Guidelines for safe handling practice

Nurses and other healthcare professionals are one of the highest groups for back injuries, causing many to give up their career prematurely. UNISON estimates that 3,600 nurses are forced to retire every year due to back injuries.
Patient moving and handling tasks are physically demanding and often performed under difficult conditions. Recruitment and retention of nurses is becoming a serious problem, and nursing shortages have been exacerbated by occupational injuries and related disabilities. Together with rising obesity rates, an ageing workforce and an increase in physical demand more pressure is being put on clinical staff increasing their risk of injury.

Legislation requires staff to avoid hazardous manual handling operations as far as reasonably practicable, and where this cannot be achieved they must take steps to reduce the risk to the lowest possible. The introduction of equipment following assessment can reduce staff injury.

A hoist is one of those items of equipment that may be required to move an immobile patient to lower the risk of injury. However, a hoist can be a deadly weapon if used incorrectly as the end result could be injury to patient/staff or both and in extreme cases the death of a patient.

Hoists and hoist slings
There are various types of hoists to choose from dependent on the patients’ needs. An active hoist is a piece of equipment used which requires the patient to be able to bear some weight through their feet for short periods of time. A passive hoist lifts the entire person’s body weight. Hoists can be categorised into three groups, overhead hoists, mobile hoists and fixed hoists. Fixed hoists are either fixed to the floor or wall mounted and are usually found in a bathroom or swimming pool.
A hoist sling and spreader bar must be compatible with the hoist chosen. The sling design is not universal and slings can be attached in various methods. There are clip type slings and loop attachments dependent on the spreader bar. The bar may be a coat hanger style or a wishbone shape.

A community nurse won £107,246 compensation from Surrey Primary Care Trust after injuring her back while trying to lift the leg of a 20 stone patient. The gentleman was so overweight he was unable to lift either foot on his own to have dressings applied. The nurse, aged 56, who was 5ft 4 inches and weighed 8 stone, had repeatedly complained to her manager about the difficulties treating this patient but had been ignored. The resulting injuries were so severe she had to give up her job. This could have been avoided if lifting equipment had been introduced.
On 24th July 1994 a nurse was awarded £205,000 for a back injury. The nurse and a colleague had been trying to help an elderly patient from a commode to a chair, when the patient’s legs gave way. Due to the lack of space the nurse was forced to twist her back to place the lady in the chair. This resulted in the nurse being forced to give up work as she was often confined to bed and regularly attended a pain clinic.
While the risk of injury to healthcare professionals is well known when moving patients. The obesity epidemic has exacerbated the problem.
There were 163 incidents in which people were injured while being moved in a hoist reported to the Health and Safety Executive (HSE) between April 2001 and December 2007.

Patient deaths
A BUPA care home in Leeds was fined £100,000 in January 2007 and ordered to pay £50,000 costs after the death of an elderly resident following a fall from a hoist while being moved. While the hoist was stationary one carer turned away to pick up the lady’s slippers and the second carer was behind the mast of the hoist. The lady fell forwards to the ground and suffered a head wound, resulting in her death a week later. The investigation found the sling loop fixings attached to the hoist were wrongly adjusted. Had it been correctly fitted this accident could have been avoided.
Two nursing home owners in Leicester were each ordered to pay £20,000 costs and fined a further £50,000 after a pensioner died following a fall from a hoist. The investigation found the hoist sling had a two-year lifespan but had been in use for nine years. The Health and Safety Executive (HSE) were told it had been an oversight as an outside contractor completed safety checks regularly but the hoist inspections had inadvertently been missed. The HSE found an unqualified member of staff had been completing maintenance checks at the home.
The Health and Safety Executive (HSE) investigate and prosecute establishments for the death of any individual which takes place at work. A number of establishments have been investigated and prosecuted over the years because a patient has died following an incident with a hoist.  

Ergonomic Assessment
When considering the use of a hoist an assessment should always be carried out to ensure the patient has the correct size sling and the hoist is appropriate for them. Staff using the equipment should be competent to use it. There is also a duty on the employer to ensure that staff who are not expected to regularly be involved in manual handling are made aware of the risks of doing so.
It is important the sling is compatible with the hoist selected and is correctly fitted. Manufacturers will provide guidance on assessing the correct size sling for individuals. Sling sizes vary between manufacturers, with no standardisation within the industry. Therefore it is important staff are taught how to measure the sling to ensure it fits correctly to avoid any accidents. The style of sling is also important to ensure the person is given the right amount of support required. The assessment should include factors such as: the task that is to be undertaken; the person’s sitting balance, trunk and head control; degree of leg support required; and skin condition and other vulnerabilities. Other considerations include the chair/bed the person is to be transferred into, the person’s position (recline/sitting) and unpredictable movements (related to restlessness, aggression, spasm, or lack of muscle tone).
It is also important to maintain the equipment and have it serviced every six months. This should include hoist slings as well as the hoist.

Staff attitude
Having taught manual handling for over 25 years I have often heard staff tell us they hardly ever use a hoist.  They feel this item of equipment should not have to be used by them during their annual updates as it is a waste of time. In response to this staff have been asked if they would get in a car and drive it without first having had a series of lessons. The response to this is usually ‘no’ however, when asked ‘why not’ they say ‘because a car is dangerous and someone could be hurt or killed.’ It could be argued that the same principle applies to using a hoist.
The benefit of using equipment to move patients is to maintain their safety. Patients are becoming larger and more immobile and the need to hoist is increasing. As the population is becoming larger hoists are used not only to hoist an individual, but also to hoist limbs during surgical procedures.

Legal obligation
Legislation is in place to protect staff at work. It is also there to ensure the safety of patients while they are being cared for in either hospitals or care homes. The employer’s duty at common law is to take reasonable care to safeguard all employees against the reasonable foreseeable possibility of harm arising from work-related disorders. Under the ‘Manual Handling Operations Regulations 1992 the employer must take steps to avoid the risk of injury to employees. Suitable and sufficient risk assessments must be carried out.
The Management of Health and Safety at Work Act 1974 requires the employer to provide information, instruction, training and supervision.
Training staff in the use of equipment as well as how to recognise defects that may affect the stability or safety of lifting equipment is part of a risk assessment (Manual Handling Operations Regulations 1992).
The HSE have published a short guide Getting to grips with hoisting people. In it, it says that practical training has an important role to play in ensuring that staff have the skills and confidence to hoist people safely.

Like any weapon competency when using the weapon decides the target. People who are trained to use the hoist correctly and understand the consequences of their actions are no longer a danger to their target.
Many Trusts have seen an increase in the number of bariatric patients that are being admitted. This increases the variety of equipment needed to ensure they are able to move them. This is not only for the safety of staff but also the safety, dignity and respect of patients.  
Ergonomics and working in partnership can make a difference to a patient’s dignity and reduce the risk of injury to staff. As the nation becomes larger more solutions are required to manage situations while maintaining dignity and safe systems of work. It is essential that staff receive training in good risk assessment to enable them to recognise the importance of hoisting safely and competently to prevent injury.

Despite unnecessary deaths and prosecutions by the HSE it appears that those responsible for providing care to those vulnerable patients requiring hoisting, senior management fail to understand the importance of knowledge, training and competence on the subject. This information should be targeted at Directors and senior managers as they are the people who should ensure their staff are properly equipped and equipment is fully and competently serviced.

Further information