. Consider:

Is there sufficient space to do the transfer / move?

Do any of the furnishings make the task more difficult ( e.g. height of chair
/ commode / trolley / bed), and if so can they be modified?

Does the curtain rail get in the way when hoisting or is there an overhead
lamp which is liable to strike someone on the head?

Is there sufficient light?

Is there is a risk of slipping or tripping?
28
E Risk to the Members of Staff
Factors which can raise the level of risk are

Stooping, twisting or bending sideways,

lifting above shoulder height or below knee height,

supporting most or all of the weight of the load,

pushing or pulling loads over excessive distances,

handling whilst seated,

handling the load at a distance from the body,

Similarity to other frequently performed tasks which may lead to tiredness,

lack of training in the technique ( e.g. no update training for three years),

inadequate strength or reach to complete the task safely, protective
clothing / uniform which may this impede safe movement,

a clinical condition that might you at increased risk (e.g. damaged
shoulder).
10.8
Pressure to complete unsafe techniques
There is the potential for staff to be pressured into completing unsafe
techniques by patients, relatives and even colleagues. Staff are reminded
that whilst the needs of the patient must always be considered they cannot be
met at the expense of the health and safety of staff.
Staff must never be coerced into completing an unsafe handling
technique by the patient, their relatives or colleagues.
10.9
Purchasing and maintenance of patient handling equipment
The purchasing of capital items is the responsibility of the Medical Devices
Group, Revenue items are the responsibility of the Directorates.
Advice on the type of equipment to buy is available from the Manual Handling
and Ergonomics Advisor. An updated list of equipment, costs and suppliers
will be maintained on the Trust’s computers at Barnet and Chase Farm
Hospitals. Any clinical area without access to a computer should contact the
Manual Handling and Ergonomics service or the supplies department directly.
Hoists are maintained by the Estates department in accordance with relevant
legislation (e.g. Provision and Use of Work Equipment Regulations 1998,
Lifting Equipment and Lifting Operations Regulations 1998). Wards and
Departments have a responsibility to ascertain any slings fitted to hoists are
free from visible damage, which might cause them to fail.
If a hoist fails, is likely to fail or is damaged the Estates department(s) must be
notified and the unit taken out of use immediately. If any other type of
equipment fails or shows signs of damage it must be immediately withdrawn
from service and the Manual Handling and Ergonomics Service notified.
29
Appendix 2 – Inanimate Load Risk Assessment Form
Date of assessment:
Name and Job Title of person(s) doing assessment:
Ward/Department area:
[ ] Barnet [ ] Chase Farm [ ] Edgware Directorate:
Hazard
Identified
Who might Load
be harmed (Is it heavy,
(give a brief
description of the
hazard)
(e.g. staff
group, patient
etc)
bulky, unwieldy,
difficult to grasp,
unstable,
unpredictable,
harmful e.g. hot,
sharp)
Individual
Capacity
(Does the job
require unusual
capability,
endanger those
with a health
problem or
pregnant women,
require special
training?)
Example:
Moving linen bags from
ward area and placing in
linen cage
Any staff member
involved in
moving the linen
bags
Bags can rip
therefore difficult to
grasp. May also be
heavy if overfilled
and heavy and
soiled.
Most staff should be
able to carry out this
task, however they
should only work
within their capability
Task
Environment
(Does it involve
holding loads away
from the body,
twisting, stooping,
reaching upwards,
long distances,
strenuous pushing
or pulling, repetitive
handling,
insufficient rest or
recovery time)
(Are there constraints
on posture, poor
floors, variations in
levels, hot/cold/humid
conditions, poor
lighting, restrictions on
posture from clothes or
Personal Protective
Equipment?)
If overfilled bags can
get stuck in trolley
and require increased
effort.
Staff may stoop to lift
bag and twist when
lifting up and over top
of linen cage.
Some furniture and other
equipment may need to
be moved to ensure good
access for whole distance
Manager’s Name:
Existing Control Further action
Measures
required
(Describe here existing
processes, systems,
mechanisms etc in
place to reduce or
prevent the risk event
occurring)
(Purchase of further equipment,
training etc). Please give details
of who is responsible for
implementing the action and a
time scale for action delivery.
- Linen trolley provided.
- Staff receive manual
handling training
- Linen cage has side
opening to prevent lifting
high
- Manager to ensure all staff are
up to date with their back care
awareness training – July 2010.
- All staff to ensure they only
half fill the bags, use the trolley
and use safe moving and
handling principles whilst
moving the bags – Immediate &
ongoing
30
Appendix 3 - Patient handling risk assessment form and safer handling
Affix name labe
plan
Name
Barnet and Chase Farm Hospitals NHS Trust 2011
Hosp no.
Patient moving / handling
Multidisciplinary assessment form
Weight kg: _______
D.O.B
Body build:  Small  Average  Above
Stature:
 Tall  Medium  Short
 Barriatric
Date:
Date:
Date:
Physical ability /
dependency
Physical ability /
dependency
Physical ability /
dependency
Identify significant issues that
may affect moving and handling
Identify significant issues that
may affect moving and handling
Identify significant issues that
may affect moving and handling
Communication,
cognitive,
emotional/psychological,
vision and hearing
Communication,
cognitive,
emotional/psychological,
vision and hearing
Communication,
cognitive,
emotional/psychological,
vision and hearing
Identify significant issues that
may affect moving and handling
Identify significant issues that
may affect moving and handling
Identify significant issues that
may affect moving and handling
Special risks
Special risks
Special risks
Please tick any significant issues
that may affect moving and
handling and give a description
Please tick any significant issues
that may affect moving and
handling and give a description
Please tick any significant issues
that may affect moving and
handling and give a description
 Skin condition
 Skin condition
 Skin condition
 Wounds
 Wounds
 Wounds
 Vulnerable joints
 Vulnerable joints
 Vulnerable joints
 Medication
 Medication
 Medication
 Risk of falls
 Risk of falls
 Risk of falls
 Catheters / drains
 Catheters / drains
 Catheters / drains
 Drips / feeds
 Drips / feeds
 Drips / feeds
 Traction
 Traction
 Traction
 Spasms / increased tone
 Spasms / increased tone
 Spasms / increased tone
 Other
 Other
 Other
Date:
Time:
Date to be reviewed:
Signature:
Designation:
Date:
Time:
Date to be reviewed:
Signature:
Designation:
 Pain
 Pain
 Pain
Give further details of how
these issues can be
managed:
Date:
Time:
Date to be reviewed:
Signature:
Designation:
31
Affix name label
Name
Barnet and Chase Farm Hospitals NHS Trust 2011
Hosp no.
D.O.B
Patient safer handling plan
Please tick box to identify if this is a manual handling task that is required at the time of the
assessment. Then specify appropriate handling aid (e.g. sliding sheet, hoist, standing
turntable) / method / number of staff required (e.g. independent, prompting, x1, x2):
Task
Date:
Date:
Date:
Turning in bed



Moving up bed



Sitting up in bed



Transfer bed to
trolley



Transfer bed to chair



Transfer chair to
chair



Repositioning in chair



Transfer chair to bed



Standing



Walking



Toileting



Bathing / Washing



Emergency
Evacuation



Other (please
specify)
If requires a hoist
please state style
and size of sling



Date
Time
Date
Time
Date
Time
Signature:
Signature:
Signature:
Designation:
Designation:
Designation:
Are additional control measures required?
Yes  No 
If yes, give details of additional control measures and inform your manager:
32
Appendix 4
Patient Handling Protocols
Valid from May 2011 until further notice
These protocols should be used as a reminder on how to perform
techniques that would have been demonstrated and practiced in the
Back Care Awareness training.
Do not attempt to perform a technique if you have not attended the
training or do not feel competent in its use.
Task
Handling Patients in Bed
Page
34
Sitting
40
Transfers
41
Hoisting
44
Standing and Walking
49
The Collapsing Patient
51
Patsliding
54
33
General Guidance on Safe Moving and Handling Principles

Always ensure that you adjust the bed to the correct working height
(if working with another staff member then generally to the shorter
person and the taller staff bends their knees more to come down to
their level).

Ensure you have considered the risk assessment process, the risk
assessment must be documented and refer to the safer patient
handling plan.

Try not to over-reach

Try to keep your back in it’s natural spinal alignment, avoid bending
and twisting.

Use weight transference to get your legs doing the work.

Maximise the patient’s ability. Consider if the patient can do it
themselves, or if they can do it with some assistance e.g. by
blocking their feet or the use of equipment. Only if not consider what
you can do to make it easier for you to assist, i.e. what piece of
equipment.

If the patient is on an air mattress it is possible to make the bed firm
before you move the patient but remember to put it back on it’s
original setting after.

Good patient handling will not only help to protect staff but will also
help provide the best care for patients. Inappropriate handling could
result in patient injury or breakdown of their skin. Use sliding sheets
to reduce friction on the skin and never move a patient by pulling on
their arm or holding under their shoulder.
34
1. Handling Patients in Bed
Inserting a Slide Sheet Lengthways Under a Patient
Preparation:
 Have the bed at the correct working height, consider your comfort and that you do not over-reach
or stoop over when performing this technique.
 If the person is in a lying position, have them to lie flat with as few pillows as possible, this will
prevent the person sliding down the bed when the sheet is fitted.
 Each person to stand close to either side of the bed
 Fold the slide sheets into 4-6” folds, so that the open ends of the tube will be facing the sides of
the bed. If using 2 flat sliding sheets then fold them up together.
 Turn the folded sheet over so that the folds are facing downwards, then turn it round so that the
loose edge of the sheet is facing the top of the bed.
 The sliding sheet is now ready to be positioned under the person lying on the bed.
Movement:
 Start to position the folded sheets from the persons head to feet. This ensures that the persons
head will be protected. If the person requires a pillow then position the sheets underneath the
pillow, this will ensure the pillow moves with the person during the transfer.
 One person passes the folded sliding sheet under the pillow towards the other person until there
are equal amounts under the patient.
 Stand close to the bed and face the direction of the head of the bed with the furthest foot forward.
Consider that you are going to be unfolding the slide sheets at the same time as performing a
gentle pulling action utilizing your own body weight.
 With your hand closest to the bed, face your palm upwards and slide your hand underneath the
slide sheets until you can grasp the fold of the slide sheet.
 Your outside hand fixes the top corner of the sliding sheet still.
 With your hand closest to the bed, slowly unfold the sliding sheets, bringing your stabilizing hand
back when required to prevent over reaching.
 If the sheets become difficult to unfold, press your outside hand down into the mattress or use a
sawing action underneath the patient.
 If the sheets do not reach the patient’s feet then use a small tubular sheet under their calves and
heels to avoid skin damage due to shearing forces, or ensure that their knees are bent.
35
Inserting a Slide Sheet Sideways Under a Patient
Preparation:
 Have the bed at the correct working height, consider your comfort and that you do not over-reach
or stoop over when performing this technique.
 If the person is in a lying position, have them to lie flat with as few pillows as possible, this will
prevent the person sliding down the bed when the sheet is fitted.
 This technique can be used with the patient lying on their back or side.
 Each person to stand close to either side of the bed
Movement:
 The sliding sheet needs to be folded lengthways into three sections.
 The person holding the sliding sheet holds the end to be pushed under the person between their
middle finger and forefinger (the scissors hold), and places their hand, palm down and flat on the
bed.
 The slide sheet is gently pushed under the person lying in the bed in the arch of their lower back.
 When the person on the other side of the bed is able to see the slide sheet they hold the sheet to
allow the first person to remove their hand from under the person of the bed.
 The slide sheet is pulled through as required. If it gets a bit stuck then a sawing action can be used
under the patient or alternatively their leg can be bent up to help free the sheet under their bottom.
36
Task
Sitting up in
bed
independently
Sitting up in
bed with
assistance
Note
Method
Rope ladder
It is always best to get a
 The patient needs to have good arm strength and
patient to sit up by
no problems with their wrists or shoulders to use
themselves. Before trying
this equipment.
any of these methods try
 Must be firmly secured to the bed
to persuade the patient
 Get patient to bend knees or support with a pillow to
to sit up by first turning
help relieve pressure on back and abdomen.
on their side.
 Patient pulls themselves up into a sitting position
All the following
using the rope ladder.
techniques require
patient ability and
Hand Blocks
comprehension. The
 Patient can support themselves
patient must be able to
 Can be used in combination with a sliding sheet to
support their own upper
move up the bed.
body and have sitting
 Not suitable for unpredictable or aggressive patients
balance.
or for patient with problematic wrist joints.
Sitting a patient up using a 4 section profiling bed
 Ensure that the patient’s bottom is positioned in the
small section of the bed that does not move (do not
worry if their head is not close to the headboard).
Before using the bed with
 If using the Huntleigh enterprise bed use the
a patient, familiarize
mustard coloured button on the head end of the
yourself with handset
bed, this will move the knee and back section
controls, brakes,
simultaneously.
electrical installation,
 If the profiling bed does not have the facility for both
CPR function and bed
parts to move simultaneously then raise the knee
rails.
section first before raising the backrest.
Sitting a patient up in a non-profiling bed
 A hoist should be used if there is a delay in
obtaining an electric bed frame.
Moving a
Patient up the
Bed
Using the profiling bed
Using a profiling bed
and a sliding sheet


Lower the head section to flat.
Raise the knee section. In many instances this will
allow the patient to move back onto the seated
section of the bed. If the patient is too far down the
bed and does not move back into place use a
sliding sheet.

Lower head and knee sections of the bed so it is
flat.
Position the sliding sheet under the patient, using
the methods given before, ensuring the head and
bottom are on the sliding sheet and a small sliding
sheet is under the patient’s heels or that the knees

37




Moving a
Patient up the
Bed
(Continued)
Using a sliding sheet
on a non-profiling bed





are bent up.
Raise the knee section and the patient will slide
into position or use the head down tilt facility of the
bed.
Place a sliding sheet underneath the patient using
the methods given before.
2 staff stand either side of the bed, facing the foot
end.
Have your feet apart, also facing the foot end of the
bed, with your outside foot forward and your weight
on your front leg and that knee bent. (That leg is
going to be doing the work).
Hold onto the top part of the sliding sheet with your
inside hand, at the approximate level of the
patient’s elbow.
Transfer your weight from the front leg to the back
leg to move the patient up the bed a little. Try to
ensure that you aren’t pulling excessively with your
arm.
If you have a longer distance to go then repeat the
procedure.
If you need to move the patient down the bed then
face the opposite direction.
If the patient is large you may need 4 people to
slide a patient up the bed or alternatively use the
hoist.
38
Task
Technique
Rolling/Turning Minimal Assistance
in Bed
Required
Method
(examples are for turning on to left side)
 Patient to hitch (lift) their bottom and shoulders to
right side of bed, if they are to remain on their left
side.
 Patient bends right leg with heel still on bed.
Patient brings right arm across their chest and
turns their head to look to their left.
 They may manage the roll on their own or may
require light assistance.
 If they require assistance then hold the person’s far
hip and shoulder, ensure you are standing in a step
stance position and using a weight transfer
technique, roll the person onto his side towards
you.

Moderate/Maximum
Assistance Required





Staff stand either side of the bed in a step standing
position.
Insert a sliding sheet under the patient’s bottom
(with the sliding sheet going across the bed). Have
the patient prepared to roll by crossing their right
leg over their left or have the right leg bent up,
head turned to the left and right arm across their
chest.
The staff member by the right side of the patient
holds onto the sliding sheet close to the person’s
hips. Using a weight transference technique, they
pull the slide sheet towards them and slightly
upwards to turn the patient over onto their side.
Ensuring that they do not raise their shoulders to
perform a lifting action.
The other staff member must stay on the other side
or the bed rails need to be up.
Remove the sliding sheet by placing your hands
between the layers of the sliding sheet, hold onto
the bottom layer and slowly pull towards you.
Ensure that your colleague is
stabilising the patient to prevent them from rolling
back.
39
Rolling/Turning
in Bed
(continued)
Rolling Using a Hoist






Ensure that you have read the section on hoisting
This is a good method if you need to hoist
someone back into bed onto their side.
Attach the sling to the hoist, lift the person up into
the air and move them across to the edge of the
bed nearest to the hoist, lower them down.
Detach the shoulder strap furthest from the hoist
and both leg straps. Only keep the near shoulder
strap attached.
Fold the sling on the side rolling onto underneath
the patient, ensuring the clips are tucked under
away from the patients skin.
Raise the hoist up, bending up the patient’s leg
nearest to the hoist. The hoist will roll the person
across onto their side away from the hoist, at the
same time pull on the far leg strap to aid in
removing the sling.
40
2. Sitting
Task
Note
Method



Sitting over
the edge of the
bed

Only use this method if
the patient has sitting
balance



Assist the patient to roll onto their side. You can
encourage the patient to bend up both knees (to approx
90 degrees) but ensure their feet are still on the mattress.
You can assist them to do this by sliding his knees over
the mattress with your lower arm at the back of the knees.
The person will now be lying on his side with his legs
drawn up. If you have a profiling bed you can now raise
the backrest to bring the patient into a sitting position.
If you do not have a profiling bed, stand with your feet
apart in the combination position facing the bed. Put your
hand nearest the patient’s head under their shoulder
whist facing the bed. Place your other hand on the top of
their pelvis.
The person places his upper arm on the mattress or edge
of the bed.
Ask the person to push themselves up on their elbow at
the same time as lowering their legs off the bed.
Whilst using a weight transference technique pivot them
up with your hand on their pelvis rather than pulling with
your arm.
Encourage the person to press down on the mattress with
his upper hand to assist the move.
An assessment may identify that a second handler is
required; if so they should kneel on the bed behind the
person.
41



Moving a
Person Back
in the Chair



Do not push the
patient’s knees
as this can
cause hip
damage if they
suffer from
osteoporosis
A one-way glide
sheet or nonslip mat under
the patient may
prevent them
slipping forward
in the chair –
ensuring
shearing forces
do not cause
tissue damage.
If the patient
has slipped so
far forward in
the chair, it
might be
easiest to slide
them onto the
floor and hoist
them back up
again.
Always ensure
the patient is
sitting on a
suitable height
chair (hips and
knees level for
ease of
standing).
If the person
often slouches
in his seat,
make sure this
is prevented
from
happening.
Look for the
cause.
The person can
push more
effectively with
the correct
shoes
Minimal Assistance Required
 Ask the patient to place their feet well under their
knees
 Have them grasp the armrests of the chair and lean
their body weight forward and to the side, as a result
of which their pelvis will come free of the seat on the
opposite side, they then move the free side
backwards by pushing backwards with their hands or
feet.
 Alternatively have the person come free of the seat
slightly by leaning forwards and standing up a little,
and then get them to sit down again a little further
back in the seat (a standing turntable may help with
this manoeuvre).
Moderate Assistance Required
 As above but you can get into an open kneeling
position in front of the patient and place your hand on
their shoulder to help lean them forward and
sideways.

Maximum Assistance Required
 A hoist should be used (see hoisting section).
42
3. Transfers
Note
Task
Method





Use of the
Standing
Turntable
Consider the
weight limit of the
equipment.
The patient must
be cooperative and
be able to stand
(just difficulty
getting into a
standing position),
so they must have
some strength in
legs and the ability
to hold on to the
turntable and have
standing balance.


Position the patient’s feet on the foot pads with
their knees close to the shin support.
Adjust the height if required (the handle nearest to
the patient should be at approximately the
patient’s shoulder height). Ensure that if you have
adjusted the height that it is locked in place
correctly.
One staff member must stand with a wide base of
support and position their front foot on the brake
at the front, holding onto the handle nearest to
them. (If the Solo version is being used then only
one staff member needs to be present if the
yellow bar is used as the brake. Most wards do
not have this version).
The patient can either push down with their hands
next to them, or position one or both arms on the
handle nearest to them and the patient stands up.
The second member of staff can be positioned
next to the patient and could help facilitate the
leaning forward with their hand behind the
patient’s back.
Once in a standing position, the staff member at
the front takes their foot off the brake but keeps
hold of the handle at all times, and rotates the
turntable around to move the patient around onto
the other surface. The second member of staff
must ensure that the chair/surface that the patient
is being transferred onto is positioned correctly;
this member of staff will also remove the patient’s
clothing if they are transferring onto a commode.
43


Use of a
Sliding Board

Consider the
weight limit of the
sliding board.
The patient needs
to have reasonable
sitting balance to
use this piece of
equipment or have
the ability to move
independently
across.
If a sliding sheet is
deemed necessary
then ensure it is
designed
specifically for
sliding boards, i.e.
is the same size as
the board with a
non-slip surface on
one side.





Adjust the heights of the surfaces if possible so
that you will be moving very slightly downhill.
Position one-third of the sliding board under the
patient’s bottom. Remember to angle the board
downwards to go under their sitting bone. The last
third of the board needs to be positioned onto the
surface that the patient is transferring onto.
If the patient needs assistance with balance, then
a staff member stands in front of them supporting
the patient’s shoulders. If the patient needs
assistance with moving their bottom across then a
staff member needs to be positioned behind them.
The patient uses their arm/arms/leg/legs to move
themselves across.
The sliding board is then removed.
44
4. Hoisting
Use of a passive hoist
 Check the weight limit of the hoist and sling and the weight of your patient.
 Check that the hoist has had a LOLER inspection within the last 6 months.
 Check that the hoist is in working order and the battery is charged.
 Check that the sling is in working order, that any plastic clips are not chipped or cracked, that the
stitching is not loose and is not damaged at all.
 You must have 2 staff to hoist.
 Do not apply the brakes to the hoist; keep the brakes on the chair or bed that you are
moving from and to.
 The staff member operating the hoist must be able to see the patient and the hoist parts to ensure
that they are not getting squashed.
 Check that the sling has the correct attachments for the hoist that you are going to use.
 You must ensure that the sling is the correct size and style for the patient. Above knee amputees
need to be in an amputee sling.
 The plastic support straps need to be in place within the sling.
 When moving the hoist, keep the hoist legs closed and try not to twist when you are changing
direction.
Task
Note
Method



The patient will need to be rolled onto one side.
The sling is rolled and positioned underneath the
patient; they would then need to be rolled in the
opposite direction to pull the sling through.
The base of the sling needs to be in line with the base
of the patient’s spine.
Positioning a
sling with the
patient in bed
45


Positioning a
sling with the
patient in bed
Removing a
sling when the
patient is in
bed
An
alternative
method to the above



Roll the patient onto the side that they are able to
roll onto.
Fold the sling in half and place about a hands
width away from the patient, ensuring that the
bottom of the sling is in line with the base of the
patient’s spine.
Take the leg strap and tuck underneath the
patient’s neck.
Roll up the top half of the sling towards the patient
and then roll the patient back onto their back.
Take hold of the leg strap that was positioned by
the patient’s neck and pull the strap down towards
the patient’s knee to unravel the sling underneath
them.
Do this by rolling the patient from side to side as
above.

Positioning a
sling when the
patient is in
the chair
One staff member would stand in front of the patient
and will lean the patient forward by placing their
hands on the patient’s shoulders and using a weight
transference technique so the legs do the work.
 The other staff member would then slide the sling
down behind the patient, ensuring that the base of the
sling is positioned by the base of the patient’s spine.
 The leg straps need to be passed around the patient’s
hips. (If the patient has very large legs a sliding sheet
can be positioned between the patient’s thighs and
the edge of the chair to aid this process).
 The staff member in front would then get into an open
kneeling position in order to help protect their backs
whilst lifting their leg to get the straps under. (This
process could also be aided by using a sliding sheet
on the staffs knee on the floor, and the patient’s foot
slid up their leg to raise it up).
Alternative when it is difficult for the patient to bend
forward
 If the patient has difficulty bending forward then a
sliding sheet could be wriggled down between their
backs and the chair and then the sling pulled down
between the back of the chair and the sliding sheet
46

Removing a
sling when the
patient is in
the chair

Never leave a
patient sitting
on the sling. It
must always be
removed.
Remove the leg straps of the sling from underneath
the patient’s legs, this should be done with the staff
member in an open kneeling position. A sliding sheet
may be used as before to help slide the patient’s legs
up.

One staff member will lean the patient forward, as
before, whilst the other staff member should remove
the sling from behind the patient.
Alternative when it is difficult for the patient to bend
forward.
 If the patient doesn’t bend forward easily then once
the leg straps have been removed, a sliding sheet
could be wriggled down between the patient and the
sling, then the sling can be slid up behind the patient
to be removed.

Attaching the
sling to the
hoist

Only attach the
sling to the
hoist as per
your training
and according
to the
manufacturer’s
instructions.
Ensure that the
attachments are
secure.
47




Attach the shoulder straps to the hoist first, then
attach the leg straps
Ensure that the patient’s knees are bent up when you
start hoisting; this prevents the sling from riding up in
the groin area.
Once the patient’s bottom is clear of the bed, bring
them into more of a seated position.
Hover the patient in the air just above the bed for a
few seconds to check that everything is safe.
Hoisting from
bed to chair





Raise the hoist so that the patient’s legs are free, so
you don’t need to lift the legs, the bed could also be
lowered, or a sliding sheet positioned underneath
their feet to assist in the legs moving to the edge of
the bed.
When you are near to the chair, open up the hoist
legs if required, and approach the chair. Start to lower
the hoist.
When the patient is near to the chair, sit them up as
upright as you can, which will help guide their bottom
to the back of the chair. (If you have a loop
attachment sling then a staff member may need to
stand behind the chair with a big base of support and
tip the chair backwards slightly).
Once the patient has been lowered and there is slack
on the straps, remove the straps from the hoist.
Remove the sling
48







Hoisting from
chair to bed




Using the
hoist to roll
onto the side

Place a sliding sheet on the bed to be positioned
where the patient’s legs will go.
Position the sling as per section
Position the hoist in front of the patient ensuring that
you do not run over the patient’s feet.
Attach the straps onto the hoist and raise the patient
up slightly.
Once they are clear of the chair a few inches, hover
the hoist for a few seconds to check the safety.
Continue to raise them up in the air and then move
the hoist over to the bed.
Turn the patient in the hoist so that they are facing the
right direction.
Try to use the hoist as much as possible so that you
do not need to lift up their legs (sometimes the curtain
rails or pressure relieving mattresses may prevent you
from doing this in which case just lift one leg up at a
time).
Ensure that they are in the correct position on the bed
(on 4 section profiling beds their bottom needs to be
in line with the small part of the bed that doesn’t
move) and then lower them down.
As the sliding sheet is in position their legs will just
slide down the bed.
Remove the sling
As stated in
Rolling/ Turning
section
49
5. Standing and Walking
Note
Task



Standing Up



Do not let patients
pull themselves up
on their walking
frame.
If standing from a
wheeled seat, apply
the brakes.
Make sure the
person is wearing
proper footwear, so
that they don’t slip.
Make sure the floor is
free from slip and trip
hazards.
When standing up
from the edge of the
bed, raising the
height of the bed can
make standing up
easier.
The person’s feet
must always be able
to touch the floor
Method
Assistance from one carer.
 Have the person place his feet on the floor
under his knees, or one foot a little further back
than the other. Ensure that their bottom is
moved to the front of the chair.
 Stand close to the person with your feet in the
combination position or step position, facing in
the direction that the patient is facing. Your
furthest foot from the patient should be forward.
(Alternatively you may wish to face the patient
but ensure that you avoid twisting when the
patient comes into standing, keep your feet
apart facing the patient).
 Encourage your patient to push down on the
armrests of the chair or from the bed.
Alternatively you can offer your further hand to
the person for some support using a palm to
palm grip. Keep the palm of your hand upward
and to do not interlock your thumb with the
person’s thumb.




Place your closest hand around the base of the
person’s back. This hand is there to help guide
the patient forward, do not grab hold of the
patient’s clothing to pull them up. A handling belt
may be used if your assessment indicates the
need for such equipment but again do not use
this to pull up on and ensure that you hold onto
the handling belt with just a thumb and finger
grip.
You may use a rocking motion to build up
momentum if needed, or just follow a verbal cue
given by staff, but move together with the upper
body forward and stand ensuring you shift your
body weight from your back leg to your front leg.
If you are standing from the bed, you can sit
next to the person on the bed and stand up
together.
Ensure the person has gained sufficient
standing balance prior to moving onto walking or
transferring to a nearby surface
50
Assistance from two staff.
 As above but with staff members either side of
the patient.
Standing Up
(continued)
Maximum assistance required.
 Therapists may choose to introduce a standing
hoist or walking vest to assist patients into
standing if deemed necessary as part of their
rehabilitation programme after a full risk
assessment has been conducted.



Walking a
Patient

Do not drag the
patient along.
Do not hold the
patient under their
shoulder




Stand close to the person, to the side and
slightly behind them, facing the direction of
travel.
Consider which side you give support if just
walking with one assistant. (For some people
you give assistance on the stronger side; if
problems occur the person can then take his
weight through his stronger leg. This is usually
the case if you want to provide support. For
others, assistance is required on the other side,
so that you can make up for the lack of strength
on that side and provide the appropriate
assistance. If the person has a walking aid, this
is often used on the stronger side. You would
then assist on the other side).
If required support the patient’s hand with your
hand furthest from the patient using a palm to
palm hold. Do not allow them to interlock
your thumbs.
Support the person with your nearer arm/hand
around the person’s back or holding onto a
handling belt. If using a handling belt ensure
that you can release your grip easily if
required.
Walk with the person at the same speed
allowing the person to walk slightly in front of
you.
Make sure the patient keeps their shoulders
above their feet and does not lean on you.
51
6. The Collapsing Patient
Method
Note
Task




The Falling
Patient



Staff must not
support most or the
full weight of a
collapsing/collapsed
patient – the risk of
injury to staff is most
likely to outweigh the
risk of injury to the
patient.
Don’t pull the arms of
the patient.
Do not attempt to
keep the patient up
on their feet.
As soon as you stand
a patient up consider
their height and
weight in relation to
your own as to how
much at risk you will
be.
If someone is taller
and heavier than
you then the greater
the risk of injury.
If the patient is
significantly taller or
heavier than you then
the safest thing is to
step back out of the
way.
You can only slow a
patient’s fall down if
they are falling to the
side that you are
standing on or falling
backwards





Make sure you remain as stable as possible with
a good base of support.
Ensure that you are standing slightly to one side
and behind the person.
Try to guide the person towards you so as to
slow their fall and let them slide down your body
if possible.
Hold onto their shoulders to guide them slowly
to the floor and to protect their head.
Most staff will not have the ability to physically
lower the patient to the floor so it is not
recommended that you do this, instead you are
just allowing the person to fall down against your
body.
52
Independently
If a person is able to raise themselves slowly
with verbal instruction and the use of
surrounding furniture then they should do so.
Moving a
Person off the
Floor

Ensure the person is
not hurt and that it is
safe to move them.
Minimal Assistance (Backward chaining)
 Fetch a chair; this will assist the person in giving
them something to ‘push’ up with.
 Approach the person and reassure them
throughout the movement. Give the person time
to carry out the movement themselves.
 Ask the person to turn themselves onto one
side.
 Ask the person to bring themselves to a half
sitting position.
 Bring the chair close to the person, so they are
able to lean their hands onto the seat of the
chair.
 Encourage the person to push themselves onto
their knees and lean their forearms and hands
onto the seat of the chair.
 Reposition a second chair behind or slightly to
one side of the person so it touches the patient’s
bottom, ask the person to raise one knee and
place their foot flat on the floor.
 The person should be encouraged to push their
bottom onto the chair, which has been
positioned behind them.
 Allow the person to regain their balance and
confidence before you ask them to stand or
transfer to another surface.
53
Moderate/Maximum Assistance
Mangar Elk (Emergency Lifting Cushion) –
available from the Porters at Chase Farm Hospital
and they are trained in its use to enable the patient
to be lifted to chair height so that they can transfer
safely to a wheelchair.


Moving a
Person off the
Floor
(continued)

Never physically lift a
patient from the floor
unless in an extreme
emergency situation.
If a patient has had
a cardiac arrest
then their condition
should be stabilized
on the floor and
then a hoist used.
If the person is in a
confined space then
use sliding sheets
under them,
preferably 2 full
length flat sheets with
extension handles,
so that you are able
to stand and achieve
better positioning
whilst moving them to
a larger area.
Hoisting – Position the correct style and sized sling
under the patient (see Section 3.3 on hoisting).
Bring the hoist in, either from the side of the person
or from the direction of their feet.
54
7. ‘Patsliding’
Task
Minimal
Assistance
Required:
Moderate
Assistance
Required:
Maximum
Assistance
Required:
Note
Method
Consider if the person can
stand and move between the
surfaces independently.
Ensure that the breaks are on Roll the patient to insert the PAT slide, ensuring that
and holding
the PAT slide bridges the gap between the 2 surfaces
adequately.
Have the surface you are
Place a sliding sheet on top of the PAT slide to reduce
moving from slightly higher
the friction and to reduce the amount of over-reaching
than the surface you will be
that the staff on the pulling side are required to do.
moving onto
Two staff will be pushing the patient across, ensuring
that they are in a position to push the patient, 2 staff will
Use 4 staff as a guideline and have hold of the sliding sheet to pull them across.
more can be added if your
Perform the manoeuvre in 2 parts, the first part is to
risk assessment suggests
move the patient onto the PAT slide (most of the work
this is necessary, e.g. size of is done by the pushers), the second part is to move the
the patient or if they are
patient fully onto the bed (most of the work is done by
ventilated. 3 staff can be
the pullers).
used if the patient’s size
allows but 1 staff member will
need to change their position
during the manoeuvre (2 to
start pushing and then 2 to
finish pulling)
55
Appendix 5 - NHSLA checklist for the Review and Approval of Procedural
Document
To be completed and attached to any document which guides practice when
submitted to the appropriate committee for consideration and approval
1.
2.
Title of Document being
reviewed – Manual Handling
Policy
Title
Yes/No/Unsure
Is the title clear and unambiguous?
Yes
Is it clear whether the document is a
guideline, policy, protocol or standard?
Yes
Policy is stated clearly
in the title.
Yes
Aims – 3.
Is the method described in brief?
Yes
Section 6.1
Are people involved in the development
identified?
Yes
Do you feel a reasonable attempt has
been made to ensure relevant expertise
has been used?
Yes
Is there evidence of consultation with
stakeholders and users?
Yes
Joint Staff Committee
HR Policy Sub
Committee
NHSLA Standard
Care Quality
Commission
Standards
HR Policy Sub Group
JSC
Managers
Rationale
Are reasons for development of the
document stated?
3.
4.
5.
Comments
Development Process
Content
Is the objective of the document clear?
Is the target population clear and
unambiguous?
Are the intended outcomes described?
Are the statements clear and
unambiguous?
Is there a statement regarding equality
and diversity main issues
Has equality and diversity screening
taken place?
Evidence Base
Is the type of evidence to support the
document identified explicitly?
Are key references cited?
Are the references cited in full?
Yes
Policy Statement – 1.
Yes
Front Page, All staff
Yes
Yes
Section 2.0
Yes
6.2
Yes
6.2
Yes
NHSLA Standards
CQC Standards
Yes
Yes
Section 9.
Section 9.
56
Are supporting documents referenced?
6.
Does the document identify which
committee/group will approve it?
If appropriate have the joint Human
Resources/staff side committee (or
equivalent) approved the document
?
7.
10.
11.
Yes
Front page
Yes
JSC
Yes
Page 50
Yes
Page 50
Yes
Front page
Yes
Board Secretary
Yes
Section 8.1- 8.4
Yes
Front page
Yes
Yes
June 2015
Front page
Yes
Back Care Consultant
Document Control
Does the document identify where it
will be held ?
Have archiving arrangements for
superseded documents been
addressed ?
9.
Appendices
Dissemination and
Implementation
Is there an outline/plan to identify
how this will be done ?
Does the plan include the necessary
training/support to ensure
compliance
8.
Yes
Approval
Process to Monitor Compliance
and Effectiveness
Are there measurable standards or
KPIs to support the monitoring of
compliance with and effectiveness of
the document ?
Is there a plan to review or audit
compliance with the document ?
Review Date
Is the review date identified ?
Is the frequency of review identified
? If so is it acceptable ?
Overall Responsibility for the
Document
Is it clear who will be responsible
for co-ordinating the
dissemination, implementation
and review of the document ?
Individual Approval
If you are happy to approve this document, please sign and date it and forward to the chair of the
Joint Staff Committee where it will receive final approval.
Name
Signature
Julie Dixon, Back Care
Consultant
J. Dixon
Date
15th June 2011
Committee Approval
If the committee is happy to approve this document, please sign and date it and forward
copies to the person with responsibility for disseminating and implementing the document and
the person who is responsible for maintaining the organisation’s database of approved
documents.
Name
Raj Chana & Noeleen Behan
Date
15th June 2011
Signature
R. Chana, Director of OD & HR
N. Behan, Chair of Staff Side
57
Appendix 6 – Policy Launch Plan - for Policy Development Framework – Manual Handling Policy
Key Issues
Communicating and disseminating
Policy to managers and staff.
Actions Required
Leads Accountable
Deadlines
Communications Manager
30th August 2011
Manual Handling and Ergonomics
Service
Immediate – for
completion 30th
July 2012

Use of BCF Newsmail and BCF Now
Magazine to inform all staff about revised
policy.

Use all training sessions (BCA Inductions
and Updates and Office ergonomics) to
inform staff

HR managers to inform General
Managers/Heads of Department about the
changes in the policy that will affect them
HR managers
30th September
2011

Old policy to be replaced by new policy on
the intranet. Trust Secretary to file old
policy.
Trust Board Secretary
30th August 2011