The future of good patient handling

TrainingIn 1981 the National Back Pain Association (now known as Back Care), published the First Edition of The Guide to the Handling of Patients. This publication outlined what was then regarded as best practice for nurses and carers involved in assisting patients to move. This initial guide book has since been regarded as the foundation stone upon which subsequent publications have been based; current back care advisors and patient handling practitioners now eagerly await the publication of the Sixth Edition. The Guide to the Handling of People (HoP), is generally regarded as the Industry Standard, and forms the basis upon which professional healthcare practitioners work.

A decade later when the Manual Handling Operations Regulations 1992 (MHOR), were adopted under European health and safety law, it further supported patient handling practitioners in their quest to improve handling techniques and encouraged healthcare workers to make better use of the ever increasing range of equipment becoming available on the market.

Together with the Health & Safety at Work etc. Act 1974, the MHOR (92), placed additional specific responsibilities on employers to undertake moving and handling Risk Assessments, highlighting appropriate control measures that would reduce any identified risk of injury down to the lowest levels reasonably practicable. Historically, the employer’s duty to provide appropriate training has always formed part of this risk reduction strategy and to date remains a requirement under the 1974 Act, in so far as he is required to provide Information, Training, Supervision and Instructions.

It goes without saying that failure to comply with statutory health and safety requirements will inevitably lead to an increase in accidents, injury, sickness absence, damage to corporate image and the likelihood of hefty legal costs. A legal case may be found for the claimant if they are able to demonstrate that:
• they were owed a particular duty of care
• the duty of care was breached
• the breach resulted in injury or harm
Clearly, where patient handling is concerned, employers have a duty of care to protect employees and patients from harm; failure to adopt adequate risk reduction strategies resulting in injury encourages claims for compensation and may constitute a criminal offence.
However, it is often personal costs that tend to go unappreciated. Research and anecdotal evidence has shown that patients are often injured or frightened by inappropriate use of handling techniques and/or equipment, for example toileting slings and standing hoists being used for patients with low muscle tone or limited cognitive ability.

The Nursing and Midwifery Council (NMC) has a professional code which all Nurses and Midwives are required to abide by. It states: “The people in your care must be able to trust you with their health and well being. To justify that trust, you must....provide a high standard of practice and care at all times.”

Standards of practice observed by non-registered carers should not fall below these expectations.

In 2001 the Department of Health (DoH), set National Minimum Standards for care; Standard 18 requires all those in receipt of care to be protected from abuse, including poor handling practices that may result in injury, harm or loss of dignity and choices. One such handling technique, the ‘Drag Lift’, (conducted by placing the carers arm underneath the patient’s axilla and dragging them into the required position) has been shown to tear soft tissue and is capable of causing joint dislocation for the patient. However, evidence suggests this technique is still widely popular as it does achieve the desired outcome, does not require any equipment and therefore is often considered quick and inexpensive to implement. But at what cost to the patient? Not to mention the long term effects upon the carers who often take the full weight of the patient through their musculoskeletal system?

From HoP 1 to HoP 5
Since the Guide to the Handling of People was first published nearly three decades ago, safe patient handling techniques and equipment has developed dramatically. In 2010 the emphasis lies very much in promoting patient choice and inclusion with a fantastic range of equipment options to choose from. Much research has been conducted resulting in a more informed assessment of risk when undertaking patient handling activities and the identification of techniques which no longer pose a threat of injury to patient and carer.

Many patient handling speciality sub sections now exist, such as handling in operating departments, handling the bariatric patient, and safe handling practices in midwifery, radiography and paediatrics to name a few.
Today most care organisations of any size will have access to one or more back care advisor, employed to effectively manage risk and reduce the possibilities of harm and injury. For organisations that do not employ their own advisor, a range of external options exist. Universities across the UK now run several formal programmes of study aimed at improving patient handling for care practitioners and for those who do not wish to study the subject in such depth, several independent organisations run four or five day courses for managers and supervisors.

It is, however, worth noting that unlike First Aid training, patient handling training remains unregulated: anyone regardless of occupational background, education or skill is able to advertise as a patient handling advisor/trainer. These “practitioners” often charge their services well below their professionally qualified and experienced counterparts and hence are an attractive option for any commissioner.

The National Back Exchange, an organisation with a membership made up of committed, professional back care practitioners and patient handling equipment manufacturers has recently released a publication entitled ‘Standards in Manual Handling’, Third Edition (2010), which outlines the recommended standards which should be adopted in order to meet with legal compliance and promote standards regarded by the membership as evidence based current best practice.

Options for training
Patient handling is by definition a practical skill that should be performed to the best standards possible by staff in possession of the appropriate underpinning knowledge and the practical hands-on abilities to work in accordance with the standards recommended by expert practitioners. However, good practice also depends upon effective management systems being in place to support these standards. Staff who have undertaken extensive training will have great difficulty putting their knowledge and skills into practice without adequate management support. It is imperative for a holistic ergonomic approach to be adopted within in any care organisation regardless of size or speciality.

There appears to be an increasing move towards DVD, e-learning and computer based systems when it comes to staff training. However, like driving a car, the practitioner is engaging in a high risk practical activity capable of the most disastrous consequences should any degree of failure occur – would we be happy to let someone have the keys to a vehicle if their training programme was delivered by watching a DVD or via a computer based system? Research has identified some programmes that allow the participant to gain a certificate of completion (not competency), although all questions answered at the end of the so called course were incorrect.

When commissioning the delivery of patient handling knowledge and skills for care, healthcare staff and managers must be vigilant when it comes to the standards of delivery they are purchasing. Employers may choose to engage a competent practitioner as an advisor/trainer, but will then need to ensure the practitioner is able to keep abreast of current trends and practices in safe patient handling techniques and equipment. Alternatively, outside agencies may be commissioned to undertake risk assessments and/or programmes of training. This clearly places a professional responsibility upon the agency to ensure their knowledge and skills are up to date. The Standards in Manual Handling Third Edition, (2010), is an invaluable guide in determining what to look for when engaging a practitioner. Poorly supported, educated and skilled staff can result in disastrous consequences.

Thought for the day – What at first can appear to be an expensive option often turns out to be the most cost effective one in the long run!

Legal requirements in the UK and Codes of Professional Practice for all healthcare workers are the driving force behind safe patient handling and as such cannot be ignored or compromised. Compliance failure could result in significant losses to corporate image, a down grade or loss in registration by the Care Quality Commission, expensive legal costs fines, and removal from a professional register for registered healthcare practitioners.

Every patient has the right to expect care based upon current best practices, delivered with a high standard of respect and consideration. This can only be achieved by staff who are well informed and skilled in the delivery of patient handling practical techniques and the use of appropriate equipment to meet the agreed outcomes for that individual patient.

Identifying suitable and sufficient safe systems of work and the underpinning risk reduction strategies is of paramount importance in ensuring legal compliance reflecting high standards of care.

About the author
Paul Titcomb P.G.C.E., M.S.F., M.A.B.Phys., M.InstL.M., NBE(RM) is managing director of ARC Learning, a consultancy and health and safety training company.

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