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SEPT - MANDATORY TRAINING MANUAL HANDLING Basic Back Care Theory Update Course SEPT - MANDATORY TRAINING Contents You can complete this course in more than one ... – PowerPoint PPT presentation

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Basic Back Care Theory Update Course
  • Contents
  • You can complete this course in more than one
    session and use the menu on the left of this page
    to navigate to the last page you viewed.
  • This course covers the following topics
  • Definitions
  • Health and Safety law as applied to manual
  • The risk assessment process in manual handling -
    a structured approach to minimising risk
  • An overview of the structure and function of the
  • Advice on how to keep your back safer when moving
    and handling
  • The unsafe ways of assisting clients.

Statistics 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. 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 including those people working in
construction and agriculture.
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. But because there are so many
different types of work being done in workplaces
across the UK, the Act sits on top of many
individual regulations each one directed at
different hazards within the workplace - for
example the Control of Substances Hazardous to
Health (COSHH) 2002 etc. The purpose of
legislation is to reduce risk exposure and target
risk factors in order to minimise the risk of
injury. Central to this course is the Manual
Handling Operations Regulation 1992. The other
regulations shown below are also relevent to
Manual Handling.
Law - Manual Handling Operations Regulation
1992 The regulation aims to eliminate or reduce
the risk of injury when moving and handling to
the lowest level reasonably practicable. The
steps that have to be taken are, in order Avoid.
(the need for manual handling if possible). For
example can we avoid the need to manual handle by
rearranging the task or using equipment? Assess.
All the manual handling tasks that cannot be
avoided must be properly assessed. Reduce.
Clearly it is not enough just to do a risk
assessment. Based on the assessment we must
ensure that the risk of injury is reduced for
staff and clients. How much does it need to be
reduced? It must be reduced so far as is
reasonably practicable (SFAIRP). Review. The
risk assessment must be written down in the
client moving and handling plan in sufficient
detail to make the system of work clearly
understandable. But change happens over time. The
environment may change, the client may change,
staff may change. Therefore the risk assessment
must be reviewed to reflect these changes. Not
only that, even if no changes happen the
assessment must still be periodically updated at
regular and scheduled intervals. This can be
summarised as follows.
What are our responsibilities as members of
staff? Once the risk assessment has been done 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
Risk Assessment - hazard and 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'
and 'that was risky'. In risk assessments
however they have distinct and different
meanings. 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. 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.
Risk Assessment - TILEE We often undertake risk
assessments in everyday life, for example driving
a car and crossing a road. These assessments are
of course informal, not structured and certainly
not written down! When completing a manual
handling risk assessment it is useful to have a
structured approach so that hazards are easier to
see and risks are easier to control. In manual
handling the risk assessment must consider the
hazards and risks in the following areas
  • Where
  • The Task is the purpose of the manual handling,
    i.e. what is being done. Examples of client
    manual handling tasks are - standing, sitting,
    walking, getting into bed, turning in bed and
    personal care.
  • The Individual is the member(s) of staff
    assisting the client to move.
  • The Load is the client who is being assisted to
  • The Environment - is the space in which the
    client is being moved.
  • The Equipment - is the available equipment.

  • Risk Assessment - The Task
  • Things (risk factors) to consider about the Task
  • How is the task currently performed?
  • What postures and movements are required?
  • How long does the task take?
  • Does it involve twisting, or bending?
  • Does it require you to reach upwards or forwards?
  • When and how often is it done?
  • Is there sufficient rest between this task and
    the next?
  • Does the task take a long time to complete and is
    there sufficient rest between tasks?
  • Risk assessment - The Individual (you and me!)
  • 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.
  • Things to consider about yourself
  • 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?
  • 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?
  • Have you read the client's moving and handling
    plan or are you undertaking the task with someone
    who is familiar with it?
  • 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?
  • Are you familiar with any equipment used in the
    workplace to assist the client?
  • If in doubt always seek advice.

  • Risk Assessment - The Client
  • Things to consider about the client - Clients are
    not like inanimate loads they may be
    unpredictable and move unexpectedly, they may be
    floppy or difficult to grasp. In addition
    clients, like everyone else, can and are likely
    to have changes in mood depending on many
  • 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
  • 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
  • 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.

  • Risk Assessment - The Working Environment
  • Things to consider in 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
  • Are there problems in the design of the
    environment? Are the doorways and corridors too
    narrow or is the shape of the environment
  • 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

Equipment Does the Task require specific
equipment, for example a height adjustable
profiling bed or slide sheets? Is the equipment
safe and is it maintained? Is everyone trained in
using the equipment and also does everyone know
how to use the equipment?
  • Moving and Handling Forms
  • The Individual Client Risk Assessment and Action
    Plan lays out in detail the risk assessment
    process (T.I.L.E.E.) and is completed when a more
    detailed structure is required to complete the
    client assessment. This would be in more complex
    situations where the method of transfer is not
    easily apparent.
  • If you are using a computer on the Trust intranet
    you can view the complete document here.
  • The Client Moving and Handling Plan is used to
    record the safe system of work resulting from the
    risk assessment. If you are using a computer on
    the Trust intranet you can view the form here.

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 at this link
Law - Human Rights Act 1998 Before leaving the
law it is important to note that 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.
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.
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.
Anatomy Given that back injuries are common and
most people will either have suffered from back
pain or know someone who has, are backs really
fragile and weak? Actually, far from it and a
fit and healthy spine used correctly is very
strong. Back injuries are so common because most
people do not use their back correctly. The next
page shows the correct way to use the back. When
looking at it please remember that we use our
backs just as much in everyday life as we do at
  • Safer Principles 1.
  • The key safer principles of manual handling are
  • Avoid. 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 think and plan the task before
    doing it for real. For example, before hoisting a
    client from a bed to a wheelchair is everybody
    able to spend the required time without hurrying
    and is all the equipment immediately to hand? 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.

  • Safer Principles 2.
  • 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.

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. These techniques are not to
be used without the express agreement of the
Manual Handling Advisor. The Drag Lift The
Orthox Lift The Bear Hug The Top and Tail The
Australian Lift
Hoisting Theory Course
Welcome to Hoisting Theory Please ensure that you
are in-date with your basic back care theory and
familiar with the concepts before continuing.
This hoisting theory course and the questions in
the quiz assume this knowledge. If necessary
please go back and complete that course now.
  • Basic Principles
  • Hoisting is a form of manual handling, i.e. it is
    the "transporting or supporting of a load ... by
    hand or by bodily force Manual Handling
    Operations Regulations (MHOR) 1992. Therefore all
    the theory covered in the basic back care course
    also applies to this hoisting course.
  • The theory in the Basic Back Care course
  • Definitions
  • Statistics
  • Law (including the need for all clients to have a
    manual handling risk assessment)
  • Anatomy and safer principles of moving and
  • The risk assessment process (Task - Individual -
    Load/Client - Environment - Equipment)

The Lifting Operations and Lifting Equipment
(LOLER) 1998 In addition to the regulations
within the Health and Safety at Work Act 1974
already covered in the Basic Back Care course,
LOLER specifically covers lifting equipment such
as cranes and patient hoists.
  • As with everything in the workplace, safety is
    important and this regulation gives a common
    sense approach to maximise safety when using
    patient hoists.
  • LOLER is concerned with ensuring safety when
    operating the hoist and requires that
  • people using the hoist are trained and competent.
    The transfer is performed safely i.e. planned and
    organised (risk assessed and with a completed
    moving and plan).
  • the equipment is strong and stable enough (marked
    with the safe working load, SWL).
  • positioned and installed to minimise risk.
  • is subject to regular (pre-use) checks.
  • inspected and serviced by competent people.

Although hoists and slings must be marked with
the Safe Working Load (SWL) this information is
not much help unless we also know the client's
Hoists and slings in our Trust are inspected by
outside engineers every 6 months and are normally
serviced at the same time.
Pre-use check for the hoist
Before using a hoist make sure that 1. The
hoist has a service label and is within the 6
monthly service date. The label will show the
date of the last service and the date the next
service is due.
2. You know the safe working load (SWL) of the
hoist and this should be marked on the hoist. You
should also know the weight of the client,
especially if they may approach the SWL of the
hoist (or sling).
You should also be familiar with the emergency
controls (emergency lower and the emergency stop)
and how to use them.
  • Also ensure that
  • the battery is charged (electric hoist)? It is
    all too easy to forget to leave the hoist on
    charge when not in use with the result that the
    hoist might stop working during a hoist. This
    risk can be reduced by ward based systems and
    also by having a second battery on charge.
  • the brakes work
  • the wheel turn freely
  • the hoist works (the hoist lifts/lowers and the
    base opens and closes).
  • that all necessary attachments are in place
  • the hoist is clean and hygienic
  • there is no obvious damage - bare wires, damage
    to sockets.
  • when using a liko golvo hoist check whether the
    belt is frayed or twisted and also whether the
    spreader bar is fitted with a padded jacket.

  • Pre-use check for the sling
  • Before using a sling the following checks must be
    made to ensure the sling is suitable and safe.
  • Is the sling clean and hygenic?
  • Is it the correct sling for the client, the hoist
    and the type of transfer?
  • Is the stitching showing signs of wear ? This
    usually happens where the loops attach to the
    body of the sling
  • Can you read the label? The ink is designed to
    fade over time with repeated washing and
    indicates the sling must be condemned as the
    fabric may have become weak.
  • Do you know the SWL of the sling as well as the
  • Is the fabric wrinkled? This usually indicates
    heat damage. The sling has been washed or tumbled
    dried at too high a temperature and must be
  • Disposable slings should be condemned and
    disposed of if they become wet. They should never
    be washed or cleaned.

1. Basic Back Care This Basic Back Care (BBC)
Theory Update course is for clinical staff who
have previously completed a whole day induction
in BBC. It must be completed before attending any
practical session or having practical techniques
assessed on the ward. To complete the annual
update in BBC, both theory and practical must be
completed. 2. Hoisting This hoisting update
course is for staff who have previously completed
a half day induction in hoisting. The course
assumes knowledge of BBC and therefore you must
have completed and be in date with BBC theory
before taking the hoisting course. Some questions
in the hoisting quiz assume this prior knowledge
of BBC. This hoist theory course must be
completed before attending any practical session
or having practical techniques assessed on the
ward. To complete the annual update in hoisting,
both theory and practical must be completed.