By Carole Johnson, chartered physiotherapist and publications officer for the National Back Exchange
A great deal has changed in manual handling in the past 25 years. Gone are the days when care staff could and would lift anyone that needed it; equipment has moved on.
However, accidents still happen; residents are still injured; and there are still staff whose working lives are cut short. There is more work to be done.
Practitioners completing manual handling assessments and managers trying to develop safer manual handling strategies have to wade through more legislation, compliance and audit. It can be even harder to balance manual handling legislation with the Care Act (2014) and the Mental Capacity Act (2005). Consideration of all the options simply adds to the fear factor and the workload of many staff.
Picture this scenario
A resident wants to use an easy access sling (sometimes called a toileting sling). These slings have less fabric in the seat area to allow easier access to clothing after transfer (for example) from a wheelchair to a commode. This type of sling eliminates the need to transfer to a bed first to remove clothing, saving time and promoting dignity.
However, the resident needs to have good upper body strength to be able to use the sling as intended. The Manual Handling Adviser (MHA) believes that there is a risk of slipping through the sling and therefore insists the handling plan must be changed. The request adds to the time required for the transfer and the resident becomes distressed that they won’t reach the toilet in time.
How each person looks at risk in this scene is different: the resident wants to get to the toilet before it is too late, the staff want to ensure the resident’s comfort and safety in a timely manner; the MHA wants all of those things too, but is aware of the risk of physical injuries.
In the end, it all comes down to risk and how it is viewed.
Dealing with conflict
So, how does the MHA deal with the inherent conflicts in the resident’s situation?
The most important thing is not to make sweeping statements or demands or develop unbending policies. The best approach is to step back, take a breath and apply some clinical reasoning, mixed with the legal requirements, evidence-based practice, dialogue and some common sense.
Here are some points to consider:
- Has there been any history of the resident slipping? Is it a real or perceived risk?
- Is there evidence linking access slings with falls, and are the factors relevant in this case?
- Is there an alternative sling on the market that meets everyone’s wishes?
- Does the resident or staff have any other suggestions?
- Can you have a discussion on the options without an emotional overlay?
- Are there any assessment tools to help with the decision-making process?
There is no doubt that a full manual handling assessment should be completed before using any equipment, sling or technique, and it is important to refer to the manufacturers’ instructions and the advice of a MHA: considerations will include resident comfort, and staff effort and competency. Staff will need to be able to respond to any early warning that the technique is no longer adequate and this will demand ongoing monitoring and education: it is unlikely that any protocols arising out of the assessment will be static.
- The Health and Safety Executive guide: Getting to grips with hoisting. www.hse.gov.uk
- Backcare guide: The manual handling of people. www.backcare.org.uk
- National Back Exchange guidance: Moving and handling in the community and residential care and Handling the plus-size person. www.nationalbackexchange.org
For the full version of this feature and other manual handling advice and information, download the July/August edition of Care Home Management magazine