manual handling of the heavy patient guidelines · manual handling of the heavy patient v2 3 manual...

Manual Handling of the Heavy Patient v2 Manual Handling Manager March 2018

Manual Handling of the Heavy Patient Guidelines


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Policy Title: Guidelines for the Manual Handling of the heavy patient

Executive Summary:

These guidelines aim to complement current guidance and provide clear advice to staff on the management of heavy patients who exceed the weight limits of some items of hospital equipment, the aim of these guidelines is to maintain the safety of staff and patients, these guidelines comply with Health and Safety legislation and Manual Handling Operation Regulations (1992)

Supersedes: Version 1

Description of Amendment(s):

Equipment updates The bariatric person is also referred to as the “plus size” person, following consultation with the client group from National Back Exchange

This policy will impact on: All staff, clinical practice and health and safety

Financial Implications: Possible financial impact for extra resource provision if identified during the risk assessment process

Policy Area: Corporate Document Reference:

ECT002279

Version Number: 2 Effective Date: 25/03/2015

Issued By: Review Date: March 2018

Author: Manual Handling Manager

Impact Assessment Date:

N/A

APPROVAL RECORD

Committees / Group Date

Consultation: Risk management sub committee 25/03/2015

matrons 25/03/2015

Approved by Director: Director of Organisational Development and Learning Risk management sub group

25/03/2015

Received for information:


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Contents Page Guidelines on the manual handling of the heavy patient (Bariatric) 4 - Purpose of the guidelines 4 - Organisational roles and responsibilities 4 - Associate Directors roles and responsibilities 4 - Ward/Department Manager’s roles and responsibilities 5 - Manual Handling Team’s roles and responsibilities 5 - Employees roles and responsibilities 5

- Assessment of the patient 6 - Manual Handling of the heavy (Bariatric) patient 6 - Communication with other wards/departments 7

- Equipment for the heavy (Bariatric) patient 7 - The collapsed heavy (Bariatric) patient 7 - Planning to stand/walk a heavy patient who is ‘High Manual Handling 7 Risk - The deceased heavy patient 8 Appendix 1 – Trust Equipment for manual handling of patients in excess of 9 160 kg’s (25 stones) hospital Appendix 2 – Hire of equipment for the heavier patient, hospital 11 Community service line use choice equip Appendix 3 - Flow Chart 13 Appendix 4 – Bariatric Risk Assessment and Care Plan 14


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Guidelines on the Manual handling of the heavy patient (Bariatric)

1. Purpose of the guidelines These guidelines have been produced to provide trust staff with guidance on the management of heavy patients who exceed the weight limits of some items of trust equipment. Within the hospital environment standard manual handling equipment tends to have a safe working load of 159 KG (25 stone), The aim of these guidelines is to maintain the safety of staff and provision of high quality care for patients. These guidelines comply with the health and Safety legislation (Health and safety at work Act) and Manual Handling Operations Regulations (1992) The purpose of these guidelines is to minimise handling risk by ensuring that specialist equipment/advice is available. So far as reasonably practicable, these guidelines should be read in conjunction with the Trusts manual handling policy. For the purpose of these guidelines the plus size (bariatric) patient is defined as anyone who has limitations in health due to their physical size, lack of mobility, due to their size, weight or high body mass index. Body mass index is a simple index of weight for height that is commonly used to classify underweight, overweight, and obesity in adults it is defined as the weight in kilograms divided by the square of the height in metres (kg/m2)

2. Organisational roles and responsibilities Chief Executive The Chief Executive has responsibility for ensuring the health, safety and welfare of staff, patients and visitors to the health services premises within the Trust are in line with the Management of Health and Safety at Work Regulations. All Directors Directors are responsible for ensuring that where the principles described in these guidelines affect their area of accountability the guidance and standards described are complied with and integrated into practice. Heads of service lines/service manager/matrons are responsible for: Manual handling matters within their areas as follows:-

take all reasonable steps to ensure that funding is identified to implement risk reduction measures as indicated in the manual handling risk assessments

ensure that manual handling equipment is available and is maintained in a safe condition and is used effectively

make provision for adequate manual handling information, instruction training and supervision and ensure up to date records are kept for this in compliance with the Management of Health and Safety at Work Regulations 1999 and the Manual Handling Operations Regulations 1992

ensure that manual handling risk assessments are completed and reviewed regularly

ensure manual handling incidents/accidents are reported and investigated as soon as possible.

Ward/Department Manager’s /Team leaders All ward/department managers should identify hazards concerning manual handling of plus size (bariatric) patients, and ensure that the ward/dept risk assessments document all appropriate measures to reduce risks for these manual handling tasks. Managers have a duty to inform each employee of the


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manual handling risks identified by these assessments and should document preventative/protective measures put in place e.g. safe systems of work. All staff should be familiar with these assessments and they should be available for reference. All managers should ensure that all staff who handle plus size patients have suitable, sufficient and current information regarding individual patient’s manual handling risk assessments and care plans. All ward managers should have local procedures in place for the management of any patient who exceeds the weight limits of any equipment/furniture in their own area, this could be information for staff on where to get manual handling equipment, large blood pressure cuff, gowns etc All ward/department managers should compile and keep a list detailing the weight limits of every relevant item of equipment, i.e. beds, mattress’s, trolleys, chairs, commodes/shower chairs. Where appropriate the weight limit should be clearly displayed on the item of equipment. Manual Handling Team The Manual Handling team’s roles and responsibilities can be found in the Manual Handling Policy. The Manual Handling Team can assist with the risk assessment process and provide advice on how the patient may be safely handled. They can offer advice on the type of equipment available, suitability and where it can be obtained. They may also offer training in safe manual handling techniques and the safe use of equipment.

Employee As an employee of the Trust, the post holder has a duty under the Health and Safety at Work act 1974 sections 7 and 8 and the Management of Health and safety at work regulations 1999 regulation 14 (1) and 14 (2) The Manual Handling Operations Regulations (1992) requires employees to co-operate and follow appropriate systems of work laid down by their employer to promote safety during the handling of loads. In particular employees should:

make known to their manager any factor which may place themselves or others at risk of injury

ensure that on commencing work in a new area they comply with the manual handling induction process and are familiar with all manual handling equipment/processes

ensure that before using any manual handling equipment i.e. trolleys, hoists, they have been provided with sufficient information, instruction training and supervision.

If staff have any concerns regarding their competency in use of equipment or work processes, they should report their concerns to their manager immediately and contact manual handling for further guidance if required. Employees must attend the appropriate mandatory manual handling training programme specific to their job role as identified in the Trust’s policy for the management of statutory and mandatory training for all staff. Employees have a responsibility to declare if they believe they are not fit enough to participate in practical training sessions, they should make their concerns known to their line manager or occupational health and to the manual handling advisors facilitating the session. Employees must have additional training where necessary, in skills relevant to their work place. This training should be provided by the manual handling advisors, manual handling link staff or the relevant equipment manufacturer.

3. Assessment of the patient (see Appendix 3, flow chart)


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All staff have a duty to follow these guidelines and ensure that the risk assessments/risk reducing measures for the ward have been taken. On admission of the plus size patient, all staff should ensure that the patient is assessed for manual handling risks, identify hazards and document risk reducing measures on the patients care plan. All staff have a responsibility to inform managers/colleagues of plus size patients with manual handling risks. Every patient must have a manual handling risk assessment completed, (see appendix 4) and include if possible the patient’s weight, waist circumference, and waist/hip ratio. If the patient cannot be weighed promptly, due to their clinical condition, this should be documented on the assessment/patients notes stating the reasons why this has not taken place, (weight is important to ensure there is no risk of equipment failure). The risk assessment/care plan should identify:

how the patient is to be moved

identify any manual handling equipment to be used

identify how many staff are required for the task

ensure that the environment is suitable to accommodate the patient and any equipment identified for their care

any other risk reducing factors should also be included. If staff need advice from the Manual Handling Team, please contact telephone extension 3973, bleep 1339, or 1340, Monday to Friday 9-16.30, other disciplines that may be able to offer advice are Physiotherapy or Occupational Therapy. Out of hours the on site managers should be contacted for advice. If a patient weighs over 160 kgs (25 stones) wards/departments will need to make special arrangements for appropriate manual handling equipment, extra staff or increased bed space, this information should be recorded on the risk assessment/care plan. Discussion should be with the matron or senior nurse in the first instance. Out of Hours this should be with the on site managers with reference to the Senior Manager on –call if required. Not all patients will present with complex needs however this will enable staff to make provision for specialist equipment where necessary.

4. Manual handling of the plus size patient All staff should refer to the Patient Escort Policy (Available on the Trust intranet policies). When transferring a plus size patient, staff should endeavour to find the mode of transfer with the least risk involved for all concerned. Some patients may need transferring on their bed/trolley utilising any mechanical aids available, or with the required number of people. If the patient is to be transferred by wheelchair, assessment as to how many staff should assist with the transfer should be made.

5. Communication with other wards/ depts. The special needs of the patient and specific instructions regarding manual handling must be passed on from the ward/dept to any of receiving dept, e.g. Radiology, Aston ward. If this instruction does not occur or you have any concerns, it should be discussed with the nurse or line manager responsible for the transfer of the patient. Please consider if a manual handling risk has been identified and not resolved, and then document further using the Trusts incident reporting system. Information on manual handling heavy patients should be passed on with as much notice as possible to allow other departments to plan for the patient’s arrival. Reference should be made on the handover documentation regarding manual handling risks and specific care required.


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6. Equipment for the plus size (Bariatric) patient All trust mobile hoists will lift up to 25 stone (160kgs), please refer to list of equipment, Appendix 1, however specialist bariatric equipment is available via rental, see Appendix 2, after discussion with the matron or senior nurse. The Community service line use Choicequip for patient handling equipment, Choicequip will;

Process equipment orders received from community staff.

Ensure a service contract is in place for the maintenance and repair of all moving and handling equipment provided by them

Circulate medical device alerts to all line managers regarding equipment

Provide advice and information to community staff

7. The collapsed plus size (Bariatric) patient There are 5 patient lifting hoists available to assist patients over 25 stone (160 kg) All patient handling areas can access the hoist from. (See Appendix 1)

Ward 2 Arjo opera SWL 200kgs (31 stone)

Ward 3 Arjo maxi-move SWL 227 kgs (36 stone)

Ward 4 Arjo maximove SWL 227 kg (36 stone)

Ward 5 & 6 Arjo maxi-move 227 kgs(36 stone)

Aston ward Arjo maxi-move 227 kgs (36 stone) Every patient should be assessed prior to allowing them to stand up out of a bed or out of a chair. If the patient weighs or is thought to weigh more than the weight limit of the nearest available hoist then staff should contact the Matron or Senior Nurse to discuss hiring of appropriate equipment. Within the community staff should use assessed equipment that is already available within the patient’s property, if there is no equipment available assistance will be required from emergency services.

8. Planning to stand/walk a plus size patient who is a “High Manual Handling Risk” This should be carefully planned and documented liaising with appropriate disciplines i.e. physiotherapy. Suitable and sufficient equipment should be available for supporting the patient if required i.e. heavy duty walking frame/overhead gantry hoist with walking pants/heavy duty Golvo or Viking mobile hoist with walking pants. Consideration should be given to the risks associated with allowing the patient to move themselves/or being moved by staff, i.e going to the bathroom. If this move allows the patient out of the range of the heavy duty hoist, consideration should be given when selecting an appropriate bathroom/toilet area. Staff should ensure that the mobile hoist is suitable and that it could be used in that area. If the patient falls to the floor in a confined space, the patient should be assessed and medically fit to be moved. The patient would need to be positioned onto a emergency transfer/slide sheet, and then pulled along the floor pulling on the emergency transfer/slide sheet, with an appropriate number of staff, using safer principles of manual handling and weight transfer technique. The patient’s sling can then be fitted and checked to ensure it is in the correct place before attaching to the hoist/gantry to lift them up. Another option would be to use an air assisted lift device that allows the person to remain in a supine position; the person is then raised to a level that will facilitate a lateral transfer onto a stretcher, bed or trolley In the event of a heavy patient collapsing, unless he / she can get up unaided they should be cared for on the floor/in the chair and made comfortable until a suitable hoist or the hoverjack is brought to lift them onto a bed/trolley.


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Any deceased heavy patient who is on the floor should be lifted with a hoist. 9. The deceased plus size patient The deceased patient should be moved onto the concealment trolley, using the hoist and flat lifting attachment, or using the lateral transfer technique, enough staff should be available for the transfer. Deceased patients weighing up to 30 stone can be managed in the mortuary using existing equipment, the mortuary has a LIKO ceiling track and flat lifting attachment, there are 2 body trolley lifts that lift up to 50 stone, one has scales, if a patient is more than 30 stone they are transferred to Leighton hospital.


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Appendix 1 - Trust equipment for manual handling of patients in excess of 25 stone

Item of equipment

Weight limit Location/ward Make of item How to get it

Arjo opera Hoist

200kgs (31 stone) Ward 2 Arjo ( ensure arjo clip slings are used with this equipment)

Ring ward 1002

Arjo maxi-move Hoist

227 kgs (36 stone) Ward 3 Arjo maxi-move MK2, with scale ( use arjo slings)

Ring ward 3 1003

Arjo maxi-move Hoist

227 kgs (36 stone) Ward 4 ARJO-use ARJO slings

Ring ward 1004

Arjo, maxi-move Hoist

227 kgs, (36 stone)

Ward 6 Arjo maxi-move with scale

Ring ward 6 1006

Arjo, maxi-move Hoist

227 kgs, (36 stone)

ICU ARJO use ARJO slings

Ring 1032

Slings; Only use Arjo slings with arjo hoists,

All slings will have the SWL identified on the sling

All wards should have a stock of sizes available

Arjo slings Purchase from Arjo

3 Theatre tables

2 Theatre tables SWL 250kgs (39 stone) 1 theatre table 350kg (55 stone)

Theatres Theatre tables Theatres need advance warning to ensure the appropriate table is prepared

Toilets Toilet seats 146 kg ( 23 ½ stone) Toilet pan 380 kg ( 60 stone)

Beds The MDGH site currently has a number of enterprise 5000bedframes,distributed on wards, that have a SWL of 248 kg (39 stone), However depending on the body weight distribution, wider beds may be required to meet the needs of the larger patient

Ring wards. If none available contact matron or senior nurse to discuss the hire of equipment See appendix 2


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Item of equipment

SWL (physio equipment with a swl of over 150kg will be marked with a “B”)

location Make of item How to get it

1 x bariatric ridgid walking frame

Physio orthopaedics

KCI medical Physio Orthopaedics Tele ex 3164

Long elbow crutches

190 kgs Physio orthopaedics

Days healthcare

Physio Orthopaedics

Gutter frame 160kgs Physio orthopaedics

Days healthcare

Tele ex 3164

2 x folding bariatric frames

227kg Therapies ward 10

coopers Tele ex 3900

Gutter frame 160 kg Therapies ward 10

trulife Tele ex 3900

Viking XL hoist

300kgs Medical equipment library. Undercroft

Use liko slings only

Log out via medical equipment library. Wards need to purchase liko slings to use with Viking XL

Hoverjack Flat lift kit

theatres theatres

Women’s and children’s Examination couch 190 kg

Scan machine couch 190 kg

Large blood pressure cuffs

Delivery and post natal beds 180 kg

Hilrom delivery bed 227 kg

Bariatric gowns

Access to operating table 250 kg


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Appendix 2 - Hire of equipment for the heavy patient for MDGH staff If there is no items available within the trust, Hire of equipment must be arranged following discussion with the matron or senior nurse. Out of hours the on site managers should be contacted for advice. Ensure appropriate risk assessment is completed to assist in receiving the correct equipment. Nightingale Bariatric rental guide 24:7 hire 0800 879 9289 A range of bariatric profiling bedframes/mattress’s, Viking XL hoist, Gantry, Commodes and seating options Huntleigh Healthcare 24 hour no. 08457342000 No Delivery charges Items available; Delivery time’s upto 24 hours

product Safe Working Load Rental price

Enterprise 5000 bedframe

250 kg(39 stone) £9.50

Enterprise 8000 bedframe

250 kg(39 stone) £12.50

Enterprise 9000 250 kg(39 stone) £35.00

Contoura 1080 ( bariatric bed frame)

450 kg(71 stone)

£76.00 per day

Bariatric bedside chairs

254 kg(40 stone ) £20.00 per day

Bariatric commodes 254 kg(40 stone) £12.86 per day

Advice on appropriate pressure relieving mattress to be obtained via the tissue viability nurse. Mattress’s are available for rental from the bed company to fit the rental bed .

LIKO rentals 01453 827272 Delivery times within 24 hours

Liko Viking hoist XL and slings

300kg (47 stone) £250.00 per week, plus £80.00 delivery charge

Liko Gantry

400 kg(60 stone) £350 per week,plus £200 delivery charge

Hill-rom rentals 01530 411000 extension 2, delivery times upto 24 hours

Bariatric bed—Totalcare Bariatric plus with built in scales and low air loss mattress Birthright Bed

227 kg(36 stone) £130.00 per day


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1st call mobility Rentals 24 hour no. 01279 425648 Delivery times 4 hours Minimal rental period 7 days Delivery charges £80.00 Collection charges £80.00

Bedframes Baros acute bed with mattress

410 kg (65 stone)

£65.00 per day

Ultra-low bedframes

455kg (70 stone) 36”- 48” width

£65.00 per day

Gantry hoists

Upto 455 kg (78 stone) £50.00 per day

Rise and recliner chairs

Upto 455kg (70 stone) Upto £45.00 per day

Static chairs

Upto 385 kg(60 stone) Uptp £26.00 per day

Commodes

Upto 385 kg(60 stone) Upto £15.00 per day

Bariatric turning mattress

Upto 455 kg( 70 stone) Upto £65.00 per day

Wheelchairs Optional powerpack

Upto 455 kg( 70 stone) Upto £44.00 per day

Benmor medical Rentals 24 hour no.0333 800 9000, Delivery times 4 hours £80.00 delivery charge £80.00 collection charge Items available;

Bedframes Aurum expandable bed and air/foam

410 kg(65 stone) £65.00 per day

Scales and weigh service available

£160.00 ( free of charge if bed rented)

Treatment couch Upto 320 kg (50 stone)

Wheelchairs Optional power pack available

Upto 320 kg ( 50 stone) £26.00 per day

Rise and recliner chairs

Upto 320 kg ( 50 stone) Upto £36 per day

commode Upto 450 kg (70 stone) £10.00 per day

Gantry Hoist Upto 400kg ( 63 stone) £50 per day


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The Community service line use Choicequip for patient handling equipment, Choicequip will;

Process equipment orders received from community staff.

Ensure a service contract is in place for the maintenance and repair of all moving and handling equipment provided by them

Circulate medical device alerts to all line managers regarding equipment

Provide advice and information to community staff

Appendix 3 - Flow chart

#

On admission of the heavy patient, risk assessment to be completed,

From the Risk Assessment . Identify how the patient is to be moved, identify any manual handling equipment that is to be used, How many staff are needed to carry out the task,

Ensure the environment is suitable to accommodate the patient and any equipment that is identified for their care

See appendix 1, to see what equipment may be available

within the trust

If no equipment is available, hire of equipment must be arranged following discussion with the matron or senior nurse

For hire, see appendix 2 Ensure R/A is completed to assist in receiving the correct equipment

At any point please contact the manual handling team for further advice, please have the initial assessment completed. MDGH Telephone 3681 3973 Bleep 1339


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Bariatric Risk Assessment & Care Plan

Manual Handling INITIAL ASSESSMENT

Height Weight BMI Hip/waist ratio

Impaired sitting balance: Yes No

Communication:

Sight:

Hearing:

Comprehension:

Analgesia needed Yes No

Impaired standing balance: Yes No Catheter: Yes No

History of falls Yes No

I.V. Drains, etc:

RISK LEVEL

Unable to assist in any way, may be unconscious and/or is likely to behave

unpredictably. or

does the persons weight impact on mobility, available space, staffing levels or

necessitate specific bariatric equipment

HIGH

Able to co-operate and can move with assistance and/or requires the use of small

moving aids please summarise in the boxes below MEDIUM

Needs minimal assistance/supervision/guidance, please summarise in the boxes below LOW

MOVEMENT HANDLING

PROBLEMS

IDENTIFIED

Options available to

reduce the risk

ACTION – Equipment,

number of handlers, etc

General mobility

General mobility in bed

Lying to sitting in bed

Bed to chair transfers

Sit to stand / stand to sit

Chair to commode /

toilet transfers

Showering & bathing

Please affix

patient’s label

here


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General mobility out of

bed/walking

Date & time:

Print name:

Signature:

Other Risk factors;

Would any specific staff group be more at risk handling this service user?

Do the tasks require any special knowledge or skills?

Is there any follow up action required?

How many staff are required?

Do you need to refer to the manual handling team/Physio or O.T.?

Regular re-assessments

Re-assess the manual handling needs every week, or earlier if the patient’s condition alters, and record

any changes below as appropriate. If there is no change in the manual handling needs then date and sign

immediately below. If the patient’s needs change complete ASSESSMENT 2 or 3 at bottom.

Date Sign and print name Date Sign and print name

ASSESSMENT 2 – RISK

LEVEL

ASSESSMENT 3 – RISK

LEVEL

HIGH HIGH

MEDIUM MEDIUM

LOW LOW

HANDLING

PROBLEMS

IDENTIFIED

ACTION –

Equipment, number

of handlers, etc.

HANDLING

PROBLEMS

IDENTIFIED

ACTION –

Equipment, number

of handlers, etc.

Date, Name & Signature: Date, Name & Signature:

Bariatric Moving and Handling Assessment Equipment checklist,

This checklist is to ensure the service user has equipment with an adequate Safe Working Load

What equipment

is required?

If on site, name

the equipment

and note the Safe

working load

If to be ordered,

name the

equipment/company,

and name of senior

nurse contacted for

agreement

Any follow up

action, by

whom?

Date when

equipment is in

place and

signature

Bariatric/ profiling bed Mattress

Additional Comments / information:


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Overhead hoist/mobile

hoist

Slings Slide sheets Rise/recliner chair

Bedside chair

Commode/shower chair Other

Training needs: Please check that all staff members involved with this patient’s care are familiar with

the use of the above equipment and adequate instructions are on site and necessary training is

arranged.

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