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Moving and Handling Handbook

Content

ASSISTED MOBILITY Page

Sit to stand from chair 4 Service User needs assistance from 1 carer 4 Assistance from 2 carers 5 Assisting a person back in a chair without assistance 6 Assisting a person with assistance from a carer 6 Stand to sit, chair or bed 7 Sit to stand with a height adjustable bed 7 Supported walking with 1 or 2 carers 8 Non Power Assisted Stand Aids 9 Power Assisted Stand Aids 10 - 11

BED MOBILITY

Safety issues 12 Rolling and Turning 12 Fitting slide sheets under service user on the bed – 13

one or two carers by rolling service user Inserting slide sheets if service user cannot roll 14 Removing separate/roller slide sheets from under service user

on the bed 15 Assisting a service user to move themselves up the bed with

instruction/supervision 16 Assisted move up the bed using slide sheets x 1 or 2 carers 17 Rolling and turning using slide sheets x 1 or 2 carers 18 Assisting legs into bed using slide sheets 19 - 20

HOISTING

Fitting sling on service user in bed 21 Removal of sling in bed 22 Fitting a sling in bed using slide sheets 23 Fitting a sling while service user is in a chair 24 Hoisting from floor 25 Raizer Chair 26 Mangar Elk 27 - 29

Hampshire County CouncilMoving and Handling Competencies

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Foreword

In order to reduce the level of injuries, robust training, policies, procedures and good risk assessments have helped staff to understand the importance of safe moving and handling.

This handbook has been designed to be used in conjunction with competency training. It will offer guidance on the moving and handling of people who require assistance. It provides a visual reference along side the principles involved in safe moving and handling and the use of equipment.

It is only to be used as a revision tool, or a reference when supporting staff in the workplace.

Sitting to Standing Hampshire County CouncilMoving and Handling Competencies

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Sit to Stand from Chair

Service user brings their bottom to the front edge of the chair Service user places feet firmly on the floor, one foot slightly behind knees, one

foot slightly in front of the other (step position) Service user places hands on the arms of the chair or on their own thighs If holding onto chair the hands must be in the forward facing position and not

rotated to hold the chair arm Service user will need to rock with instruction – ready, steady, stand Service user leans forwards and pushes up on the arms of the chair/own

thighs Encourage service user to look up and stand up straight and look in the

direction they are going Once standing is achieved, pause for service user to get their balance before

giving them their walking aid

Service User needs assistance from 1 carer

Encourage service user to bring their bottom to the front edge of the chair Service user places their feet firmly on the floor as independent service user Service user places their hands on the arms of the chair or thighs Carer to stand to the side of the service user Carer place hand nearest service user at service user’s lower back, this hand

is only to glide service user forwards Hand furthest away can be placed on the front of service user’s shoulder

nearest to the carer Carer will need to rock backwards/forwards with service user, whilst offering

verbal encouragement – ready, steady, stand Carer needs to bend knees, have their weight on the back foot transferring the

weight to the front foot as service user stands Encourage service user to stand up straight, look up and in the direction they

are going Pause for service user to get their balance before giving them their walking

aid


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Assistance from 2 carers

As above but one carer each side with carers arms/hands crossing over the back of the service user

Once service user is standing always pause for service user to get their balance

Carer must be careful to not lean into the service user


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Assisting a person back in a chair

Without assistance

Chair must have armrests Service user must have their feet firmly on the floor Slightly apart and slightly tucked back Service user to place their hands on the armrests of the chair Keep hips and legs at right angles Encourage service user to lean forwards and slightly to the side so their upper

body weight is over their knees Raise one hip off of the chair Push back using the armrests of the chair Slide hip backwards towards the back of the chair as far as they can

With assistance from a carer

Carer to kneel in front of the service user Follow as above but as service user lifts their hip Carer places the palm of their hand on the raised hip Rest the other hand below the knee of the service user and gently push back


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Stand to sit, chair or bed

General Observations

Make sure brakes are applied if sitting to a wheeled chair May be helpful to come in from the side if service user tends to sit down

before they have turned around Advise service user to walk backwards until they feel the chair or bed on the

backs of their legs Service user to let go of their walking aid if using one Service user to reach backwards with their hands and feel for the arms of the

chair or bed Service user to gently lower themselves down onto the chair or bed At the same time encourage service user to push their bottom out towards the

back of the chair or onto the mattress as far as they can If assistance is required carer needs to maintain good posture bending their

knees, not the back, as in sit to stand

Sit to stand with a height adjustable bed

Make sure the bed is a good height if bed is not a height adjustable profiling bed

Follow same procedure as sit to stand from a chair Encourage service user to come to edge of the bed Service user to have feet firmly on the floor Service user to have hands on the bed ready to push up Carer can sit alongside with hand or arm along service user’s back to

encourage and prompt to stand If bed is height adjustable, slowly raise bed making sure service user’s feet

are kept firmly on the floor Verbal encouragement - ready, steady, stand Pause and let service user get their balance Give service user walking aid if used

This can be reversed for stand to sit with a height adjustable bed


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Supported walking

Supported walking with 1 or 2 carers

Carer to be as close to the service user as possible. Carers hand across service user’s back Carers other hand supporting service user’s hand by tucking service user’s fingers in

There are other holds to assist walking

Arm hold (cupping individual’s middle lower arm. No thumbs) Elbow hold – service user holding carers elbow


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Non Power Assisted Stand Aids

Safety issues

Must be able to weight bear Have upper body strength Good grip Able to follow instructions Service user able to lift feet onto platform In good working order

Raising

Bring stand aid towards the service user, asking then to raise their feet and place on the platform

Check that knee brace is adjusted to service user appropriate position Apply brakes Ask service user to hold onto handle securely and push through feet securely

when starting to rise

Lowering

Be sure the service user’s legs are touching the back of the chair Ask them to stick their bottom out Lower them back into chair Release brakes


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Power Assisted Stand Aids

Safety issues

Must be able to weight bear Have upper body strength Good grip Able to follow instructions LOLER checked In good working order Right stand aid for person (need to check with manufacturer of equal weight

bearing) Service user able to lift feet onto platform

Raising (Molift)

Apply hoist sling behind service user’s back. (lower part of sling should be at pelvic area)

Ask service user or assist service user to raise their arms so that the clip can be tightened to avoid slippage when rising


Check that knee brace is adjusted to service user appropriate position Apply brakes Position strap around legs Bring Handles forward and insert rope straps onto hooks. (this should be firm

and not loose) Ask service user to hold onto both handles securely and push through feet

securely when starting to rise Release brakes Raise the service user until they are able to weight bear in almost a upright

position DO NOT KEEP RAISING THEM UNTIL FEET OF PLATFORM

Raising (mini lift)

Apply hoist sling behind service user’s back. (lower part of sling should be at pelvic area)

Ask service user or assist service user to raise their arms so that the clip can be tightened to avoid slippage when rising

If person has a one sided weakness place weak arm into arm support on the sling


Check that knee brace is adjusted to service user appropriate position Apply brakes Position strap around legs


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Undo bolts on handles and push handles forward Connect hooks to stand aid and pull back until tight Tighten hooks Ask service user to hold onto handle/s securely and push through feet

securely when starting to rise Release brakes Raise the service user until they are able to weight bear in almost an upright

position

Lowering

Be sure the service user’s legs are touching the back of the chair. Ask them to stick their bottom out. Lower back into chair. Remove ropes from stand aid Undo leg strap and ask service user to raise feet Remove stand aid Remove sling


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Bed Mobility

Safety checks when using a profile bed

Carer knows how to use the controls of the bed Raises the bed to the appropriate height Has read and understands the bed rail policy

Rolling and Turning

Safety issues

Roll and turn service user to the side that has the most space It is an advantage for the carer who has the longest arms to be the person to

reach across service user when rolling and turning. Decide who is to be the lead person when 2 carers are required

When service user is rolling to their right side

Service user’s right hand to hold onto left shoulder Service user’s left hand to hold onto right elbow Raise service user’s left leg (bend knee, place foot flat on bed whilst

supporting heel off bed) Ask service user to turn head in direction they are going Lead carer to follow safe principles Place one hand on service user’s far shoulder and hip 2nd carer to place her hands in same position on their side Lead to communicate instruction – ready, steady, roll

This is reversed for left side rolling


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Fitting slide sheets under service user on the bed – one or two carers

By rolling service user

Always make sure the bed is at a good working height Follow instruction for rolling service user in bed Hold 2 flat slide sheets length ways, about a foot from either end and pleat up

one half Place under the service user, pleated edge up against service user Push slightly the pleated edge into the mattress under the service user Flatten the remaining slide sheet out Allow service user to roll back onto the slide sheet As service user rolls back, the slide sheet may be eased out from under the

service user if not Service user may need to roll slightly in the opposite direction to enable the

slide sheets to be smoothed out from under their back- or raise shoulder if they are able


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Bed Mobility

Inserting slide sheets if service user cannot roll

Carers fold 2 flat slide sheets over in approximately 10 inch widths until they have folded all the way down

This must be done in unison with each other otherwise the folds will be uneven

Together carers take the slide sheets and place under the pillow with the folds underneath

Hold open end down onto the bed with outside hand With inside hand palm facing upwards place underneath the folded slide

sheets and grasp the folded slide sheet With one foot slightly in front of the other for good posture One carer needs to take the lead and say ready, steady, slide Unfold one section at a time pressing down into the mattress as you go, Smooth out the slide sheet each time a section is unfolded If after a few folds the slide sheet becomes stuck under the service user’s

back ,the slide sheet may need to be see-sawed backwards and forwards across the bed to free it

Then continue to unfold section by section until you reach the end of the bed Flatten and smooth sheet out so there are no creases


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Bed Mobility

Removing separate slide sheets from under service user on the bed

Always make sure the bed is at a good working height Always remove bottom slide sheet first Start by sliding hand and arm underneath natural gap in service user’s body

e.g. neck, ankle and reach for the bottom slide sheet at the corner on the far side

Pass through to partner and they take hold of the corner and turn it under bring it towards themselves to service user’s shoulder level.

Your partner to repeat with top sheet. Both carers to take hold of folded down corner with inside hand and walk

down the bed on the instruction – ready, steady, walk. Two hands can be used if difficult.

Both sheets should be removed together but make sure the corners of the slide sheet are underneath themselves so there is no shearing of service user’s skin.


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Removing tubular slide sheets from under a service user

Always make sure the bed is at a good working height Start by sliding hand and arm underneath natural gap in service user’s body

e.g. neck and reach for the bottom slide sheet on the far side. Pull slide sheet in a downward direction towards the service user’s pelvic area Slide hand and arm underneath service user’s natural gap e.g. ankles and

reach for the bottom slide sheet on the far side. Pull slide sheet in a upwards direction towards pelvic area Gently pull any excess slide sheet until it is removed.

Bed Mobility

Assisting a service user to move themselves up the bed with instruction/supervision

Assisted move up the bed using slide sheets and 1 carer Place an extra pillow at the head end of the bed Make sure the slide sheets are not under service user’s feet Make sure service user’s pillow is on the slide sheet which encourages

service user to move up the bed Service user bends their knees and places their feet firmly on the bed Carer to support service user’s ankles firmly to keep feet flat on the bed Encourage service user to push their feet into the bed sliding themselves up

the bed This process may need to be repeated depending on the distance that needs

to be covered Remove slide sheets


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Bed Mobility

Moving service user up the bed with slide sheets - with two carers

Always make sure the bed is at a good working height Place an extra pillow at the head end of the bed Carers to be standing alongside the bed angled towards opposite end corner Feet slightly apart Take hold of the top slide sheet at the hip and shoulder and hold tight to the

service user’s body One carer to take the lead by saying ready steady slide Each carer on the command slide shifts their weight from one foot to the other

moving the service user up the bed Depending how far service user needs to be moved up the bed this may take

several movements as service user is only moved a few inches at a time Readjust feet and repeat process until service user is in the desired position in

the bed DO NOT try and move service user quickly and in one move as this can

cause distress and likely to result in service user’s head coming in contact with the head of the bed


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Bed Mobility

Rolling and turning using slide sheets x 1 carer

Service user to be in appropriate position for rolling and turning Bed rail to be raised on opposite side of carer Service user to hold onto bed rail with hand furthest away from bed rail Carer to hold onto slide sheet at service user’s hip and shoulder level Step back so arms are almost straight (to avoid the likelihood of pulling in a

upwards direction) Position feet in front and slightly apart, weight on forward leg (as safe

principles) On command of ready, steady, slide move weight backward onto back leg

and moving arms in a backwards direction (like rowing a boat) DO NOT PULL IN AN UPWARDS DIRECTION

Rolling and turning x 2 carers

Service user to be in appropriate position for rolling and turning Carer 1 to place hands on service user’s hips (furthest away) and shoulder

(nearest). Feet to match position Carer 2 to hold onto slide sheet at service user’s hip and shoulder level Step back so arms are almost straight (to avoid the likelihood of pulling in a

upwards direction) Position feet in front and slightly apart, weight on forward leg (as safe

principles) On command of ready, steady, slide move weight backward onto back leg

and moving arms in a backwards direction (like rowing a boat) Carer 1 to guide service user into position


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Bed Mobility

Legs into bed using slide sheets

Make sure the bed is at a good height for the service user to sit on If height adjustable lower so it is easier for sitting on and moving back into the

middle of Raise slightly if necessary to raise legs into bed so carer is not stooping

Using two flat slide sheets

Lay one slide sheet length ways on the bed leaving a 6 inch gap on the edge of the bed that the service user will be getting into

Lay the 2nd sheet cross ways across the bed allowing enough sheet to be down behind the back of the service user’s legs

This is to be slightly tucked under the mattress so service user does not step back onto it or tucked right under the bed

Encourage service user to sit back on the bed as far as possible Encourage service user to ease themselves back into the middle of the bed Carer to bend knees collect surplus slide sheet from behind the back of the

service user’s legs and stand up straight Service user’s legs will be wrapped in the slide sheet With carers back straight walk round and place service user’s legs on the bed Encourage service user to move into the centre of the bed or up the bed If they are unable to do this themselves they may need some assistance Carer to remove slide sheets


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Using one flat slide sheet

Fold approximately one third of the slide sheet under itself and lay on the bed cross ways

Make sure there is a gap on the edge of the bed of about 6 inch where there is only one layer of slide sheet; this is on the side of the bed that the service user will be getting in on. This is to stop service user slipping when sitting on the very edge of the bed

Make sure there is a single layer of slide sheet at the back of the service user’s legs and it is tucked back under the bed so service user does not slip on it when walking backwards

Encourage service user to sit back on the bed as far as they can Encourage service user to ease themselves back into the bed Carer to bend their knees and pick up the slide sheet at the back of service

user’s legs Wrapping service user’s legs in the sheet as you stand up straight Carer then walks round taking service user’s legs around and onto the bed Encourage service user to move into the middle of the bed if they are too near

the side Carer to remove slide sheet


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Hoisting

Fitting sling on service user in bed and hoisting Always communicate with service user Always make a visual check of any lifting equipment before use Make sure you have the right size sling Flatten the bed as much as service user will tolerate Place a pillow under service user’s head Roll the service user onto their side Fold sling in half, label inside Measure against spine, and place along service user’s spine lengthways –

checking for size Bring top half over service user Tuck under bottom Pleat sling and lay alongside service user, making sure edging is tucked

under. Place upper loops under pillow. Roll service user back, carer to find loops and gently pull and feed sling

through. If this is difficult a slide sheet can be used or service user may need to roll in the opposite direction for the sling to be rolled through completely

Bring leg piece through between legs


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Cross over any centre leg straps If service user is in a profiling bed raise the foot end slightly and elevate the

head end so service user is in a sitting position before being hoisted Bring in hoist, keeping spreader bar a low as possible. (between chest and

tummy area) Attach sling onto spreader bar (see handling plan for appropriate hooks)

attaching shoulders first for stability of spreader bar Slide sheet must be placed under heels before raising Lower bed and check service user comfort Raise hoist To return to bed, reverse procedure

Hoisting

Removal of sling in bed

Bed to be in profile position Raise bed and remove leg piece of sling by folding under itself and pulling

back to service user’s hips Whilst individual still in sitting position, roll slide sheet down between sling and

individual. Lower bed and roll in corners of top of sling Follow safe principles and pull sling from behind individual Remove slide sheet


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If unable to use above technique

Roll individual to one side Pleat sling and place top tag/hooks under pillow Roll individual back Other care worker to find hooks/tag under pillow and walk down the bed If this is still difficult you will need to roll and turn both ways

Hoisting

Fitting a sling in bed using slide sheets

Slide sheets may be used for fitting a sling on the bed Use two flat sheets slide the sling down between the two slide sheets until the

bottom of the sling is in line with the service user’s base of the spine Bring the legs piece round along the side of the service user Remove the top sheet before hoisting Bring the legs piece through and cross any centre leg straps Hoist as above


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Hoisting

Fitting a sling while service user is in a chair

Always communicate with service user

Encourage service user to sit forward in the chair

Slide the sling down the back of the chair with label and any handles facing

the back of the chair

Ensure the bottom of the sling reaches the base of the spine

Fit the legs piece one at a time

Bring the leg strap along the side of the service user and tuck under the leg

It may be helpful for the carer to kneel down in front of the service user and

ask them to lift their leg up and place the foot on carer’s leg


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This gives a gap under the service user’s leg and gives the carer two hands to

fit the leg pieces under the service user’s leg

Or a slide sheet can be used under the service user’s leg and the leg strap

fed through to second carer to adjust.

Always make sure the leg pieces are flat and fitted at the back of the service

user’s knees

Bring in hoist, keeping spreader bar a low as possible. (between chest and

tummy area)

Attach sling onto spreader bar (see handling plan for appropriate hooks)

attaching shoulders first for stability of spreader bar

Raise hoist

Hoisting

From floor

Insert sling as in bed

Tuck all sides/hooks of sling into body of service user

Place pillow under service user’s head

Bend service user’s knees so feet are flat on floor

Open legs of hoist to widest position

Bring in sideways to service user

One leg of hoist to go under service user’s bent legs

Rotate hoist to bring into position

Pillow may need to be used to protect service user’s skin


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Bring boom as low as possible

Place shoulder straps on longest hooks onto hoist

Carer behind service user to support head on pillow with her knees.

Raise hoist up a little (make sure the sling does not slide)

Shuffle knees closer to service user so your knees are now supporting her

head and neck or use an upside down back of chair

Lower hoist and rearrange sling hooks to require length

Hoist up into chair

Raizer Chair

1. Approach the fallen person

2. Place the seat on the floor by the person’s side

3. Lift the thighs to an angled position

4. Carefully push the seat under the thighs

5. Turn the person’s shoulder slightly

6. Carefully push the back rest (marked red for left handed side) under the person’s

shoulder

7. Push the rear leg onto the shaft and click into place


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8. Slide the front leg onto shaft and click into place

9. Repeat for right hand side

10. May need to use a slide sheet in the person’s back to help with sliding on the

chair

11. Ask SU to support their own head if possible. Gently assist support of the head

with one hand and raise the chair using the hand control

Mangar ElkSafety Issues

This equipment must only be used by person practiced in its use To maintain stability, persons being lifted must have the assistance of one or

more competent assistants. Users should assess what assistance may be required before commencing a

lift. Ensure that the surface, on which the ELK is to be placed, is free from sharp

objects.


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While in use, never allow a chamber to become partially deflated while any chambers above it are inflated. Chambers must always be fully inflated from the bottom up, in sequence, in order to maintain stability

Raising from the floor

Unroll the ELK by unclipping the flap from the ends of the stability bar

Remove the end cap and then the stability bar from its pocket in order to provide a more comfortable transfer for the patient.

Fold the edge of the ELK underneath itself, by folding almost in half. Roll service user over Position the ELK so that its ‘upper’ edge is approximately level with and tight

up against the patient’s waistband

Roll the patient over onto the ELK

Carry on rolling until the patient is lying fully and squarely on the ELK

Unfurl the folded over edge of the ELK

Replace the stability bar and refit the end cap.

Connect the four distribution hoses from the 4-Way Hand Control to the four

connectors on the ELK The ends of the hoses are colour coded and


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numbered to match the corresponding ELK connectors (No. 4 is the top

compartment; No.1 the bottom).

Position the Airflo compressor at the side of the ELK ensuring that it will not

be in the way while lifting and supporting the patient. Connect the hose from

the 4-Way Hand Control to the air outlet socket on the Airflo compressor and

SELECT THE ‘AUTO’ FUNCTION ON THE AIRFLO COMPRESSOR. TO

ACTIVATE THE ‘AUTO’ FUNCTION, PRESS AND HOLD THE ‘AUTO’

BUTTON UNTIL IT’S L.E.D. LIGHTS UP

Place chairs or people to support service user on either side and behind if

required

Having positioned the ELK under the patient and connected it to the 4-Way

Hand Control and Airflo compressor, position a sturdy chair, if possible, next

to the patient for them to hold to provide additional stability.

When in the seated position, the patient should place their arm on the chair

seat to provide further stabilization.

Kneeling beside the patient, place them in a seated position

Explain to the patient what to expect when the ELK elevates.

Press the number 1 button on the 4-Way Hand Control. Steady the patient as

the ELK lifts.

Stop inflation when the first (bottom) compartment becomes hard. The

compressor will automatically stop as each compartment becomes fully

inflated.

Continue to operate buttons 2, 3 and 4, in sequence, in exactly the same

manner.

Always inflate the ELK sections from the BOTTOM UP BEGINNING WITH

THE NO. 1 BUTTON.

When all four compartments are inflated, the patient may be helped to stand

or to transfer

To deflate, disconnect each of the air hose from the ELK.

After use, roll the ELK up with the 4-Way Hand

Control and re-secure the flap around the ends of the stability bar


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