RM06 Manual Handling Policy v10 1
Policy No: RM06
Version: 10.0
Name of Policy: Manual Handling Policy
Effective From: 11/06/2018
Date Ratified 17/05/2018
Ratified Health and Safety Committee
Review Date 01/05/2020
Sponsor Director of Strategy and Transformation
Expiry Date 16/05/2021
Withdrawn Date
Unless this copy has been taken directly from the Trust Intranet site (Pandora) there is no assurance that
this is the most up to date version
This policy supersedes all previous issues.
RM06 Manual Handling Policy v10 2
Version control
Version Release Author/
Reviewer
Ratified
by/Authorised
by
Date Changes
(Please identify page no.)
1.0
2.0
October 2002 Marian
Morrison
Risk
Management
Committee
October
2002
3.0
July 2005 Marian
Morrison
Risk
Management
Committee
May 2005
4.0
5.0 Sept 2006 Marian
Morrison
Risk
Management
Committee
Health and
Safety
Committee
Sept 2006
6.0 Sept 2009 Aileen
Hunter &
Deborah
Southworth
Health and
Safety Sub
Committee
Format and monitoring changes 1-
18
Additional Appendices: Training
Matrix and Risk Assessment Forms
updated
7.0 02/08/2012 Deborah
Southworth
Health and
Safety
Committee
10/07/2012 Review and Format as per OP27
Policy
Pg 5-30
Main changes to Risk Assessment
section and Training. Monitoring
and Appendices reviewed
8.0 19/06/2014 Deborah
Southworth
Health and
Safety
Committee
15/04/2014 Review and Format as per OP27
Policy.
Pages 1,4,5,7,9,11,12,13,14,
15,22,23,25,28
Main changes to Risk Assessment
section 6.1, minor changes to
wording, Updated references.
Monitoring and Appendices
reviewed
9.0 31/05/2016
Deborah
Southworth
Health and
Safety
Committee
12/05/2016 Review and Format as per OP27
Policy
Pages 1, 2, 3, 4, 6, 10,16, 20,23,24
Monitoring reviewed
Updated references
10.0 11/06/2018 Deborah
Southworth
Health and
Safety
Committee
17/05/2018 Review /Format as per OP27 Policy
Pages1,2,4,7,8,9,11,12,15,17,18,19,
20,21,22
Training section/Monitoring
reviewed
Updated references
RM06 Manual Handling Policy v10 3
Contents
Page No
1. Introduction ............................................................................................................................ 4
2. Policy Scope ............................................................................................................................ 4
3. Aim of Policy ............................................................................................................................ 5
4. Duties (Roles and responsibilities) ............................................................................................... 5
4.1 Trust Board ......................................................................................................... 5
4.2 Chief Executive ................................................................................................... 5
4.3 Executive Directors ............................................................................................. 5
4.4 Divisional Directors, Divisional Managers and Heads of Service ....................... 5
4.5 Modern Matrons ................................................................................................ 6
4.6 Ward/departmental Managers .......................................................................... 6
4.7 Employee Responsibilities ................................................................................. 7
4.8 Occupational Health Department ...................................................................... 8
4.9 Clinical Ergonomics ............................................................................................. 9
4.10 Estates and Facilities Department (QEF)………………………………………………………….10
4.11 Health and Safety Advisor (QEF)……………………………………………………………………..10
4.12 Procurement Dept.(QEF)…………………………………………………………………………………10
4.13 Tissue Viability Specialist Nurses ........................................................................ 11
5. Definitions ............................................................................................................................ 11
6. Main Body of Policy
6.1 Risk Assessment ................................................................................................. 11
6.1.1 Generic risk assessment ...................................................................... 13
6.1.2 Inanimate Objects................................................................................ 14
6.1.3 Patient Risk Assessment ..................................................................... 14
6.1.4 Rehabilitation Handling ....................................................................... 16
6.1.5 Specialist Services ................................................................................ 16
6.2 Equipment .......................................................................................................... 17
6.3 Bariatric Patients ................................................................................................ 17
7. Training ............................................................................................................................ 17
7.1 Training ............................................................................................................... 18
7.2 Record Keeping................................................................................................... 19
8. Diversity and inclusion.................................................................................................................. 20
9. Monitoring Compliance with the Policy ............................................................................... 20
10. Consultation and review ...................................................................................................... 22
11. Implementation of policy (including raising awareness) ...................................................... 22
12. References ............................................................................................................................ 23
13. Associated documentation (policies) ........................................................................................... 24
Appendices
Appendix 1 Manual Handling of Loads Risk Assessment Form .......................................................... 26-27
Appendix 2 Patient Manual Handling Assessment Form ................................................................... 28-29
Appendix 3 Controversial/Unsafe Practices Handout ........................................................................ 30-41
RM06 Manual Handling Policy v10 4
Gateshead Health NHS Foundation Trust
Manual Handling Policy
1 Introduction
Musculoskeletal disorders continue to be the most common type of work- related illness reported
by general practitioners. Work related musculoskeletal disorders (WRMSDs) can affect muscles,
joints and tendons in all parts of the body and the majority of work-related musculoskeletal
disorders develop over time. An estimated of 8.9 million working days were lost due to work
related musculoskeletal disorders, an average of 17.6 days lost for each case. (HSE Statistics
2016/2017).
On 1st
January 1993 the European Directive 90/269/EEC Manual Handling Operations Regulations
1992 (as amended 2002) under the Health and Safety At Work Act 1974, came into force. The
guidance on regulations L23 was reviewed in 2016, with the release of the 4th
Edition to support the
continued risk reduction of handling activities.
The regulations require the employer to adopt an ergonomic approach to the removal or reduction
of risk from manual handling injuries, also to ensure safe systems of work within a safe working
environment. The ergonomic approach requires manual handling to be seen in the context of a
wide range of factors, which includes the nature of the task, the load, the working environment,
and the individual’s capability.
Gateshead Health Foundation Trust has prepared this policy in order to meet its statutory
obligations and with the aim of reducing the risk, to the lowest level possible, to staff from
potential manual handling incidents.
Although ideally the need for manual handling of loads (as outlined in the HSE Guidance document
L23 on the Manual handling Operations Regulations) should be avoided, it is recognized that due to
the nature of the work undertaken by the Trust, staff may have no alternative but to move loads
manually.
As stated in the policy, managers and staff should follow measures to manage the risk in order to
minimize the risk of injury to themselves and others so far as reasonably practicable.
The Trust will ensure that the necessary arrangements are in place to facilitate the implementation
of this policy, by ensuring they have in place appropriate professionally competent persons with
those duties specified in their job brief.
The Trust will continue to work towards a “safer lifting policy” and as part of this process will
ensure a current policy of minimal lifting.
2 Policy scope
This policy is Trust wide and applies to all members of staff employed/working within Gateshead
Health NHS Foundation Trust involved in the manual handling of people and loads.
The policy applies to all staff, locums, students, bank staff, and voluntary workers involved in the
manual handling of people and loads.
The regulations make the self-employed responsible for their own health and safety during
handling. They should take the same steps to safeguard themselves as would be expected of an
employer in protecting their employees in similar circumstances.
RM06 Manual Handling Policy v10 5
The standard of this policy should be the minimum standard expected of other employers when we
contract with them for work to be done.
3 Aim of policy
The aim of this policy is to:
• Implement a consistent, safe, and effective approach for managing manual handling risks
(in line with the Risk Management Policies).
• Assist all employees of the Trust to adopt a positive approach to safer manual handling in
order to minimise the risks of musculoskeletal injury and achieve a reduction in the number
of injuries and disablements caused by manual handling operations.
• Assist the Trust in implementing the manual handling requirements of Health and Safety
legislation in particular the Manual Handling Operations Regulations 1992 (as amended)
and relevant associated regulations, arrangements and national guidance.
• Outline the responsibilities of all staff and the organisation with regard to their role in
developing and implementing this Policy.
4 Duties (Roles and responsibilities)
4.1 Trust Board
The Trust Board is responsible for implementing a robust system of corporate governance
and risk management within the organisation.
The Director of Strategy and Transformation sponsors this policy and is responsible for its
implementation.
4.2 Chief Executive
The Chief Executive has overall responsibility for the implementation of this Policy.
However day-to-day responsibility for the operational implementation of the policy has
been devolved to a local level as described hereafter.
4.3 Executive Directors
Are responsible for ensuring that appropriate health and safety management systems are in
place within their own area, so that this policy is adhered to, enabling the Trust to meet its
duty under current legislation.
4.4 Divisional Directors, Divisional Managers, and Heads of Service
Are responsible for:
4.4.1 The implementation of the policy and for ensuring that adequate resources are
available for staff to fulfil their duties and responsibilities, in reducing the risk
associated with handling tasks.
4.4.2 Implementing the Manual Handling Operations Regulations and the Trust Manual
Handling Policy within their work area.
RM06 Manual Handling Policy v10 6
4.4.3 Promoting and supporting the Manual Handling Risk Assessment process within
their area of responsibility.
4.4.4 Ensuring attendance of all relevant staff at the Trusts Moving and Handling Training
Programme in accordance with the training matrix in the Trust Mandatory Training
Needs Analysis, this can be found on the Trust Intranet.
4.4.5 Seeking advice from the Clinical Ergonomics team, Control of Infection, Tissue
Viability, Medical Devices and/or the QEF Estates Department, before purchasing
manual handling equipment and accessories.
4.5 Modern Matrons
Are responsible for:
4.5.1 Supporting Divisional and Ward managers in ensuring staff attend training,
appropriate and timely records are kept, and risk assessments are carried out.
4.5.2 Implementing the Manual Handling Regulations and the Trusts Manual Handling
Policy within their area and developing and implementing safe systems of work.
4.6 Ward / Departmental Managers
Local Managers must be aware of the Manual Handling operations undertaken in their
area.
Local Managers are responsible for:
4.6.1 Implementing the Manual Handling Regulations and the Trust’s Manual Handling
Policy within their area and developing and implementing safe systems of work.
4.6.2 Avoiding the need for their staff to undertake manual handling tasks, which involve
a risk of injury so far as is reasonably practicable.
4.6.3 Carrying out an appropriate risk assessment of any manual handling task, which
cannot be avoided but where there is a significant likelihood that an injury may
occur. The appointment of Manual Handling Risk Assessors who have undertaken
appropriate training will support this process.
4.6.4 Making a clear record of the assessment using the Trust paperwork, communicating
its findings to all staff involved and including significant risks in the local risk
register.
4.6.5 Ensuring all (generic) manual handling related action plans are addressed with
relevant staff at ward/departmental level, prior to forwarding the action plan to the
relevant Divisional Manager, and where further advice is required, to the Clinical
Ergonomics and/or Health and Safety department.
4.6.6 Introducing appropriate measures to avoid reduce or manage the risks by
redesigning the task or the use of mechanical aids.
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4.6.7 Identifying the training needs of staff and ensuring staff attend the appropriate
moving and handling training as outlined in the core skills training framework.
Details can be found on the Trust Intranet.
4.6.8 Ensuring that manual handling requirements are appropriately identified during the
recruitment process, in job descriptions and/or risk assessments.
4.6.9 Making reasonable allowances for any known health and ability problems, which
might impact on an individual’s ability to carry out manual handling tasks safely.
4.6.10 Referring a member of staff to Occupational Health if there is a good reason to
suspect that an individual’s state of health might significantly increase the risk of
injury from manual handling operations.
4.6.11 Documenting, monitoring and reviewing manual handling assessments to reflect
any change in working conditions, personnel involved or significant change in the
manual handling operations effecting the nature of the task or the load. Risk
Assessments should be reviewed annually or if circumstances changes.
4.6.12 Maintaining records of any accident, ill health, and/or training related to manual
handling operations.
4.6.13 Ensuring all manual handling accidents, incidents and near misses are reported and
investigated via the Trust’s Incident Reporting Tool DATIX, to establish if there has
been any breach of policy. It is important that findings from such investigation are
shared with the local team.
4.6.14 Ensuring a manual handling risk assessment is completed in a timely manner
following the return to work of any member of staff suffering from musculoskeletal
problems.
4.6.15 Ensuring that manual handling practices used are ‘best practice’ and that
controversial methods are not routine practice within their area.
4.6.16 Ensuring suitable and sufficient manual handling equipment is available to reduce
risk and that equipment is easily accessible, properly maintained, cleaned, and used
correctly, seeking appropriate specialist advice prior to purchasing any equipment.
4.6.17 Ensuring adequate staffing levels for safe working practice.
4.6.18 Carry out an appropriate risk assessment in relation to pregnant workers to reduce
the risk of injury to the individual and others at work.
4.7 Employee Responsibilities
The employee must:
4.7.1 Take reasonable care of their own health and safety and that of others who may be
affected by their activities when involved in manual handling operations.
4.7.2 Co-operate with their manager in the making of assessments of hazardous manual
handling tasks and applying the principles promoted at Trust training.
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4.7.3 Read and comply with the Trust’s Manual Handling Policy and seek advice if
anything in the policy is not understood.
4.7.4 Inform their manager of pregnancy, medication, or musculoskeletal conditions,
which may affect their ability to handle loads safely.
4.7.5 Present themselves in a suitable mental and physical condition to undertake the
work they are contracted to do.
4.7.6 Observe safe systems of work and use of equipment provided to reduce risk,
reporting any defects in mechanical aids to their manager. The equipment should
be labelled and the faulty equipment withdrawn from use.
4.7.7 Identify and report any change in the nature of the task, work area, personnel
involved, or load, which may necessitate a review of the risk assessment.
4.7.8 Report all accidents and near misses arising from manual handling procedures in
accordance with Trust Policy.
4.7.9 Seek advice from the manager or appropriate advisor of any situation where they
are unsure of the correct procedure to adopt or when they are unsure how to use
any manual handling equipment in their work area.
4.7.10 Wear suitable clothing and footwear to facilitate free movement and allow a stable
posture.
4.7.11 Participate in training as outlined in the core skills training and apply the principles
of efficient movement, risk assessment and ergonomics to handling tasks in their
workplace.
4.7.12 To use the people handling methods that are currently considered to be best
practice as routine (as demonstrated and practiced in training sessions) and avoids
using controversial methods.
Reference: Guide to the Handling of People 5th
Ed 2005 and 6th
Ed 2011
4.7.13 Carry out a full and comprehensive risk assessment of the task/situation in cases
where “best practice” is not possible, contacting the Clinical Ergonomics Team for
advice as necessary.
4.8 Occupational Health Department Responsibilities.
The Occupational Health Department will:
4.8.1 Ensure that appropriate pre-employment health screening is carried out, which
takes into account any manual handling operations necessary, as identified in the
prospective employees job description. Managers will be advised as to the outcome
of such screening.
4.8.2 Review any musculoskeletal problems arising out of or in connection with work and
where necessary the nurse advisor will seek advice from the Clinical Ergonomics
Advisor, Physiotherapist or Occupational Health Physician as appropriate.
4.8.3 Provide assistance with assessments of work tasks as identified in the job
description.
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4.8.4 Make arrangements for assessing the staff member’s ability to return to work and
to full duties when there has been a period of absence from work. When
appropriate, a referral will be made to the Clinical Ergonomics team.
Refer to Trust Occupational Health Policy PP45
4.9 Clinical Ergonomics
The Clinical Ergonomics Service will:
4.9.1 Act as the specialist advisors in manual handling on behalf of the Trust. This service
is available Monday – Friday and is based within Occupational Health. Out of hours,
staff should contact the Modern Matron Bleep 3039 or their manager for further
advice.
4.9.2 Design, develop, and deliver manual handling educational/training programmes for
all Trust employees. This also involves the evaluation and monitoring of the training
course content.
4.9.3 Provide specialist advice to all managers on measures and equipment to help
minimize moving and handling risks within their area of responsibility.
4.9.4 Ensure that staff are notified of their training course details
4.9.5 Ensure that all training registers are sent to workforce learning to enable them to
be recorded on ESR training database.
4.9.6 Carry out an annual audit of compliance on the manual handling risk assessment
process in conjunction with the Health and Safety department. An overview will be
taken by the department, problem areas and issues identified, and
recommendations made. An Annual Report and any required actions will be
presented to the Health and Safety Committee.
4.9.7 Work with the Health and Safety Department to review and report annually on
manual handling Datix information.
4.9.8 Work with and provide advice to the Occupational Health nursing team in assessing
and making arrangements for staff returning to work or being re-deployed when
appropriate, particularly in cases covered by the Equality Act 2010.
4.9.9 Lead on the format and verification of all necessary documentation for patient
handling and inanimate load handling. Awareness training and training on the use
of the documents will be undertaken on the Introduction to Moving and Handling,
Manual Handling Risk Assessor, Practical Skills sessions and Core Skills refresher
sessions as appropriate.
4.9.10 Produce a Manual Handling Annual Report for consideration by the Health and
Safety Committee.
It will include:
- compliance with this policy,
- update on training,
- specific handling related data from incidents reported,
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- handling linked claims data,
- information specifically linked to the interpretation of trust risks.
- appropriate Action Plan
4.10 Estates and Facilities Department (QEF)
Are responsible for:
4.10.1 Maintaining equipment and certification to reduce risks (PUWER and LOLER 1998).
4.10.2 Working with Clinical Ergonomics Team, Medical Devices, Procurement and Trust
managers regarding the purchase and location of equipment such as bariatric
equipment, mobile and overhead tracking hoists.
4.10.3 Giving specialist advice regarding equipment faults via the Trust call logging system.
4.10.4 When undertaking either a new build or refurbishment, consideration is given to
the issue of manual handling. Designs and plans should take account of ergonomics
in intended designs, to minimise the risks caused by manual handing and poor
postures. Advice from Clinical Ergonomics, and other relevant departments, should
be sought where appropriate.
4.11 Health and Safety Advisor (QEF)
The Health and Safety Advisor will work in conjunction with the Clinical Ergonomics
Department to provide additional competent advice in relation to the implementation and
application of this policy including: -
• Supporting clinical ergonomics team in providing advice to managers in relation to
manual handling risk assessment as requested.
• providing support to managers in relation to the investigation of manual handling
incidents
4.12 Procurement Department (QEF)
The Procurement Department will ensure that:
4.12.1 Any equipment purchased is of a suitable standard
4.12.2 The relevant professionals and departments are consulted prior to the purchase of
equipment, if appropriate.
4.12.3 Appropriate information accompanies equipment supplied e.g., manufacturer’s
instructions
4.12.4 The relevant departments are informed e.g., QEF Estates and Facilities, and medical
devices department of new equipment purchased so that appropriate service and
re-certification schedules are drawn up
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4.13 Tissue Viability Specialist Nurses
Are responsible for:
4.13.1 Advising on specialist beds and pressure relieving equipment and may be contacted
by switchboard.
4.13.2 Advising on tissue viability and pressure care issues, which may impact on moving
and handling.
5 Definitions
The following definitions apply to this policy document:
• Manual Handling refers to the transportation or supporting of a load/person by hand or
bodily force including lifting, lowering, pushing, pulling carrying and moving. (MHOR 1992
as amended). Manual Handling includes both transporting of a load and supporting a load
in a static posture
• In the context of this policy a Load is defined as an inanimate object such as equipment or a
box, or a person e.g. patient, which needs to be supported, transferred or moved. The level
of risk is balanced against any potential movement or any piece of equipment that is moved
• An injury is any harm to the body arising as a result of carrying out a manual handling task.
• Risk Assessment: The process whereby hazards and risks are evaluated alongside controls
designed to reduce the risk to ensure that risks are eliminated or reduced as far as is
reasonably practicable. This may be generic, completed for an area or department, or
individual completed as an assessment of any manual handling risks in providing care or
rehabilitation for a patient/client.
• Reasonably Practicable: The process of balancing time, cost, and effort against the
reduction in risk achieved. The level of risk is balanced against any potential resource input
that is required to remove or reduce the risk.
• Ergonomics: - Designing the task, workplace, and equipment to fit the individual and
reduce the risk of strain and injuries.
• Electronic Staff Records (ESR): This is the NHS Electronic Staff Records Database (ESR)
• Core Skills Training Framework (CSTF): This is a nationally recognised framework for use by
healthcare organisations provided by Skills for Health. It sets out the requirements of each
core subject which includes moving and handling training, it provides guidance on what
should be covered by which staff, frequency and standardises the focus and the delivery of
key statutory and mandatory training skills.
6.0 Risk Assessment
6.1 Risk Assessment
The Management of Health & Safety at Work Regulations 1999 require an employer to
carry out a ‘suitable and sufficient’ assessment of the risks to the health and safety of their
RM06 Manual Handling Policy v10 12
employees and to anyone else who may be affected by their activity, so that the necessary
preventative and protective measures can be identified.
The process of risk assessment begins with the identification of hazards and risks. Further
guidance on the consistent and comprehensive identification of health and safety hazards
can be found in the Health and Safety section within SharePoint Pandora of the Trust
Intranet.
A ‘suitable and sufficient’ risk assessment should:
• identify the significant risks arising out of the work;
• identify and prioritise the measures required to comply with any relevant statutory
provisions;
• remain appropriate to the nature of the work and valid over a reasonable period of
time.
In order to be suitable and sufficient, the risk assessment should be carried out by an
individual (or team), who understands the processes/work concerned, and can identify all
relevant risks. It must cover both employees and non-employees affected by the
undertaking, and take account of those more vulnerable due to inexperience, disability, or
age e.g. Young persons.
Risk Assessors will conduct workplace risk assessments as required, including manual
handling assessments.
Risk assessments should be undertaken as required, and all risk assessments must be
reviewed no less than every two years or more frequently especially where:
- new technology has been identified
- actions have been taken as a result of risk assessment
- they have become invalid or can be significantly improved
- there has been a substantial change in the work
- manual handling incident has been reported
- information about the risk changes
Risk assessments should be recorded on the trust’s documentation and should be passed to
the manager for review.
A copy of each risk assessment should be stored locally in a ‘risk assessment file’. Managers
should ensure that all staff are aware of the risk assessments and that they are readily
available to all staff. All new staff should be directed to the department/ward risk
assessment file.
Where risk assessment identifies an issue for which the area/department does not have the
resources to eliminate or control the risk, this must be escalated to the divisional
director/divisional manager/assistant divisional manager. The health and safety advisor
should be notified (Ext 3758) and these risks should be entered onto the risk register for
appropriate escalation and management as outlined in the Trust Health and Safety Policy
RM02.
Guidance for risk assessors and risk assessment templates are available in the Health &
Safety section on the trust’s Intranet site, within SharePoint Pandora.
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A risk assessment is required to be carried out for all handling tasks, both patient and non-
patient which have been identified as being necessary, but where there is a significant risk
of an injury occurring. (MHOR 1992 as amended).
The risk assessment should be carried out BEFORE the task is undertaken.
All paperwork must be dated and signed and should include any associated paperwork on
action plans or risk reduction solutions. This is evidence that the process is seen as a cycle
of continuous management of risks and improvement.
Risk assessments can cover a number of situations in the workplace as follows:
- generic situations
- movement of inanimate objects
- patient movement
- rehabilitation
- specialist services.
Guidance for each of these is covered below in more detail.
6.1.1 Generic Risk Assessment
The stages of the Generic Risk Assessment are outlined in the Trust Risk Assessment
Guidance, which can be found on the Trust Intranet site and Trust Health and Safety
Policy RM02.
The same manual handling risk may be apparent in more than one ward or
department, therefore, where possible, a generic risk assessment can be adopted
which has been checked, adjusted to reflect any local details or changes where
necessary and confirmed as applicable to that area. The risk assessment should be
dated and signed and should be reviewed according to the normal process.
A set of generic risk assessments, including those related to manual handling, have
been developed that will cover the main areas of risks. Work will continue to
ensure that the number of generic risk assessments available is extended until as
many generic risk assessments as necessary are in place. Generic risk assessments
are assessments produced only for a given job/task or activity.
A generic assessment is undertaken when the activity involved extends to several
departments within the organisation and where a core set of precautions should be
taken to prevent injury or harm.
Generic risk assessments must be edited to ensure that all the risks and controls
relevant to the area are included and any details that are not relevant are removed,
with a risk rating inserted, completed, signed, and dated so as to ensure that the
assessment is suitable and sufficient.
Each task is given a risk rating. Tasks/activities with a risk rating of 8 or more, will
require a detailed manual handling risk assessment. In the case of manual handling
tasks, a specific manual handling risk assessment form must be completed on the
appropriate form. (Appendix 1)
Copies of generic risk assessments are available to download from the Health and
Safety Section on the Trust Intranet A copy of each generic risk assessment should
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be filed in the Directorate/Dept., health, and safety policy folder, a copy placed in
the relevant area where the task or activity is undertaken (as per Trust Guidance)
Examples of generic risk assessments can be found within the risk assessment
section of Share Point Pandora in the Trust Intranet site.
6.1.2 Inanimate Objects
Where there is a significant risk of injury a risk assessment MUST be carried out
before the job is undertaken.
The assessment should be carried out by a nominated risk assessor, who has under
gone the necessary training.
The assessment should be in suitable and sufficient detail to consider and record all
reasonably foreseeable risks, and other factors, including the use of appropriate
equipment, that relate to complete handling task.
The assessment will identify short term and/or long-term risk reduction methods
and specify the safest method of carrying out the task within what is reasonably
practicable, taking into account those staff who are at particular risk.
The assessment will be reviewed at least annually as part of a management
process, or more frequently should there be any significant changes in the handling
task or when an incident occurs. (Management of Health and Safety at Work
Regulations 1999)
The assessment and its outcome must be shared with the team carrying out the
tasks. The assessment should be completed on the correct paperwork.
HSE risk assessment tools e.g., MAC assessment tool is used by some departments
where this tool may be considered to be the most appropriate method of
assessment.
(Ref: http://www.hse.gov.uk/msd/mac/index.htm and booklet and score sheets
accessed via http://www.hse.gov.uk/pubns/indg383.pdf).
6.1.3 Patient Risk Assessments
The Trusts approach to people handling aims to promote the safety of staff while
protecting the human rights of patients.
The Trust will ensure that manual handling risks, whether clinical or non –clinical
are reduced, so far as is reasonably practicable. This will be achieved by balancing
the safety and human rights of employees and the assessed care needs and human
rights of patients.
Patient risk assessments should be discussed and completed in consultation with
patients and relatives where possible.
Staff must take into account the cultural and beliefs of the patient when carrying
out manual handling to ensure that no distress is caused and to ensure promotion
of independence and privacy of patients in our care.
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Pre-operative and In-patients Risk Assessments
A specific manual handling risk assessment must be completed as appropriate using
Trust documentation.
Individual patient risk assessments will be undertaken using appropriate Trust
documentation, e.g., Pre-Operative and In-Patient Adult Risk Assessment Tool
booklet.
The assessment should be completed, as appropriate, for all in patients and should
be linked to the Mobility/Moving and Handling Care Standard documentation.
(Reference to Trust Care Standards documents, which are on the Trust Intranet
Site)
The risk assessment should be completed appropriately to form an action plan
detailing the handling risk level, number of staff and any equipment required to
carry out the task safely.
The patient risk assessment MUST be reviewed weekly or as the patient’s condition
changes, e.g. when there is reason to believe the assessment is no longer valid
because the patient’s condition and ability has changed, circumstances of the task
have changed, or there have been significant changes in the environment or the
task. In accordance with the Regulations, a review must also take place if an
accident or incident occurs.
The assessment must consider the patient, and their condition and all other clinical
circumstances, which are likely to impact on the handling tasks prior to a final safer
system of handling being chosen.
All patient risk assessments should be signed (or countersigned) and dated by a
qualified health care professional.
Other Patient Risk Assessments
There are some clinical areas within the Trust where the Pre-Operative and In-
Patient Adult Risk Assessment Tool booklet is not appropriate.
In these areas, a single individual patient risk assessment form may be used e.g.,
Physiotherapy, Day units, some community based services (An example can be
found in Appendix 2).
In some areas, modifications to the single patient risk assessment form have been
made to suit individual departmental needs and requirements e.g., Paediatric
Physiotherapy. However, any modifications to this form must be discussed with the
Clinical Ergonomics Department to ensure that the form contains the required
patient risk assessment information.
The assessment must consider the patient, and their condition and all other clinical
circumstances, which are likely to impact on the handling tasks prior to a final safer
system of handling being chosen.
The single patient risk assessment should be completed appropriately to form an
action plan detailing the handling risk level, number of staff and any equipment
required to carry out the task safely.
RM06 Manual Handling Policy v10 16
The risk assessment must be kept under constant review and changes made when
appropriate e.g. when there is reason to believe the assessment is no longer valid
because the patient’s condition and ability has changed, circumstances of the task
have changed or there have been significant changes in the environment or the
task.
In accordance with the Regulations, a review must also take place if an accident or
incident occurs
All patient risk assessments should be signed (or countersigned) and dated by a
qualified health care professional.
6.1.4 Rehabilitation
Rehabilitation handling is aimed at promoting or maintaining function and
independence, in accordance with individual treatment goals (Guide to the
Handling of People V5 2005 and V6 2011).
A risk assessment must be carried out as part of the overall assessment and
treatment plan by the relevant Therapy team.
Handling methods must be realistic for all those carrying out the tasks. Less skilled
people should not be expected to compromise their safety or that of their patients
by working outside of their capabilities in carrying out handling tasks.
In accordance with the risk assessment, equipment should be used to complement
handling methods.
Therapists should not be using controversial handling methods as routine practice.
Therapists may have to work from a position in front of the patient, and their
greater skill and knowledge may make this less of a risk than for those who are
unskilled. However the risk assessment must consider any additional risks.
Therapists must, when delegating therapeutic handling to staff, ensure the health
and safety and competencies of those involved.
Patient handling assessments must be constantly monitored and adjusted, where
required, to indicate assessment decisions, which is the responsibility of the
assessing clinician.
6.1.5 Specialist Services
In areas where there is a rapid through put of patients it may not be practicable to
carry out a risk assessment on each patient. In these circumstances a generic risk
assessment of handling situations, where there is likely to be a significant risk of
injury must be carried out (MHOR as amended).
If at a procedure/surgical pre-assessment meeting, a patient is identified as having
a specialist handling need, then a full risk assessment must be completed in line
with Section 6.1.3
RM06 Manual Handling Policy v10 17
Areas where generic risk assessments may be required include:
- Breast Screening
- Endoscopy & Colposcopy
- A & E including Plaster Room
- Out Patient Clinics
- ENT
- Theatres
- Screening Services e.g., AAA screening, ECT
- Woman’s Health
- Mortuary
- POD Surgery Centre
- Radiology & Medical Physics
- Maternity
- Day units e.g., Chemo day unit, Woodside, Ellison unit, Chronic Pain service,
Jubilee Day Unit
- Community Services e.g., Podiatry, Speech and Language Therapy,
Occupational Therapy, some nursing services
This list is not exhaustive. If in doubt, then the Clinical Ergonomics team should be
contacted for advice.
6.2 Equipment.
Equipment shall be provided to assist in the avoidance or reduction of the risk from the
handling event.
Equipment should be used in accordance with manufacturer’s instructions
Staff should be trained in the safe use of any equipment used to reduce such risks or for
musculoskeletal injury risk reduction. Clinical/departmental managers must establish
minimum competencies for using equipment and ensure that their staff are trained
accordingly. Records of all training and attainments of competencies must be taken and
maintained by line managers (Refer to Trust Medical Devices Policies)
Advice should be sought regarding equipment suitability from appropriate trust advisors,
e.g. Clinical Ergonomics, Hotel Services, Infection Control, Tissue Viability, Health and Safety
Advisor, Medical Devices or QEF Estates and Facilities Departments.
Equipment should be cleaned and decontaminated between uses with different patients as
per Manufacturer’s instructions and Trust Infection Control Policies.
For purchase of equipment refer to Policy for the Procurement Management and Use of
Medical Devices RM30
6.3 Bariatric Patients
Moving and handling very heavy, dependent patients involves a foreseeable risk. In such
cases the guidelines and procedures for caring for these patients should be followed. There
will be occasions when tasks require adjustments to the process due to changing needs or
poor initial assessment.
The Moving and Handling Guidelines for the Management of the Bariatric Patient can be
found on the Trust intranet site.
RM06 Manual Handling Policy v10 18
7 Training
7.1 Training
Moving and Handling is part of the UK Core Skills Training Framework and the requirements
are mapped against the individual job roles within ESR.
As laid down in the Regulations, the Trust will:
7.1.1 All newly appointed staff to the Trust will receive Moving and Handling Training on the
Corporate Induction training, in line with the Trust Induction Policy. This incorporates full
manual handling training appropriate to their individual work role requirements on
commencement of their employment, in line with Trust policies.
7.1.2 To ensure all new staff attend the appropriate training session(s), Workforce Information
co-ordinate the Induction Training and supply the names of all new starters to the Trust to
the Clinical Ergonomics Team All staff should attend moving and handling training as
required by the Trust in line with the Core Skills Training.
7.1.3 The moving and handling training programmes include all or some of the following
elements depending upon the type of course and training needs in line with core skills
training framework:
• Legislation, local policies and procedures
• Understanding of the basic principles of biomechanics including mechanics and
function of spinal structures
• Recognise the difference between safe and unsafe/controversial practices and their
relationship to Musculoskeletal Injuries.
• Importance of back care and posture including the risk factors of back pain and
musculoskeletal injuries
• Importance of an ergonomic approach to risk assessment and management and the
role of the individual
• Work place specific handling methods to include inanimate loads and people
handling.
• Promotion of person independence, where appropriate.
• Work place specific handling equipment
• The principle of general fitness for handling.
• Opportunity to practice safer handling methods.
Course handouts and further information on manual handling can be located on the Trust
Intranet site.
Controversial /unsafe Patient handling practices handout can be found in Appendix 3.
Provide training programmes for appropriate groups of staff before any manual
handling tasks are undertaken.
7.1.4 Provide training for groups of staff at all levels, which include skills involved in making
ergonomic assessments and a problem solving approach to manual handling operations.
7.1.5 Monitor and review-training programmes to meet the needs of specific occupational
groups and develop good practice based on assessment of current training status and the
skills required to supervise and monitor established safe practice.
RM06 Manual Handling Policy v10 19
7.1.6 Staff should attend courses relevant to their job role. If a manager considers this to be
unnecessary, then a risk assessment must be carried out indicating how any risks will be
managed in the workplace. Copies of the assessment should be sent to the relevant
Manager and Clinical Ergonomics who will carry out a review, where applicable.
7.1.7 Training will be provided on the principles of efficient human movement, and their
application to manual handling tasks and on equipment available at the training session.
Training will also include skills involved in making an ergonomic assessment and a problem
solving approach to manual handling tasks.
7.1.8 The Clinical Ergonomics team will monitor and review all training programmes to ensure
that the content is current, meets recognized standards, reflects the needs of the Trust,
and addresses issues reported in DATIX as appropriate.
7.1.9 Attendance on training will be monitored by Clinical Ergonomics who will report on
attendances. Managers will be made aware of non-attendance and be responsible for
ensuring that training is completed.
7.1.10 The frequency of Refresher training is dependent upon individual job roles. For further
details contact workforce information or refer to core skills training section on the intranet.
7.1.11 Refresher training for staff returning after absence may be recommended by Occupational
Health, where appropriate, as part of their return to work programme.
7.1.12 Where possible the Trust will adhere to the “trainer to delegate ratios” as recommended by
the National Back Exchange: HSE 2007. The recommended number currently stands at 6 – 8
delegates per trainer.
7.1.13 Customized awareness/refresher training will be provided for all staff where a unique
manual handling task has been identified or a piece of equipment e.g. hoist, is used
infrequently.
7.1.14 All staff completing the appropriate training programme will receive a Certificate of
Attendance to include in the personal/professional development record.
7.2 Record Keeping
Training
7.2.1 Records of attendance and non-attendance at Manual Handling Training will be
recorded on the NHS Electronic Staff records (ESR).
7.2.2 It is the responsibility of the Workforce Information to record all Induction and Core
Skills onto ESR, in line with Trust Policies.
7.2.3 A core course elements document is completed following the main training courses
i.e., Induction, Introduction to moving and handling and practical skills courses and
is a record of course content, practical elements covered and level of participation
during the sessions. For other courses, course documentation is also completed
outlining the session content.
7.2.4 For the full outline of the process for the Management of Non-Attendance for
Mandatory and Statutory Training for directly managed staff, which includes
manual handling, refer to Mandatory Training Policy PP25.
RM06 Manual Handling Policy v10 20
7.2.5 Any areas where there is persistent non-attendance, consultation will take place to
ascertain the reasons with the relevant line manager.
7.2.6 Manual Handling is classed as a Core Skill within the UK Core Skills Training
Framework and failure to comply may result in further action being taken. Refer to
Mandatory Training Policy PP25
Risk Assessments
7.2.7 Any risk assessment completed must be accurately recorded using the relevant
Trust documentation
7.2.8 Copies of all non clinical risk assessments must be available for inspection in line
with health and safety policies by the relevant manager.
7.2.9 The Clinical Ergonomics team, with the Health and Safety Advisor, will monitor and
review all manual handling risk assessments to identify trends/risks for further
action or follow up, and in addition will develop and monitor the implementation of
an appropriate action plans, where required.
8 Diversity and Inclusion
The Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide
services to the public and the way we treat staff reflects their individual needs and does not
unlawfully discriminate against individuals or groups on the grounds of any protected characteristic
(Equality Act 2010). This policy aims to uphold the right of all staff to be treated fairly and
consistently and adopts a human rights approach. This policy has been appropriately assessed.
9 Monitoring compliance with the policy
Standard/process/
issue
Monitoring and audit
Method By Committee Frequency
Process for recording
Manual Handling Training
information.
All manual handling
training records put
onto ESR database
Clinical
Ergonomics/
Workforce
Information
Health and
Safety
Committee
(HSC)
For each
course
Process for following up
those who do not
complete training
course registers given
to
Workforce Learning
who update on ESR.
Managers have access
to staff training
records via Manager
ESR for follow up and
monitoring
Clinical
Ergonomics
/ Workforce
Information /
ESR Manager
Self Service
Health and
safety
Committee
For each
course
updates to
committee
as required
RM06 Manual Handling Policy v10 21
Standard/process/
issue
Monitoring and audit
Method By Committee Frequency
Moving and Handling managing the risk associated with moving and handling
Moving and handling
patient risk assessments
Ward Audits of
patient risk
assessments
Clinical Ergonomics
Health and
Safety
Committee
Rolling
Programme/
Annually
Generic Moving and
Handling clinical and non
clinical risk assessments
Department
and Ward
audits
Clinical
Ergonomics/
Health and
Safety
Health and
Safety
Committee
Every two
years or sooner
if assessed
necessary
How action plans are
developed and followed
up as a result of risk
assessments
Audit Clinical
Ergonomics/
Health and
Safety/Managers
Health and
Safety
Committee
As above
Monitoring of the above
Annual report
Clinical
Ergonomics/
Health and Safety
Health and
Safety
Committee
Annually
Compliance with the
policy
Annual report Clinical
Ergonomics/
Health and Safety
Health and
Safety
Committee
Annually
Incidents Incident
statistics
Managers/ Health
& Safety
Health and
Safety
Committee
Annually
The Clinical Ergonomics Team, in conjunction with Health and Safety, will carry out an annual audit
on compliance of the manual handling risk assessment process. The findings will be analysed and
included in a report, together with recommendations and supporting action plan where
appropriate. This will be presented to the Health and Safety Committee.
Manual Handling incidents recorded on Datix will be reviewed annually by clinical ergonomics and
health and safety. Where trends are identified within the year or where there is a significant
increase in accidents or incidents, these will be reported to the Health and Safety Committee.
Managers have access to Manager ESR Self Service and therefore will be able to identify those staff
who require core skills moving and handling training. The information within ESR will allow them to
take the appropriate action in accordance with their responsibilities as specified in Section 4 of this
policy.
For Core Skills training and Corporate Induction training, Workforce Information will monitor and
report on attendance and non-attendances as per the relevant Trust Polices.
To ensure that all relevant issues are addressed an appropriate action plan will be drawn up
annually, identifying areas for improvement/change, with leads and timescales clearly specified.
RM06 Manual Handling Policy v10 22
Any action plan and updates will be discussed at the Health & Safety (General aspects of Manual
Handling including training) and implementation monitored by the Clinical Ergonomics Team.
Regular monitoring and audit of health and safety is essential to ensure that the arrangements in
place for managing health and safety are effective and compliant with relevant statutory
provisions. The Trust will use a variety of mechanisms to monitor and audit the health & safety
arrangements.
A Manual Handling Annual Report will be produced by the Clinical Ergonomics Service on each
financial year (April – March), which will be reviewed, by the Health and Safety Committee.
10 Consultation and review
This policy has been reviewed and updated and has been circulated for comment and consultation
to the following: Clinical Ergonomics and Occupational Health department, Risk Management;
Health and Safety Advisor, Internal Audit and Counter Fraud Service, and the Equality and Diversity
Co-ordinator, staff side health and safety reps, Heads of Departments, Medical Devices; Compliance
and Assurance, Tissue Viability Specialists; Workforce Information ,Workforce Learning and
Development in line with OP27 Trust Policy for the development, management and authorisation of
policies and procedures.
The policy has been reviewed and approved by the Health and Safety Committee and will be
regularly reviewed according to OP27 Policy or more frequently depending on updates in health
and safety legislation, guidance or requirements or significant changes in work practices.
11 Implementation of policy (including raising awareness)
This policy will be implemented in accordance with OP27 Policy for the development, management,
and authorisation of policies and procedures. It is also included in corporate and mandatory
training, and relevant staff education/training events.
This policy reflects the Trusts stance on the Management of Risk and the provision of good Health
and Safety standards. Managers must have named individuals who progress manual handling
within each Directorate or Service Area. These named individuals are responsible for ensuring the
policy is implemented, in full, in each locality of the trust. They are key in the assessment process
and the maintenance of records within their own departments.
The Trusts risk assessment process will provide the evidence for each management unit to identify
any needs, relating to manual handling compliance, e.g. need for training, equipment etc. This
should be conveyed to the Clinical Ergonomics, Health and Safety and Risk Management Teams.
The Clinical Ergonomic Service will provide assistance and guidance for managers and staff on any
assessments, they feel require specialist knowledge. The service will also provide assistance on
solutions requiring changes to work places, changes to the environment and further staff training
when managers request such support
The Trust Membership Coordinator as detailed within OP27 will circulate this policy.
RM06 Manual Handling Policy v10 23
12 References
College of Occupational Therapists (2006) Manual Handling (Guidance 3), London
Gateshead Health NHS Foundation Trust. Standard of Practice No. 23. Moving and Handling/
Mobility
http://staffzone/trust-documents/clinical-documents/clinical-documents-care-standards.php
Gateshead Health NHS Foundation Trust Risk Management Guidance Risk Assessment Forms and
Guidance Procedure V 3 2012
Trust Intranet site link:
http://pandora/docs/healthandsafety/risk-assessments/Pages/Home.aspx
Gateshead Health NHS Foundation Trust Intranet site: Staff zone
http://staffzone/trust-documents
Gateshead Health NHS Foundation Trust: Guidelines for the Management of the Bariatric Patient
http://staffzone/trust-documents/clinical-guidelines/clinical-guidelines-general.php
Gateshead Health NHS Foundation Trust: Training Needs Analysis
http://staffzone/ddi/departments/o-d-and-training/staff-development.php
The Management of Health & Safety at Work Regulations 1999. Statutory
Instrument 1999 No. 3242. ISBN 0 11 085625 2
The Chartered Society of Physiotherapy: Guidance on Manual Handling in Physiotherapy 4th
Ed.
London The Chartered Society of Physiotherapy 2014
Great Britain. Health and Safety at Work etc Act 1974. Elizabeth II. Chapter 37 (1974) London: The
Stationary Office
Health and Safety Executive (1992) Manual Handling. Manual Handling Operations Regulations (as
amended): Guidance on Regulations L23. Revised 4th
ed (2016). Sudbury: The Stationary Office.
Health and Safety Executive (1998) Manual Handling Manual Handling Operations Regulations
1992 .2nd Edition. London: The Stationary Office.
Health and Safety Executive (1998). Provision and Use of Work Equipment Regulations Approved
Code of Practice and Guidance, L22 (4th
Ed.) (2014) Suffolk, HSE Books
Health and Safety Executive (1992). Workplace health, safety and welfare. Workplace (Health,
Safety and Welfare) Regulations 1992. Approved Code of Practice and Guidance, L24 ( 2nd
Ed.)
(2013) Suffolk, HSE Books
HSE: Health and Safety Statistics 2016/2017
• http://www.hse.gov.uk/statistics
• http://www.hse.gov.uk/statistics/overall/hssh1617.pdf
• http://www.hse.gov.uk/statistics/causdis/musculoskeletal/msd.pdf
• http://www.hse.gov.uk/statistics/causdis/musculoskeletal/index.htm
Health and Safety Executive (1999) The Management of Health and Safety at Work Regulations.
Sudbury: Health and Safety Executive
HSE (2007) Manual Handling training. Investigation of current practices and development of
guidelines RR583: London; The Stationary Office
RM06 Manual Handling Policy v10 24
HSE Mac Tool http://www.hse.gov.uk/msd/mac/index.htm and booklet and score sheets accessed
via http://www.hse.gov.uk/pubns/indg383.pdf)
Lloyd, P (Chairman of Co-ordinating Committee) (1997) The Guide to the Handling of Patients.
Revised 4th
ed (1998): Middlesex. National Back Pain Association in collaboration with the Royal
College of Nursing.
National Back Exchange. (1993) Essential Back – Up. Recommendations for setting up effective back
care programmes. Revised 2002 ed, Middlesex: Scutari Projects Ltd.
National Back Exchange (2010) Standards in Manual Handling (3rd
Ed): Towcester
RCN (2000) Introducing Safer Patient Handling Policy. Royal College of Nursing, London.
Skills for Health (2017) UK Core Skills Training Framework. Statutory/Mandatory Subject Guide
Version 1.4 (October 2017)
http://www.skillsforhealth.org.uk/services/item/146-core-skills-training-framework
Smith, J. (ed) The Guide To The Handling of People. 5th
ed. Middlesex: Backcare in collaboration with
the Royal College of Nursing and The National Back Exchange. (HOP5)
Smith, J.(ed) The Guide to the Handling of People. 6th
edn. Middlesex: Backcare in collaboration with
the Royal College of Nursing and The National Back Exchange. (HOP6)
The Inter-professional Advisory Group. The Inter- Professional Curriculum Framework for Back Care
Advisors. Revised Edition (1997). London: College of Occupational Therapists in collaboration with
the Chartered Society of Physiotherapist, Ergonomics Society, national Back Exchange and Royal
College of Nursing.
13 Associated documentation
This document represents the Trust’s Manual Handling Policy. It is recommended, therefore, that
this document be read in conjunction with the following documents which can be found on the
Trust website:
Risk Management Policies
RM01 Risk Management Strategy
RM02 Health and Safety Policy
RM04 Incident Reporting and Investigation Policy
RM05 Reporting Defects & Failures Policy
RM07 Display Screen Equipment
RM13 Provision & Use of Work Equipment Policy
RM17 Personal Protective Equipment at Work Policy
RM19 Lifting Equipment Policy
RM30 Procurement, Management and Use of Medical Devices Policy
RM41 Young People at Work Policy
RM45 Training Policy for Medical Devices
RM50 Slips, Trips, and Falls Policy
Health and Safety Intranet on Office Sharepoint Pandora: risk assessment section within document
centre Risk Assessment Procedure V 3 2012
RM06 Manual Handling Policy v10 25
Infection Control Policies
IC01 Control of Infection Policy
IC03 Standard Precautions for the Prevention & Control of Infection
IC15 Cleaning and Disinfection Policy
HR Policies
PP10a Recruitment and selection policy Non medical Staff
PP11 Supporting and Managing Sickness Absence Policy
PP14 Diversity, Equality and Inclusion Policy
PP25 Mandatory Training Policy
PP29 Education, Training and Development Policy
PP30 Induction Policy and Procedure
PP45 Occupational Health Policy
Operational Services Policies
OP06 IT and Information Security Policy
OP27 Policy for the development, management, and authorisation of policies and
procedures.
This list is not an exhaustive list but represents key documents which outline arrangements and
processes which complement the approach outlined in this Policy
RM06 Manual Handling Policy v10 26
Appendix 1
MANUAL HANDLING OF LOADS: ASSESSMENT CHECKLIST
Section A - Preliminary: Ref: No ....................
Job description
Load Weight ( if applicable):
Frequency of lift ( if applicable):
Carry distances ( if applicable):
Is an assessment needed?
(i.e. is there a potential risk for injury, e.g., if the task falls
outside the limits of the guidelines)
YES/NO*
If ‘YES’ continue If ‘NO’ the assessment need go no further
Operations covered by this assessment
(detailed description):
Locations:
Personnel Involved:
Date of assessment:
Diagrams/Photos (other information including existing control
measures):
Section B - See over for detailed analysis
Section C - Overall assessment of the risk of injury? LOW/MED/HIGH* (*Circle as appropriate)
Section D - Remedial action to be taken: (Use additional sheet if necessary for action plan)
Action Plan / Remedial steps that should be taken. (include date by which each action should be taken and by whom if
appropriate:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Review Date:
Date for reassessment:
Assessors name: Signature:
TAKE ACTION....AND CHECK THAT IT HAS THE DESIRED EFFECT
RM06 Manual Handling Policy v10 27
SECTION B: Questions to consider:
NOTE: If a question is not applicable please tick N/A
If YES, tick appropriate
Level of Risk
Problem occurring from the task
(Make rough notes in this column in preparation for the
possible remedial action taken) taken)
Possible remedial action/ action plan
(Possible changes to be made to system/ task/ load
workplace/space/environment. Communication
required
LOW MED HIGH N/A
The tasks – do they involve:
• Holding loads away from trunk?
• Twisting?
• Stooping?
• Reaching upwards?
• Large vertical movements?
• Long carrying distances?
• Strenuous pushing or pulling?
• Unpredictable movement of loads?
• Repetitive handling?
• Insufficient rest or recovery?
• A work rate imposed by process?
The loads – are they:
• Heavy?
• Bulky/unwieldy?
• Difficult to grasp?
• Unstable/unpredictable?
• Intrinsically harmful (e.g. hot/sharp)?
The working environment – are there:
• Constraints on posture?
• Poor floors?
• Variations in levels?
• Hot/Cold/Humid conditions?
• Strong air movements?
• Poor lighting conditions?
Individual capabilities – does the job:
• Require unusual capability?
• Hazard those with health problems?
• Hazard those who are pregnant?
• Call for special information/training?
Other Factors:
Manual Handling Policy v10 28
Appendix 2
PATIENT MANUAL HANDLING RISK ASSESSMENT
Patients Name and Address:
DOB:
WEIGHT: FALLS
SCORE:
Body build : Above Average, Average,
Below Average,
Height : Tall, Medium, Short,
Initial Assessment on admission By:
(Print Name)
Is Patient Independent with or without aids Yes/No
If Yes go no further
If No Full Assessment Required
HANDLING CONSTRAINTS (please circle)
Pat. Physical - Weakness, Pain, Medical problems, Skin integrity, Joint problems, Balance
Pat. Other - Comprehension, Behaviour, Co-operation , Sight, Hearing, Drug Therapy
Physical Environment - Space, Lighting, Flooring, Temperature, Furn/Fittings, Other
Any further relevant information:
TASK : mark any
areas not
appropriate with
N/A
MH
RISK
No of
staff
HOIST TRANSFER TECHNIQUES/
EQUIPMENT REQUIRED
Date/Time Initials
H M L
IN/OUT BED
TURNING IN BED
UP & DOWN BED
SIT TO STAND
WALKING
BATH OR SHOWER
TOILETING
OTHER
WARD: ………………… ROOM: ………….. DISCHARGE DATE: ………………
Manual Handling Policy v10 29
HOIST TYPE:
………………………..
………………………..
Safe working Load of
hoist:…………….
SLING TYPE
PLEASE TICK
SLING SIZE
Universal
Amputee
Standing
Other: Please state
Any Additional information/ Action Required ( use additional sheet if required):
SIGNATURE:…………………………………… DATE:…………………………
Print Name………………………………………... Grade…………………………………………….
1st
REVIEW/DATE COMMENTS SIGNATURE
2
nd REVIEW/DATE COMMENTS SIGNATURE
3
nd REVIEW/DATE COMMENTS SIGNATURE
NB This is a general risk assessment, In addition the following should be considered.
1) Staff should be trained for the level of risk identified
2) The capabilities of individual members of staff should be considered.
3) Prior to commencing each task staff should determine whether the assessment is valid.
4) The assessment should be based on the best practice possible
Manual Handling Policy v10 30
Appendix 3
CLINICAL ERGONOMICS SERVICE
MANUAL HANDLING CONTROVERSIAL PRACTICE
In 1997 the Royal College of Nursing together with the National Back Pain Association have in the 4th
Edition of the Guide to Patient Handling produced a resume of what they consider to be “banned practices”
The R.C.N. is a recognised, respected, professional body, and any text relating to manual handling that this
organization promotes cannot simply be ignored or dismissed. This would not only be unprofessional, but
from the Trust’s legal point of view, it would be unwise and unsound.
The Guide to People Handling 5th
Edition provides evidence through accepted risk assessment tools of the
risks associated with a variety of manual handling tasks including controversial practice. This evidence
considers the risks for beginners through to experienced practitioners as suggested by BENNER (1984)
However, the Guide to Patient Handling 4th
Edition and the Guide to People Handling 5th
Edition and The
guide to the Handling of People a systems approach 6th
Edition are NOT legal documents. They are pieces
of work intended to inform anyone experienced or otherwise, who may be handling people, of what is
generally considered to be practice which may increase risk and that which may reduce risk.
The Manual Handling of Loads Regulations is the legal instrument, in which it states that risks must be
reduced to the “lowest level reasonably practicable”. It is to this standard that we must work.
In order to comply with statutory obligations, the Trust has adopted a risk management approach.
This does not mean that the Trust either condones or will tolerate the habitual, prolonged or continued use
of poor practice. The Trust expects that in managing risks a suitable and sufficient risk assessment is
undertaken and that the principles of good practice are given primary consideration when deciding how the
task should be carried out. There will be times when there needs to be a balance between risk reduction,
individual care, treatment provision and perceived best practice. In these cases anything less than best
practice must be justified through risk assessment and poor practice must never be tolerated as a routine
choice of handling techniques.
Time is spent explaining these issues on the Introduction to Manual Handling day. These issues are
discussed further on the practical skills course.
Introduction
The persistent use of poor posture and practice continues to be the source of much ill health and injury
associated with manual handling. This statement is supported within the Trust by the Datix information.
The Guide to Patient Handling 4th
Edition, 5th
Edition and 6th
Edition contains a description of “unsafe
practice and controversial techniques”.
The Guide to People Handling 5th
Edition attaches evidence through approved risk assessment methods of
the risks associated with controversial practice in addition this evidence considers the risk for different
levels of skill within the staff group.
The list is as follows:
Manual Handling Policy v10 31
The Original Four
a. the drag lift
b. the orthodox lift
c. lift with the patients arms around the carers neck
d. lifting using poles and canvas
The Extended List
a. top and tail lift
b. cross arm lift
c. Australian lift
d. Elbow lift
e. Through arm lift
f. Two sling lift
g. The bear hug
h. Belt holds from the front
i. Pivot transfers
j. Front transfers with one nurse
k. Shoulder slide
l. Moving a patient across a bed
m. Flip turn
This list is not exhaustive and reference should be made to complete original text.
Manual Handling Policy v10 32
GATESHEAD HEALTH NHS FOUNDATION TRUST
This information from professional bodies needs to be considered in the context of Gateshead Health NHS
Foundation Trust policy, procedure and philosophy for managing risk.
The list is one of TECHNIQUES. It must be remembered that the Trust bases its practice on the application
of physical, biomechanical anatomical, physiological and developmental principles. It subscribes to the
philosophy stated in chapter 5 of the 4th
Edition that “efficient movement of the human body involves the
application of principles rather than the learning of techniques”.
This does not mean that the Trust will tolerate the habitual, prolonged and continued use of poor practice
and posture.
The Trust Requires That:
1. ALL issues associated with that handling task must be considered. This is done by the risk
assessment process.
2. A suitable and sufficient assessment of risk is carried out BEFORE the task is attempted.
3. That the manual handling risks are considered and evaluated alongside any other risks which may
exist in carrying out this task in a given situation.
4. The principles of safer, good practice are given primary consideration when deciding how to carry
out a task and are applied to all handling activities.
Has Lifting been banned
As stated the Guide to People Handling 5th
Edition in the past ‘lifting’ was condemned as ‘unsafe’ and In the
Guide to the Handling of People 6th
Edition “Techniques become controversial when they increase risk of
injury to the person or handler(s) beyond acceptable limits” however it is now argued that in certain very
limited defined situations with named people it may be assessed as necessary to perform a manual lift.
The risk assessment supporting the use of such practice must be very thorough; supported with suitable
and sufficient documentation and systems of work that as a MINIMUM standard address the following:
1. Copy of the risk assessment plus clinical reasoning which explain why this handling method is being
employed. There should be an explanation of what other best practices have been considered and why
they could not be used in this situation.
2. Procedures must be detailed in writing
3. Space, equipment and furniture details
4. Risks associated with carrying out the task e.g. lifting for both the person and ALL the handlers
involved both formal and informal.
5. The minimum number of people needed to do the job
6. Those doing the job MUST be assessed as being fit to carry out the task. Vulnerable people e.g. those
who are pregnant; those who have reduced mobility or capabilities should not be expected to participate.
Where appropriate Occupational Health / Clinical Ergonomics should be contacted for advice in accordance
with the Manual Handling Policy.
Manual Handling Policy v10 33
7. Handlers and supervisors must receive specific additional training for the task and there needs to
documented evidence that this has occurred.
8. Provision must be made to ensure that skill levels are maintained through regular refresher training.
This training must be documented.
9. Staffing rotas must ensure that there is adequate numbers of suitable trained staff on duty at all
times. Annual leave and sickness absence situations must be considered.
10. The manager should sign any documents to support the need for using this method.
11. Alternative arrangements must be documented to provide a fallback option for use in foreseeable
circumstances.
12. The situation MUST be kept under constant review and when possible there should be a change to
best practice and where appropriate using equipment.
Drag lift
This manoeuvre is one in which the carer places their hand or arm under the patient’s axilla.
NB some authorities are also describing the ‘drag lift’ as any manoeuvre where carer places their hand or
arm between the patient’s arm and chest wall.
Common Uses:
1. to sit a patient in bed
2. to move a patient up the bed
3. to move the patient from sitting to standing
4. to support the patient in standing
5. to move the patient from one position to another
This manoeuvre is performed with one or two carers; with equipment and without: from the front or the
back.
Dangers to Carer:
1. Posture: the carer stands in a top-heavy position.
This position is known to be dangerous because of the compression forces
created in the spine and the consequent effect on the spinal discs.
The static muscle activity associated with maintaining this position is
known to result in muscle fatigue with a consequent loss of protection.
Overtime the habitual use of this posture will result in a reduction in the
ability of these elastic tissues to stretch and recoil – like ‘knicker’ elastic.
The risk of injury is increased significantly
2. Poor Leverage: The above position provides poor leverage for handling tasks.
The patient load is handled at some distance from the carer’s body. In this
position the weight and resistance offered by patient load must be added
to the weight of the head, trunk and arms of the carer carrying out the task.
Thus the WHOLE load can be much heavier than we think.
Manual Handling Policy v10 34
The force that ligaments and muscles have to exert to move the load are
very large indeed; all this effort hold the position comes from small
muscles, which were not designed to bear this kind of load.
3.Lack of stability: this position causes the operator to be off balance, because the centre of
gravity moves forwards and the line of gravity falls outside the base area:
the operator doesn’t fall because the ligaments and muscles in the back
tense and work hard to provide a counter balance: there is an increased
risk of the carer falling or being pulled further out of balance by the patient.
4. Shoulder Damage: because of the posture of the carer and the effect this has on muscle
activity, to carry out an action the only muscles available are the arm
muscles – these muscles are meant for mobility not strength, so the action
is inefficient and increases the likelihood of the carer having a shoulder or
neck injury.
5. Lack of Friction: the carer cannot slide the patient in this position; therefore they tend to
take the full weight of the patient.
6. Increase in pressure because the upper arms are being relied upon to do all
Gradients of the activity brute force is applied and the action is
Associated with carried out too quickly causing pressure to rise within
Speed of movement. the spinal segment, which are damaging to the discs.
7. Lack of Control: should the patient collapse or take their feet off the floor, the carer
will take the full weight of the patient and will find it difficult to
safely lower the patient to the seat or floor.
Disadvantages to the Patient
1. Shoulder Injuries: the patient is balanced on the carers forearm and
as a result soft tissue damage may be done to the patients shoulder; the
shoulder may be dislocated: the manoeuvre is very painful.
2. Bedsores: when dragging a patient up the bed or to the back of a chair, skin may be
damaged and pressure damage may result.
3. Lack of the patient is completely dependent on the carers:
Rehabilitation they are unable to participate in the activity.
4. Increased likelihood the nurses cannot control the patient load very easily
of being dropped and so there is an increase in the likelihood of the
patient being dropped.
5. Inappropriate because of the discomfort and speed of the action
Behaviour the patient may be afraid and react in an aggressive way.
Manual Handling Policy v10 35
EVIDENCE REVIEW
REBA 13 VERY HIGH IMMEDIATE ACTION REQUIRED
SKILL LEVEL: NOVICE: ADVANCED BEGINNER: COMPETENT
Very high risk and high postural risk for the handler. High effort required.
Potential risk of shoulder damage for patient.
Person being handled cannot help with activity.
Lifting and Lifts
A lift may be considered to be taking all or a substantial part of the weight of the load.
Lifting a patient must be avoided whenever possible lifting should never be the first course of action
considered.
Orthodox Lift
Two carer’s stand one each side of the bed. They clasp wrists under the patient’s back and thigh and the
patient is lifted.
NB this lift may also be referred to as the cradle or traditional lift and may be carried out using patient
handling slings.
Dangers to Carers
1. Poor Posture: The static muscle activity associated with this posture leads to muscle
fatigue with a consequent loss of protection and an increased likelihood of
injury. Overtime there will be adaptive shortening in otherwise elastic
tissue, which further increases risk.
In addition compression forces increase in the spine.
2. Poor leverage: the load is held at a distance from the carer’s body thus the LEVER ARM
increases in length. As a consequence the muscles in the lower back and
around the shoulders have to work extremely hard to stabilize the area and
move the load.
3. Lack of stability: the posture causes the operator to be in an off balance position, because
the line of gravity is close to the edge of the base area. As the base area of
the operator is fixed the patient is moved out of the operator’s base area.
The operators posture moves from bad to worse as now an element of
twisting is superimposed on a top-heavy position. At the end of the
manoeuvre the operator is even more off balance.
4. Lack of use of this is a lift and therefore friction is not used.
Friction:
5. Increased pressure efficient movement cannot be used, so brute force
gradients associated takes over. The task is carried out quickly to make
with velocity use of momentum, but this causes a rise in pressure
within the spinal segment, this may damage the disc
6. Lack of control of the the patient load is moved away from the operators,
load: usually well outside their fixed base area. Thus the operators
Manual Handling Policy v10 36
are pulled further into a top-heavy, twisted position whilst bearing the full
weight of the load and controlling that load to set it down.
It is a tall order to ask the spine and spinal muscles to exercise this amount
of control. Injury is likely to occur
Dangers to Patient
1. Skin damage: the skin may be damaged as the carers push their arms into position. The
skin may also be damaged as a result of increased pressure from the carer’s
arms on a relatively small area of the patient’s skin. The heels may drag on
the bed.
2. Increased likelihood due to lack of control of the load on the part of the
of patient being dropped: operators.
3. Lack of rehabilitation: the patient is completely dependent on the operators.
4. Inappropriate because of the possible discomfort e.g. from the head being
behaviour unsupported and speed of the action the patient may be afraid and react in
an aggressive way.
EVIDENCE REVIEW
REBA: 10-12 HIGH TO VERY HIGH ACTION REQUIRED NOW
SKILL LEVEL: NOVICE: ADVANCED BEGINNER: COMPETENT
Very high risk activity due to posture adopted for task and effort required.
Person being handled cannot help with activity.
Australian or Shoulder Lift
Dangers for Carers
1. Poor Posture: unless the carer has reasonable tissue flexibility and is careful about getting
into a good position, then the carer tends to be on a significant twist. If the
free hand is then used to support the patient the carer’s trunk will be even
more twisted
2. Lack of Stability: the base of support is fixed, therefore as the patient load is moved up the
bed, the load is moved outside the carers base area, thus the carers line of
gravity moves close to the edge of the base are (sometimes it is moved
outside of the base area) which increases instability.
3. Poor Leverage: as the patient load is moved away from the operator, the lever arm
increases small back muscles have to work inappropriately hard to stabilize
and control both the operator and the load. Any mechanical advantage
that did exist is now lost at an important phase of the manoeuvre.
4. Shoulder damage: a substantial part of the weight is taken on one shoulder, therefore there is
likely to be a strain on the joint. The arm under the patient’s thigh is
usually at an awkward angle and as a result is likely to be damaged.
5. Lack of use of friction: this is a lift. Sliding is not used. The carer therefore
supports the full weight of the patient.
6. Increase in pressure in order to get the job over and done the carers often
within the spine: carry out the task quickly and with jerky movements.
This increases the pressure within the spinal segments.
Manual Handling Policy v10 37
7. Lack of Co-ordination: the carers cannot see each other, nor can they see
the patient, therefore there is an increased likelihood that the procedure
will be uncoordinated. If the two carers are of substantially different
heights than the lack of co-ordination increases further.
8. Lack of Control: the carers cannot see what the patient is doing and so risks increase. The
patient may push on a foot unexpectedly or they may move backwards.
The patient may also nip or hit the carers or may attempt to push
downwards on the carers. The carers will have no control over the load
and as a result the manoeuvre may go very wrong resulting in injury.
Disadvantages for Patient
1. Shoulder Movement: the patient must have good shoulder girdle stability
and movement, otherwise the shoulder would very easily be damaged.
2. Sitting Posture: the patient must be able to achieve and maintain a good sitting position.
The patient must therefore have good hip movement.
3. Skin Integrity: heels and bum may be dragged. If a paddle is used under the knees
delicate skin may be damaged due to excessive pressure or it may cut into
the back of the knee.
General Disadvantages
1. It is invasive with regards to personal space. This may be unacceptable to some people.
2. Some patient’s e.g. those with increased extensor tone; those who are confused and those with hip
problems may have difficulty in maintaining a good position.
3. It is unsuitable for patients with fractured ribs, bone secondaries or other chest injuries.
EVIDENCE REVIEW
REBA: 12-13 VERY HIGH CHANGE REQUIRED NOW
SKILL LEVEL: ADVANCED BEGINNER: COMPETENT
(NOVICE SHOULD NOT BE DOING THIS)
Very high risk activity due to posture and effort required.
Top and Tail Lift/ Through Arm Lift
The carer at the body end of the patient places their arms under the patient’s shoulders between the
patient’s chest wall and arms. The carer takes hold of the patient’s forearms; the carer at the foot end of
the patient takes hold of the patient’s ankles or calves.
Disadvantages for Carers
1. Poor Posture: carers cannot assume a good posture to carry out this lift. They are top-
heavy and twisted and as a result the risk of injury is increased.
2. Lack of Stability: the carer’s base area is fixed and inappropriate for the task resulting in an
initial unstable position, which increases as the action progresses.
Manual Handling Policy v10 38
3. Poor Leverage: associated with poor postures assumed by the carers. Poor leverage is also
associated with the patient load being handled at a distance from the
carer’s body.
4. Lack of use of friction: this is a lift and so the total weight of the patient is
being taken by the carer. Sliding principles are not used.
5. Lack of Control: there is an increased risk of the carers losing control of the load. This lack
of control is associated with poor posture and stability. The risks are
increased further if the patient is unco-operative or cannot or will not keep
skill and follow instructions.
6. Increase in spinal this technique is usually carried out in a quick
pressure associated manner, which serves to increase the pressure
with velocity: within the spinal units.
Disadvantages for the Patients
1. Shoulder Damage: it is likely that the patient will be damaged.
2. Inappropriate if the patient is caused pain it is likely that they will
Behaviour: respond in a way, which may put the carers at risk.
3. Falls: if there is insufficient control of the patient load the patient may be
dropped or fall.
4. Skin Damage: the paddle may damage delicate skin due to excessive pressure or it may
cut into the back of the knee. The patient may be dragged at the point of
lift.
Two Sling Lift
This lift is very similar to an Orthodox Lift and is just as dangerous. The presence of the slings does not
make the manoeuvre safe; it is still a total body lift.
The disadvantages for the carers are the same as those described for the Orthodox Lift.
The disadvantages for the patient are the same as those described for the Orthodox Lift. In addition if the
patient is unable to control her/his head the head may flop back and cause injury
EVIDENCE REVIEW
REBA: 10-13 HIGH – VERY HIGH CHANGE IS NEEDED NOW
SKILL LEVEL: NOVICE: ADVANCED BEGINNER:- COMPETENT
High risk activity due to posture, effort and weights handled.
Person being handled cannot assist and is likely to experience discomfort.
Manual Handling Policy v10 39
Elbow Lift and Pivot Transfers
These two manoeuvres are very similar and are therefore being considered together.
In both rocking is used to build up momentum the patient is half stood, turned and sat down.
NB in the ELBOW TRANSFER the patient is bundled up so that the head is under the handler’s upper arm.
The patient is brought into a stoop standing position. Unless the patient is very small they usually cannot
extend the knees.
THE RISKS ARE THEREFORE INCREASED.
Disadvantages for Carers
1. Poor Posture: carers tend not to assume a good posture. They adopt a top-heavy stance.
2. Lack of Stability: the carer’s base is fixed and as a result of the rocking, the carer constantly
moves in and out of balance. The risk of being off balance significantly
increases at the point where the patient is brought onto their feet.
3. Poor Leverage: associated with the poor postures of the carer. The patient is likely to be
handled at distance from the carer’s body.
4. Lack of use of it is a manoeuvre where the carer is very likely to
Friction: support a substantial amount of the weight of the patient load. Sliding
cannot be used.
5. Lack of Control: there is an increased risk of the carer losing control of the load as they not
only have to generate enough force to control their own movement, they
also have to be able to control the movement of the patient. Should the
patient’s knees collapse or in the case of the elbow lift, should the patient
stand up the risks are increased further.
6. Increase in spinal the speed of the manoeuvre will result in an increase
pressure associated in pressure within the spinal unit.
with velocity:
7. Lack of use of head: neither the carer or the patient can use the
developmental principles of moving the head away first at the
effort phase of the action. The spine is therefore likely to lock
in a top-heavy position.
Disadvantages for patients
1. Inappropriate the patient may respond in an inappropriate manner
Behaviour: if they feel vulnerable or afraid. This may put both them and the carers at
risk.
2. Falls: if there is insufficient control of the load they may fall. If the task is taking
place too close to a wall the patient may hit their head.
3. Inability to help: the patient is totally dependent and cannot help.
4. Instability: as a result of the base of support and speed of movement the patient load
is out of balance.
Manual Handling Policy v10 40
Holds from Front
These include the Bear Hug and Belt Hold
The bear hold in itself provides a poor hold with which to assist a patient load.
The use of a belt provides a better holding point BUT the carer’s control of the load is compromised
especially if the belt is not applied correctly or fastened tightly. In addition if the carer holds the straps
incorrectly, should an accident occur the carer may be hurt?
Working from the front of a patient
This is now being considered to be poor practice. In some areas it is said to be “banned practice”.
However, where the handling environment is poor and / or out of the control of the employer and in
rehabilitation settings working from the front may be the only option.
In order to MINIMIZE the risks certain aspects need to be carefully considered.
1. A RISK ASSESSMENT should always be carried out in accordance with the Manual Handling of Loads
Regulations.
2. Consideration must be given to the level of skill experience and training of the staff/carers carrying out
the task as well as the abilities of the patient load.
3. Consideration must be given to the application of physical, anatomical, physiological developmental
and biomechanical principles not just for the handler but also for the patient load and for all parts of
the task.
4. A mini appraisal of the situation should be carried out before each handling episode.
Patient
NB the patient MUST bring their back away from the chair back in order to bring the centre of gravity
into the pelvis and then be moved forwards on the chair seat.
Carer
If the patient requires assistance to move away from the chair back then the carer SHOULD NOT
assume a top-heavy forward flexed position and pull the patient forward from the shoulders. In this
position the leverage is such that the loading end in the lumbar spine and because of the length of the
lever arm the spinal muscles have to exert a force approximately five times greater than the weight of
the load in order to achieve the task. The head and he leg muscles cannot assist. It is a brute force,
unskilled movement which undoubtedly increases risk. This is the case whether a male or female
carries out the task.
Allowing a Patient to hold the Carer
It is advisable NOT to allow a patient load to hold the carer in a handling task.
In this situation if the patient begins to fall they cannot be lowered to the floor. It is highly likely that the
carer will be pulled to the floor and will be injured.
Use of Equipment
Using equipment to reduce the risks associated with handling tasks needs careful assessment and
consideration.
Manual Handling Policy v10 41
The equipment available in this Trust has not been “banned” from a Health and Safety point of view, but
the equipment must be chosen carefully and used correctly. It must be suitable for its chosen task; it must
not be faulty; staff must know how to use it correctly and be aware of what could happen if the equipment
is misused or if it is inappropriate for the task.
The need for equipment and the type of equipment chosen should form part of the risk assessment
process.
The same physical, biomechanical, anatomical, physiological and developmental principles should be
applied to the use of equipment as are applied to carrying out tasks without equipment.
Equipment should not be used if you do not know how to use it. This will only increase the risk for both
carer and patient.
The clinical ergonomics service will be able to provide information about equipment whose use is
considered to be less than best practice.
Conclusion
Gateshead Health Trust does not condone the routine and habitual use of poor practice. However, in
following a risk management philosophy, the Trust does understand that in some circumstances when ALL
the risks associated with providing care and treatment for a specific patient have been assessed and
considered some action which, falls short of best practice will be the only option.
In such circumstances it is expected that staff will be able to provide a reasonable argument supported by a
risk assessment for the decision made. It is also expected that the situation will be kept under constant
review and a change to best practice made as soon as reasonably practicable
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