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Health and Safety in Elderly Care - Methods of Moving and Handling in Health Care Practice

Updated on May 1, 2011
By Integracp (Own work) [CC-BY-SA-3.0 or http://www.gnu.org/copyleft/fdl.html" GFDL],  a hre http://commons.wikimedia.org/wiki/File:User-Integra-lifter1.jpg
By Integracp (Own work) [CC-BY-SA-3.0 or http://www.gnu.org/copyleft/fdl.html" GFDL], a hre http://commons.wikimedia.org/wiki/File:User-Integra-lifter1.jpg

The significance of moving and handling activities in care homes

The critical nature of moving people with disabilities in care homes and other health care facilities is classified as a high risk activity for both the health care provider and the patient. As such, the health care industry have rules set forth for the safe handling of patients which aims to reduce the risk of injury and accidents and to as much as possibly ensure safe lifting, transferring and repositioning of patients.

Health care providers are required to strictly adhere to the imposed rules and guidelines in health care facilities which sets out specific methods and procedures of safe handling of disabled patients requiring assistance in their daily life activities, especially patients in nursing homes or elderly care facilities requiring assisted living support.

Responsibility of health care institutions

Proper provision of care to promote health and safety when doing patient handling involves correct procedure of transporting and supporting patients in hospitals and care homes. Employers and employees of health care institutions are responsible for the effective implementation of these health and safety work regulations which includes risk assessment in the context of patient handling when undertaking such hazardous workplace activities.

The patient handling legislation also requires the use of suitable mechanical lifting aids when manual lifting is not possible, and to undertake regular inspection of lifting equipment so that such equipment are maintained in good condition at all times. The regulation also includes the provision to health care staff of regular safety training and supervision to ensure their competence in manual moving and handling of patients and the proper usage of lifting equipment is maintained.

It is important to understand that almost all health care errors are directly associated with the implemented system in care homes and in any health care facility, and not as a circumstance of human carelessness or misbehavior.

Since every caregiver's workplace activities is administered by an implemented system of work procedure established within an organizational framework, then improving this system to provide better care services is the key to reducing health care related errors.

Assessment of risk involved

There are many factors to consider when carrying out the patient handling activity. An assessment of the risk involved must firstly be undertaken before initiating the moving of the patient. It is best to avoid patient handling as much as possible considering the inherent risk on the safety of the patient. Evaluating the condition of the patient is the first priority in order to determine if the situation at hand necessitates for transferring or repositioning of the patient. 

When moving of the patient is necessary, patient behavior and health condition must be considered such as signs of pain or fear and anxiety, their ability to understand and follow instructions, their physical size and weight, taking into account that one health care worker will not have sufficient physical strength to lift heavy patients or patients who are immobile.

Additionally, the patient handling skills including the caregiver's physical and health condition which can directly affect their ability to perform the task should also be considered. Furthermore, before proceeding to perform the lifting and moving activity, ensure that there is enough space to move around and that the pathway for the transfer is free from any obstruction.

The main objective of conducting prior assessment is to reduce the risk of injury and accidents inherent in patient handling activity. The risk assessment log should be kept on file for future reference and review in order to monitor the worsening or progression of the patients health condition such as weight and mobility which will help determine for the best suitable approach appropriate for the moving and handling activity applicable to the patient's existing condition, this concerns both the use of either manual handling or when requiring the use of mechanical lifting equipment.

Manual Handling

Only one health care worker would usually be sufficient enough when doing manual lifting of patients who are able to walk with assistance. For patients who are immobile or heavily dependent it is advisable to practice safe handling by always enlisting the help of another health care worker in order to distribute the weight of the patient between two or more workers, this way health care workers can prevent the occurrence of patient falls while minimizing the potential risk of causing accidents and injury to both the caregiver and the patient.

Remember also to always place a gait belt fastened around the patient's waist at all times when doing manual handling. And if possible, always allow the patient to participate in the moving activity.

Examples of assisting abled patients who are capable of moving:

Typical support transfer of abled patients from sitting to standing by one health care worker.

Assistive walking maneuver of abled patient by providing support at the waist or hip.

Assistive Support Maneuver for Patients requiring more help

...from sitting position

...to standing position

Lifting with Assistive Device

Impossible situations that prevents the use of manual handling necessitates for the use of suitable mechanical lifting equipment. Although it takes longer time to prepare than manual handling and requiring more effort to effectively implement, patient transfer using lift mechanism is proven as a much safer preference compared to manual handling which is prone to human errors that has the tendency for careless caregivers to drag the patient rather than applying gentle maneuver in doing the task.

While one caregiver can manage the hoisting of patients using lifting devices, it is strongly advised in most care settings that two health care workers should be present at all times when lifting patients using assistive device in order to handle the task efficiently.

Some important points must be considered when hoisting the patient using lifting devices. Ensure the use of appropriate type and size of sling for each particular patient since not all patients have the same body structure and weight, and slings have different types of purpose and applications too, there are slings for toileting, slings for bathing, slings for amputees, and shoulder slings, but the most commonly used is the general purpose sling.

Health care workers assigned to operate lifting equipment should have the appropriate training and knowledge to be competent enough to do the patient transfer using the hoist, they should be able to differentiate which type of hoist and slings to use for each particular type of application, this includes awareness on the weight capacity of the hoist with respect to the load about to be carried, and to also have the ability to determine the correct sling compatible with the hoist. Care staff should also ensure that the patient is securely strapped to prevent falls.

Two of the most typical types of lifting equipment used are as follows:

Shown above is an illustration of a General Purpose Hoist

Above is an illustration of a Standing Hoist

General Purpose Hoist with General Purpose Sling

This demonstrates a wrong selection of sling. The small size of the sling is not providing support to the head and neck of the patient. The undersized sling is too constricted for the patient, the limited space is preventing a comfortable positioning for the shoulder and thighs.

This is another example showing improper selection of sling. This oversize sling causes intense strain due to the incorrect positioning of the thighs and knees of the patient, this position have the potential tendency for the patient to slip through the sling and fall.

This is an example of a correct selection of a general purpose sling carrying a patient who is comfortably rested with proper support. Notice the way the correct selection of appropriate size sling covers the head and back of the patient, this is ideally the most suitable position that protects the patient's head, neck, shoulders and back. With the patient facing away from the hoist's mechanical structure, the tendency to knock their knees, legs and feet is avoided.

General Purpose Hoist with Toileting Sling

The patient is certainly in a very uncomfortable position with this type of toileting sling emplacement. As seen here, the patient is already slipping through the toileting sling. Head, neck, shoulder and back support is not achieved, placing the patient's weight concentrated under the arms and legs.

This demonstrates a correct positioning of the patient on a toileting sling, providing sufficient support to the patient's head, neck, shoulder and back.

Standing Hoist with Shoulder Sling

This is an incorrect application of the shoulder sling. The patient appears to be hanging by the sling around his armpit, making his weight focused on the sling under his arms, where extreme pressure can cause injury to his arms and shoulder. There is also a potential risk of slipping through the sling.

This is a correct application of the shoulder sling. The patient is positioned in a slightly upright position with back fully supported by the sling and the knees and feet properly rested.

I, the copyright holder of this work, hereby publish it under the following license:

Health and Safety in Elderly Care - Methods of Moving and Handling in Health Care Practice by ianjonas is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

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    • ianjonas profile imageAUTHOR

      ianjonas 

      7 years ago

      Thanks nickshamrock, I appreciate your comment.

    • nickshamrock profile image

      nickshamrock 

      7 years ago

      Good read for anyone looking to start a career in nursing or health care. The number 1 reason I see people in the ER is FALLS. And trust me, old people fall A LOT.

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