How to find your way around …

1. How to find your way around … You can play the PowerPoint and the Test here. Example Course START FINISH

2. How to find your way around … Always click the ‘home’ icon to save your progress and log off. This is important! Example Course START FINISH

3. Basic Back Care Theory For all staff undertaking patient handling as part of their job role. START FINISH

4. Course Objectives On completion of the Basic Back Care Theory course you will understand the: • The definition of a Risk & Hazard • The Health and Safety law that applies to manual handling • The risk assessment process in manual handling • An overview of the structure and function of the spine • Best practise on how to look after your back • Highlight unsafe procedures when assisting clients START FINISH

5. Manual Handling Injuries are common across the care sector Manual handling injuries account for approximately 30% of all general workplace reported injuries and almost 50% of reported injuries by care workers who assist clients to move. manual handling all other causes However, these only represent the tip of a very large pyramid. For each injury reported it is estimated that there are 10 additional injuries that are not reported and approximately 200 near misses. Remember that moving and handling people presents the highest risk of injury, far higher than any other group of workers. START FINISH

6. What does the law say we must do about the risk of harm associated with manual handling? This is covered by the Health and Safety at Work Act 1974 which aims to make the workplace as safe as reasonably possible for staff and anyone affected by their work and puts requirements on employers and employees. Central to this course is the Manual Handling Operations Regulation 1992 with other regulations that are also relevant. Health and Safety at Work Act 1974 Manual Handling Operations Regulation 1992 The Management of Health & Safety at Work Regulation 1999 Provision & Use of Work Equipment Regulation 1998 START FINISH

7. Manual Handling Operations Regulation 1992 Where there is a risk of injury in manual handling the regulation requires: Avoid the need for manual handling if possible for example by rearranging the task or using equipment? Assess all the manual handling tasks that cannot be avoided. Reduce the risk of injury to the lowest level reasonably practicable (SFAIRP). Review the risk assessment and the safe system of work. This is done if anything changes to affect the level of risk and also at regular and scheduled intervals. This can be summarised as follows. START FINISH

8. Law -Manual Handling Operations Regulation 1992 Manual Handling Operations Regulation 1992 Avoid if possible Assess the risk of injury Reduce the risk of injury to the lowest level reasonable practicable Review the assessment START FINISH

9. What are our responsibilities as members of staff? We need to follow the safe system of work as laid down in the moving and handling plan. If any changes occur that make the moving and handling plan no longer current and applicable, this must be reported immediately to the responsible person. We must therefore consider this each time we undertake the task. START FINISH

10. Risk assessment – the different between a hazard and a risk Central to understanding the risk assessment process is the difference between a hazard and a risk. In everyday language these terms are used to express the same thing. For example, 'that was hazardous' or 'that was risky'. In risk assessments however they have distinct and different meanings. A Risk - is the chance or probability of harm occurring from a hazard and takes into account the likely seriousness of the injury or incident should it occur. identical trip hazard such as a box is a higher risk on stairs than it is in the corner of a seldom used store room. A Hazard – is anything that has the potential to cause harm. Trailing leads, confined spaces, water on the floor are all examples of a hazard. START FINISH

11. Question If something has the potential to cause harm, it is labelled as a... RISK HAZARD Continue START FINISH

12. The Risk Assessment Process in Manual Handling - TILEE Manual Handling Operations Regulation 1992 T ASK E QUIPMENT I NDIVIDUAL L OAD (CLIENT) E NVIRONMENT START FINISH

13. Risk Assessment – The Task Risk factors to consider about the Task Does the task take a long time to complete and is there sufficient rest between tasks? How is the task currently performed? Is there sufficient rest between this task and the next? Does it involve twisting, or bending? Does it require you to reach upwards or forwards? How long does the task take? What postures and movements are required? When and how often is it done? START FINISH

14. Risk Assessment – The Individual (you & me) Things to consider about yourself How well do you know the client and do you know how they might react to a given situation.? Do you know them well enough to maximise their level of cooperation? Have you read the client's moving and handling plan or are you undertaking the task with someone who is familiar with it? Are you pregnant and does the pregnancy mean that this particular manual handling task is an excessive risk? Are you trained and even with training are you confident that you have the knowledge to undertake this particular task? Just because most people can undertake a task safely does not mean that everyone can do so. You must consider whether it is safe for you to do the task. Are you fit enough to do the task or do you have an injury or a medical condition that might put you at excessive risk of injury or prevent you from applying best practice techniques? If in doubt always seek advice. Are you familiar with any equipment used in the workplace to assist the client?

15. Risk Assessment – The Client • The following list is not meant to be exhaustive but includes some factors relating to clients that need to be taken into account during a risk assessment: • apprehension or fear of being moved • degree of cooperation • ability to understand and communicate • behaviour • sensory impairment • pain • tissue viability • medication • weight • type of clothing • For example: • Clothing - tightly fitted non-elastic clothing will increase the risk when assisting a client with dressing. Different clothes or making adaptations such as Velcro seams can reduce the effort and risks and is appropriate for some clients based on the assessment. • Pain - pain relief and manual handling should be coordinated. • Ability to understand and communicate - communication with clients should • always be specific to that individual and be at appropriate level in terms of content, • speed, pitch etc. START FINISH

16. Risk Assessment – The Environment • Is there enough space for the task? Is there enough space for the client, for you and your colleagues and all the equipment you may need to use? • Are there problems in the design of the environment? Are the doorways and corridors too narrow or is the shape of the environment awkward? • Is there anything on the floor that you or your client might slip or trip on? Slide sheets are particularly high risk slip hazards. • Is it too hot or too cold which might impair your grip or cause fatigue? • Is your environment very busy, noisy or distracting? • Does the Task require specific equipment, for example a height adjustable profiling bed or slide sheets? • Is the equipment safe and is it maintained with all attachments? • Is everyone trained and competent in using the equipment. Risk Assessment – The Equipment START FINISH

17. Work equipment requirements are stated in the: • Provision and Use of Work Equipment Regulation (PUWER) 1998 • Equipment is often used to assist clients to move and these must be fit for purpose. • What work equipment is covered? • Generally any equipment which is used at work, for example; beds, patient hoists, slide sheets and rota stands. • What are the requirements? • it must be suitable for the intended purpose • it must be safe for use and maintained in a safe condition • it must be used by people who have received adequate training and instruction to use it safely • - it must be fitted with adequate guards and warning signs where appropriate. • A simple guide to PUWER 1998 can be found on the Health and Safety Executive website START FINISH

18. Moving and Handling Forms • Policies and Procedures/Risk Management • Appendix 2 is a guide to completing the risk assessment and handling plan for LOADS and CLIENTS • Appendix 3 is the LOAD handling risk assessment • Appendix 4 is the CLIENT handling risk assessment START FINISH

19. Law – Human Rights Act 1998 On a final but important note regarding law, clients also have rights including those laid down in the Human Rights Act 1998 which is based on the European Convention on Human Rights. The relevant articles of the Convention are: Article 2 - The right to life Article 3 - Inhuman treatment. No one shall be subjected to torture or to inhuman or degrading treatment or punishment. Article 8 - The right to privacy. Everyone has the right for his private and family life, his home and his correspondence. Good and effective communication with the involvement of the client and where appropriate relatives and advocates is all important. START FINISH

20. Anatomy The human spine consists of 32 individual bones (vertebrae) that are stacked one on top of another to form a flexible column. Viewed from the side the spine has a series of curves which act like a spring to protect our heads from the forces generated by walking and jumping. What are the different structures that form the spine? (Intervertebral) disc - Are flat, round discs that act as shock absorbers and physical spacers to separate the vertebrae to allow room for the spinal nerves to exit the spine. The discs also allow the spine to be as flexible as it is. The facet joints are paired joints at the back of the spine which direct and limit the range of movement between vertebrae. The Vertebrae (individual spinal bones) START FINISH

21. Anatomy Ligaments - are tough bands of tissue that surround the facet joints and also pass between the bodies of the vertebrae. Ligaments help limit movement and they hold everything together Spinal Muscles - like all muscles these provide the power to move bones, in this case the vertebrae. These muscles are small, delicate and weak (when compared with the large leg muscles) and form a network that runs the length of the spine. For example, any individual muscle may span one, two, three or more vertebrae which allows very fine control over the spine. These muscles are not designed for powerful work, such as bending the back to lift loads. Tendons - are non contractile bands that join the muscles to the bone. These are needed because they take up less space on the bone. The best place to see tendons is the wrist where they pass from the forearm muscles to the fingers. The spine is a remarkably strong and flexible structure but only when used correctly START FINISH

22. Question How many vertebrae make up the human spine? 32 34 36 Continue START FINISH

23. Advice on moving and handling more safely When moving or handling any load, object or person Avoid the need to do the task if it is practicable to do so. Think. If it is not practicable to avoid then where necessary plan the task before doing it for real. For example, before hoisting a client from a bed to a wheelchair is all the equipment available? Is the bed at the correct height and can both sides of the bed be accessed? Spine-in-line. Once you are ready to begin manual handling you should keep your back as straight as possible. This is called 'spine-in-line. It simply means avoid twisting your back or bending forwards, backwards or to the side. Stable and mobile base. The feet should be placed shoulder width apart with one foot in front of the other and the knees and hips slightly bent. By using the hips and knees the need to bend the spine is reduced. Load close. The load should be kept as close to the body as possible although when assisting a client this can be problematic as clients can sometimes be unpredictable in behaviour. START FINISH

24. Advice on moving and handling more safely • In addition to the Key Safer Principles you should always try to: • Move smoothly rather than jerk • Report any concerns that you may have, for example if something within the environment prevents you from adopting these principles when moving and handling. • Finally, consider how a small child would pick up a toy from the floor. • A child lifts with a straight back and using the hips and knees to bend because of his lack of balance and back muscle strength but this is the way that we are 'designed' to lift. The way that most adults move, lift and handle loads and objects is essentially a learned bad habit.

25. Controversial Techniques A number of techniques used to be used to move and handle clients but since the Manual Handling Regulation 1992 and the need to reduce the risk of injury they are now considered unsafe and not to be used. The Orthodox Lift The Top and Tail The Drag Lift The Australian Lift The Bear Hug Attempting to catch a falling client (unless in contact at the time of falling and when the member of staff is able to following the advice on safer handling and the client is not taller or heavier than the member of staff) These techniques carry a high chance of injury to staff and to clients START FINISH

26. Controversial Techniques • The drag lift • Is the most common of the controversial handling techniques in the care sector as a whole. It is an attempt to move the client by application of force under the arms/armpits. Examples include dragging a client • Into standing • Whilst walking • Into a sitting position in bed • Up the bed whist the client is sitting • The drag lift can result in harm to the member of staff and to the client who may sustain gradual damage to the shoulders or a sudden traumatic injury such as a dislocated shoulder. • Beyond the Trust such injuries are likely to be of interest to numerous bodies including the Crown Prosecution Service. START FINISH

27. Summary Recommended Loads

28. Remember, if you want to find more information / evidence about this subject or anything else which is relevant to your work or study, join your local healthcare library. For staff in Essex contact Basildon Healthcare Library. www.btuheks.nhs.uk library@btuh.nhs.uk 01268 524900 EX3594 It may be that you work in a different area, for example Luton. Details of all the Health Libraries in the East of England can be found at this site… You are welcome to join any of these. www.eel.nhs.uk START FINISH

29. Review of Objective(s) Before completing the test, please ensure you have acquired the relevant knowledge against the modules objective(s) below: “On completion of the Basic Back Care Theory course you will understand the: • The definition of a Risk & Hazard • The Health and Safety law that applies to manual handling • The risk assessment process in manual handling • An overview of the structure and function of the spine • Best practise on how to look after your back • Highlight unsafe procedures when assisting clients” If not, please take this opportunity to revisit the presentation content. CONTINUE START FINISH

30. You now need to take the test! Remember to click the ‘home’ icon when you have finished the test to save your results! Example Course START FINISH