Transferring People Safely - Web
Transferring People Safely - Web
Transferring People Safely - Web
CONTENTS
Tool 1:
The patient risk assessment worksheet.. . . . . . . . . . . . . . . . . . . . . 4
Tool 2:
The patient transfer guide.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Tool 3:
Patient and resident records.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Tool 4:
Task descriptions and class risk assessments.. . . . . . . . . . . . . . 16
Further information.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
The information presented in Transferring people safely is intended for general use only. It should not be viewed as a denitive guide to the law and should be read in conjunction with the Occupational Health and Safety Act 2004 (OHS Act) and the Occupational Health and Safety Regulations 2007 (OHS Regulations). While every effort has been made to ensure the accuracy and completeness of the guide, the advice contained may not apply in every circumstance. Accordingly, the Victorian WorkCover Authority cannot be held responsible and extends no warranties to the suitability of the information for any particular purpose and actions taken by third parties as a result of information contained in Transferring people safely. Copyright 2009
Injuries in health, aged care, rehabilitation and disability services due to the handling of people remain a major occupational health and safety (OHS) issue in Victoria, despite more than 30 years of research in Australia and overseas. For workers, this can mean personal pain and discomfort which sometimes lasts for years, affecting not only their work but their everyday lives, families and relationships. For employers, this type of workplace injury may lead to WorkSafe claims and increased premiums and other costs and may affect morale.
iNJUrY STaTiSTiCS iN THE viCTOriaN HEaLTH iNDUSTrY Hospitals and nursing homes percentage MSD Back injuries Manual handling related 71% 31% 59% All industries (Victoria) percentage 55% 21% 44%
This guide has been produced specifically for Victorian employers to assist in reducing the incidence and severity of injuries to their staff resulting from manual handling risks when transferring people. This guide complements the publication, A guide to designing workplaces for safer handling of people. In the guide the terms people or patients have been used to include patients, residents and clients. The guide offers the following practical tools:
repetitive or sustained application of force repetitive or sustained awkward posture repetitive or sustained movement application of high force exposure to sustained vibration
* Occupational Health and Safety (Manual Handling) Regulations 2007, regulation 1.1.5 Source: WorkSafe Victoria claims statistics 2005-06, 2006-07 and 2007-08, including public and private hospitals, nursing and convalesence homes.
3. Reaching
RiSk FaCTOrS 1. Patient behavioural or cognitive variables 2. Patient physical variables or constraints 3. Clinical constraints or contraindications 4. Poor environment design
5. Inappropriate furniture and fittings 6. Inadequate or insufficient patient handling aids 7. Staffing factors
Management representative:
The high risk (red) methods described on the guide, for example: top and tail lift, cradle lift, hook arm lift are not recommended practice. They are included to make it clear they are dangerous. An employer who allows high risk practices to be used is likely to be in breach of Occupational Health and Safety legislation.
THE GUiDE CaN BE USED TO: quickly identify current work practices assess the risk associated with each practice choose the safest way of performing each task determine and record the method to be used with each patient at different occasions and times using the blank spaces provided.
Every situation is different. For example, the methods of transfer and handling are likely to change frequently within an acute care setting. However, they may remain comparatively constant over long periods in extended care. If the conditions described in this guide are different in your workplace, and the difference increases risk of injury or if the task is carried out differently to the method described, you should conduct a new, separate risk assessment.
PaTiENT TraNSfEr SUMMARY TABLE (refer to pages 18-29 for further details)
This is a guide to help managers and staff reduce risks associated with patient transfers, as required by the OHS Regulations and Victorian Manual Handling Code of Practice (2000) and is consistent with the Australian Nursing Federation (Victorian Branch) No Lifting Policy 2006. Methods in green are preferred. Techniques in red are included only to emphasis how dangerous they are - they should be eliminated from all workplaces as soon as practicable. For each patient, choose the lowest risk transfers possible (ie furthest to the left). Write the date and method (A, B, C etc) when changing a method. Afx patient ID label onto back of this page, if required.
TraNSfEr
DaTE
TraNSfEr CODE HiGH riSk: vErY LikELY TO CaUSE iNJUrY - NOT rECOmmENDED praCTiCE
Overhead bar
ABLE TO ASSIST
2 Manually operated or wind-up backrest with bed rope or monkey bar ABLE TO ASSIST E Roll with a turning frame ABLE TO ASSIST D Manual log roll E
Sit up/lie down A Roll using patient's body mechanics A B ABLE TO ASSIST B
Roll
ON BED
Roll
Off BED
ABLE TO ASSIST
Slide sheets
Turn/reposition in bed
Bed stick
ABLE TO ASSIST
ABLE TO ASSISTA
ABLE TO ASSISTA
ABLE TO ASSISTA
ABLE TO ASSISTA
ABLE TO ASSISTA
11
Bed to trolley
12
In/out of bath
Legend: A = Most preferred (Safest) on a sliding scale to G = High risk (Not recommended); ABLETOASSIST = Help is required from patient (patient must be able to understand, cooperate, and physically assist)
aCTiviTiES
iNiTiaL pLaN/aDmiSSiON Or rEviSED pLaN DaTE 1/10/2006 DaTE 2/10/2006 A OB A BS LL A WH A SC Hearing aid BP 4/24 Full diet NAD test daily Dressng BD In progress refer to progress notes L. Jones J. Smith T. Brown A LL A WH A SC Hearing aid BP BD Full diet NAD test daily Daily dressing In progress refer to progress notes L. Jones J. Smith T. Brown DaTE 3/10/2006 I
D SS x 2 D SL ST D WC D SC Hearing aid BP 4/24 Full diet NAD test daily Refer to dressing chart Dressing 4/24 In progress refer to progress notes L. Jones J. Smith T. Brown
mOBiLiTY
Hygiene Speech, sight, hearing Observations, specific Diet/fluids, weight Urine/bowels Wound care Discharge plan ND AM PM
SiGNaTUrE
CODE D
mOBiLiSE Wheelchair Walking frame Wheely frame Gutter frame Walking stick -4 point or single Walking sling
CODE Wc Wf Wh GF WSK WS
EQUipmENT Sling hoist Standing hoist Slide sheets Overhead bar Bedstick Leg lifter Turning frame Bed mechanics Shower chair Shower trolley Slide board Walking sling
CODE SL ST SS OB BS LL TF BM SC SH SB WS
Unable to understand and/or cooperate Physically unable to carry out task Able to assist: Understand/cooperate Physically able (needs assistance) Independent: I A
10
aCTiviTiES
On bed assessment: Equipment Off bed assessment Equipment Mobility assessment Equipment
Hygiene Speech, sight, hearing Observations, specific Diet/fluids, weight Urine/bowels Wound care Discharge plan ND AM PM
SiGNaTUrE
CODE D
mOBiLiSE Wheelchair Walking frame Wheely frame Gutter frame Walking stick -4 point or single Walking sling
CODE Wc Wf Wh GF WSK WS
EQUipmENT Sling hoist Standing hoist Slide sheets Overhead bar Bedstick Leg lifter Turning frame Bed mechanics Shower chair Shower trolley Slide board Walking sling
CODE SL ST SS OB BS LL TF BM SC SH SB WS
Unable to understand and/or cooperate Physically unable to carry out task Able to assist: Understand/cooperate Physically able (needs assistance) Independent: I A
11
prOCEDUrE Sitting up/ lying down Moving up in bed ON BED Turning in bed Rolling in bed Sitting on side of bed
CODE / EQUip
CODE / EQUip
CODE / EQUip
CODE / EQUip
D D SS x 2 D SS x 2 D
I I I I
I A
Patient transfers self Stabilise chair
Bed to chair
A
Patient transfers self Stabilise chair
(Off BED)
Chair to bed
Date Signature
Special needs
Needs a lot of prompting to assist on bed 1/10 Roll gently onto left side, discomfort ++ 4/10 Mobilises short distance only 10/10
CODE D
mOBiLiSE Wheelchair Walking frame Wheely frame Gutter frame Walking stick -4 point or single Walking sling
CODE Wc Wf Wh GF WSK WS
EQUipmENT Sling hoist Standing hoist Slide sheets Overhead bar Bedstick Leg lifter Turning frame Bed mechanics Shower chair Shower trolley Slide board Walking sling
CODE SL ST SS OB BS LL TF BM SC SH SB WS
Unable to understand and/or cooperate Physically unable to carry out task Able to assist: Understand/cooperate Physically able (needs assistance) Independent: I A
12
prOCEDUrE Sitting up/ lying down Moving up in bed ON BED Turning in bed Rolling in bed Sitting on side of bed
CODE / EQUip
CODE / EQUip
CODE / EQUip
CODE / EQUip
CODE / EQUip
CODE / EQUip
Bed to chair
Chair to bed
I WS
DaTE SiGNaTUrE
Special needs
CODE D
mOBiLiSE Wheelchair Walking frame Wheely frame Gutter frame Walking stick -4 point or single Walking sling
CODE Wc Wf Wh GF WSK WS
EQUipmENT Sling hoist Standing hoist Slide sheets Overhead bar Bedstick Leg lifter Turning frame Bed mechanics Shower chair Shower trolley Slide board Walking sling
CODE SL ST SS OB BS LL TF BM SC SH SB WS
Unable to understand and/or cooperate Physically unable to carry out task Able to assist: Understand/cooperate Physically able (needs assistance) Independent: I A
13
TaSk
On bed assessment: ON BED Move up the bed Sit up/lie down Reposition Off bed assessment: (Off BED) Bed to chair Chair to bed Chair to chair
mOrNiNG
D SS x 2 Electric backrest
afTErNOON
D SS x 2 Electric backrest
NiGHT
D
Electric backrest SS x 2
Toileting
Hygiene WC Encourage to roll self, lift own legs onto the footplate, feed self, wash own upper body 1/11/06 C. Firth
Mobility/therapy
WC Encourage to roll self, lift own legs onto the footplate, feed self, wash own upper body 1/11/06 J. Lee 1/10/06 J. Lee
Date Signature
Special needs
May be resistive in the morning. Gets up after 10.30am - responds to conversation about flowers and gardening.
CODE D
mOBiLiSE Wheelchair Walking frame Wheely frame Gutter frame Walking stick -4 point or single Walking sling
CODE Wc Wf Wh GF WSK WS
EQUipmENT Sling hoist Standing hoist Slide sheets Overhead bar Bedstick Leg lifter Turning frame Bed mechanics Shower chair Shower trolley Slide board Walking sling
CODE SL ST SS OB BS LL TF BM SC SH SB WS
Unable to understand and/or cooperate Physically unable to carry out task Able to assist: Understand/cooperate Physically able (needs assistance) Independent: I A
14
TaSk On bed assessment: ON BED Move up the bed Sit up/lie down Reposition Off bed assessment: (Off BED) Bed to chair Chair to bed Chair to chair Toileting Hygiene Mobility/therapy Date Signature
mOrNiNG
afTErNOON
NiGHT
Special needs
CODE D
mOBiLiSE Wheelchair Walking frame Wheely frame Gutter frame Walking stick -4 point or single Walking sling
CODE Wc Wf Wh GF WSK WS
EQUipmENT Sling hoist Standing hoist Slide sheets Overhead bar Bedstick Leg lifter Turning frame Bed mechanics Shower chair Shower trolley Slide board Walking sling
CODE SL ST SS OB BS LL TF BM SC SH SB WS
Unable to understand and/or cooperate Physically unable to carry out task Able to assist: Understand/cooperate Physically able (needs assistance) Independent: I A
15
16
17
18
HiGH riSk: vErY LikELY TO CaUSE iNJUrY - NOT rECOmmENDED praCTiCE
One slide sheet B Reaching Reaching Awkward postures, exerting high force, uneven loading, fast movements Awkward postures, exerting high force, uneven loading, fast movements c e f G Awkward postures, exerting high force, low working, reaching, uneven loading, fast movements Not able to assist Patient is lifted up the bed using the handlers shoulders Two slide sheets Draw or incontinence sheet Lifting slats Shoulder Lift Able to assist Patient assists by moving on the slide sheet, handler stabilises the patients ankle/ foot 1 2 2 2 Slide the patient up the bed using two slide sheets Patient is lifted up the bed using the sheet, which is already positioned under the patient Not able to assist Not able to assist Not able to assist Patient is lifted up the bed using the lifting slats 2 Position the folded slide sheet under the patient by rolling the patient once. Patient bends their legs with the foot positioned at on the bed (not on the slide sheet). The handler holds the patients ankle/foot against the bed to ensure it doesnt slip during the move, while the patient simultaneously pushes through their feet and slides up the bed. Remove the slide sheet by rolling the patient or pulling the bottom layer of the slide sheet from under the patient. Position the two slide sheets under the patient by rolling the patient. Using weight transfer, both handlers pull the top sheet, sliding the patient up the bed. Remove the slide sheet by rolling the patient or pull the slide sheets from under the patient (bottom layer rst). This dangerous practice includes the following: Handlers stand opposite each other on either side of the bed, grasp the draw or incontinence sheet that is positioned under the patients upper body and thighs, then lift and carry the patient up the bed using the sheet as a sling. This dangerous practice includes the following: Handlers stand opposite each other on either side of the bed, position the lifting slats under the patients upper body and upper thighs by rolling the patient onto the slats, grasp the handles of the lifting slats and then lift and carry the patient up the bed. Handlers remove the lifting slats by sliding the slats out from under the patients body or rolling the patient. This dangerous practice includes the following: Bed is positioned at, patients upper body is pulled forward into a sitting position. While supporting the patients upper body, both handlers position their inner shoulder under the patients upper arm with the patients arm positioned across the handlers back. Both handlers link their inner hands under the patients upper thighs and place their outer hands on the bed for balance. Using their body positioned under the patients upper arms, and inner hands positioned under the patients thighs, both handlers lift and carry the patients body up the bed, then support the patients upper body while removing the patients arms from the handlers backs. The patients upper body is then lowered into a supine position.
RISK
Method
Overhead bar
Code
Patient
Able to assist
Description
Patient assists by using the overhead bar, handler stabilises the patients ankle/ foot
Number of handlers
Procedure
Patient grasps the overhead bar. Patient bends their legs up with the foot (feet) positioned on the bed. The handler holds the patients ankle/foot against the bed to ensure it doesnt slip during the move. The patient pushes off through their supported foot/feet against the bed while lifting and carrying their own body up the bed.
RISK
Method
Bed rope
Manually operated or windup backrest with bed rope or monkey bar e Awkward postures, uneven loading, exerting high force Awkward postures, exerting high force, uneven loading, fast movements f g
Code Reaching
Behavioural, physical and clinical constraints, awkward postures, uneven loading, high force
Patient
Description
Number of handlers
Procedure
19
20
INCREASED RISK: NOT PREFERRED HiGH riSk: vErY LikELY TO CaUSE iNJUrYNOT rECOmmENDED praCTiCE
Roll using patients body mechanics B Reaching Reaching, exerting high forces C D Awkward postures, exerting high forces, reaching, uneven loading Not able to assist The handlers manually roll the patient/resident in a log roll position onto their unaffected side, lifting and supporting the outside leg 2 to 4 This dangerous practice includes the following: Two to three handlers stand along the unaffected side of the patients body, lean over to the patients far (affected) side of the body and pull the patients body over onto the near (unaffected) side, maintaining the patients body alignment and lifting and supporting the patients outside leg. An additional handler positioned on the patients far side may simultaneously push the patient over onto their unaffected side. The handlers hold the patient on their side until the procedure is completed then lower the patient onto their back, maintaining the patients body alignment. Roll with a turning frame Rolling patient in a log roll position Not able to assist Roll the patient onto their side using the patients body mechanics in order to carry out a particular procedure 2 Handlers stand opposite each other on either side of the bed. Position the patients arms across their chest. Bend up the patients knee or place the leg across the opposite leg. One handler pushes the patients hip and shoulder over while the other handler gently guides the patients knee and elbow over. Hold the patients body on their side. At the completion of the task, allow the patient to gently roll back into position. 2 to 3 Lift the turning frame onto the bed. Position the frame under the patients lower limbs by minimally lifting the patients legs. Two handlers position themselves on the near side of the patient at chest/thigh level and thigh/lower leg level. The handler at chest level grasps the far portion of the rolling frame chest bar and the leg support bar. The far handler grasps the turning frame at thigh/leg level. Instruct the patient to grasp the turning frame chest bar with both hands. Instruct the patient to bring their shoulders and upper body with the turn. The near handler guides the chest bar over and both handlers push down on the leg support bar. When the task is completed, allow the patient to gently roll back into position and remove the frame. Roll the patient onto their side maintaining body alignment with a turning frame Able to assist
RISK
Method
Roll
Code
Reaching
Patient
Able to assist
Description
Roll the patient on their side in order to carry out a particular procedure
Number of handlers
1 or 2
Procedure
Handler stands on the side the patient will turn towards. Instruct the patient to raise far knee and position the far arm across the body. Assist the patient to roll over. Support the patient on side or alternatively use the cot side or bedstick to enable the patient to support him/herself.
RISK
Method
Slide sheets
Manually reposition the patient using two handlers f Awkward postures, exerting high force, uneven loading, fast movements g
Code Awkward position exerting high force, reaching, uneven loading, fast movements
Reaching
Awkward postures, exerting high force, reaching, uneven loading, fast movements
Patient
Description
Number of handlers
Procedure
Position the folded slide sheet or two slide sheets under the patient by pushing the slide sheets under the patient and then rolling the patient onto side. One handler pulls the top layer of the slide sheets, while the other handler pushes the patients body into the middle of the bed. The patients body is maintained on its side during this procedure. Remove the slide sheets by pushing the slide sheets under one side of the patients body and then pulling the sheets out on the other.
21
22
HiGH riSk: vErY LikELY TO CaUSE iNJUrYNOT rECOmmENDED praCTiCE
Patient positions self or uses aid Electric backrest Manual lift from lying to sitting B Reaching Reaching C e Awkward postures, exerting high force, Able to assist The patient transfers from lying to sitting in a balanced position on the side of the bed using their body mechanics 1 Encourage the patient to bend up their legs and roll over onto their side. Instruct the patient to position their hand/ elbow at their chest level to enable them to push their upper body upwards. Position the patients feet at the edge of the mattress. Slide the patients feet off the bed while the patient pushes through their hand/elbow and lifts their upper body off the bed. The patient will be then sitting on the side of the bed. 1 or 2 Encourage the patient to bend their legs and roll onto their side. Raise the backrest to approximately 35 per cent and slide the patients feet off the bed. Continue raising the backrest until the patient is sitting in an upright position on the side of the bed. Use the electric backrest to raise the patient from lying to sitting in a balanced position on the side of the bed Able to assist Not able to assist The patient is manually lifted from lying to sitting on the side of the bed 1 or 2 This dangerous practice includes the following: Handler rolls the patient onto their side. Handler positions his/her near arm under the patients upper body and holds the patients legs with the other hand, then lifts the patients upper body into the sitting position while sliding the legs off the bed.
RISK
Method
Code
Reaching
Patient
Able to assist
Description
The patient transfers from lying to sitting in a balanced position on the side of the bed using an aid such as a bedstick
Number of handlers
Procedure
Encourage the patient to bend up their legs and roll over onto their side. Position the patients feet at the edge of the mattress. Instruct the patient to sit up or grasp the bedstick (positioned at the lower chest level) and raise their body using the stick as a brace. Simultaneously slide the patients feet off the bed. The patient will be then sitting on the side of the bed.
RISK
Method
Overhead tracking hoist with walking sling b Reaching, low working height, awkward postures Reaching, low working height, awkward postures Awkward postures, uneven loading Awkward postures, exerting high force, uneven loading, reaching C c d e f Awkward postures, exerting high force, uneven loading, reaching Not able to assist The patient is lifted from bed to chair using a hook arm lift
Standing aid
Code
g Awkward postures, exerting high force, uneven loading, fast movement, reaching Not able to assist The patient is lifted from bed to chair using a top and tail lift
Patient
Able to assist
Description
Using an aid such as a slide board, the handler assists the patient to transfer from the bed to a chair
Number of handlers
Procedure
Position the patient on the side of the bed with their feet on the oor. The chair is then positioned next to the bed with the near side arm removed or lowered. If appropriate, the slide board or other aid is placed under the patients near side buttock and across the chair. The patient grasps the far arm of the chair and positions feet in the direction of the turn. Encourage the patient to lift their buttocks up and across onto the slide board and move their body over to the chair. The slide board is then removed and the arm of the chair reinserted or raised into position.
23
24
INCrEaSED riSk: NOT prEfErrED HiGH riSk: vErY LikELY TO CaUSE iNJUrY - NOT rECOmmENDED praCTiCE
Overhead tracking hoist with walking sling
Standing hoist/ sit to stand aid Electric sling hoist
RISK
Method
Standing aid
Code
C Reaching, low working height, awkward postures Reaching, low working height, awkward postures c
A Awkward postures, uneven loading Awkward postures, exerting high force, uneven loading, reaching Not able to assist The patient is lifted from chair to bed using a standing pivot transfer with or without a walk belt
f Awkward postures, exerting high force, uneven loading, reaching Not able to assist The patient is lifted from chair to bed using hook arm lift
g Awkward postures, exerting high force, uneven loading, reaching Not able to assist The patient is lifted from chair to bed using a top and tail lift
Able to assist The patient transfers from chair to bed using ceiling mounted tracking hoist with walking sling The handler assists the patient to transfer from chair to bed while supporting their weight using a standing aid 1 The chair is positioned at a right angle beside the bed. Position the patient toward the front of the chair. The handler instructs/ assists the patient to stand up and assists the patient to transfer so they are positioned in front of the bed. The handler instructs/ assists the patient to lower themselves onto the bed, and to lift their legs onto the bed using an aid if necessary. 1
Able to assist
Description
Using an aid such as a slide board, the handler assists the patient to transfer from chair to bed
Number of handlers
2 Encourage/assist the patient to lean forward. Position the sling across the patients small of the back and under the patients arms, and attach the sling to the hoist. Using the hoist mechanics, transfer the patient off the chair and ask patient to lean forward for sling to be removed.
1 Attach the walking sling to the patient and the overhead tracking hoist. Instruct the patient to position buttocks to the edge of the chair and hands on the arm rest of the chair. Instruct the patient to push up into a standing position, using their legs and arms for strength and support. Once the patient is stable, re-adjust walking sling and provide mobilising aids as appropriate such as wheely walker, crutches. Instruct the patient to walk to the bed and position self with back of legs to the edge of the bed and sit down on the bed as far back as possible. Instruct the patient to lift their legs onto the bed using an aid if necessary. Detach and remove sling.
2 This dangerous practice includes the following: The handler is in front of the patient. The patients arms are crossed in their lap or around the handlers body. The handlers knees are positioned on either side of the patients knees. The handlers far hand is positioned under the patients far buttock and the near hand around the patients waist or the handler holds the patient with a walk belt. The patients chin is on the handlers far shoulder. The chair is beside the bed. The handler then leans back, bringing the patients body forward, and lifts, carries and lowers the patient from the chair to the bed. The handlers lower the patients upper body into the lying position while lifting the patients legs onto the bed. This dangerous practice includes the following: Both handlers place their near arms under the patients arm/shoulder. Both handlers lift, carry and lower the patient onto the side of the bed. One handler lowers the patients upper body into the lying position while the other handler grasps the patients legs and swings them onto the bed.
2 This dangerous practice includes the following: One handler pushes the patients upper body forward and positions his/ her arms from behind, under the patients upper body grasping hands across the patients chest. The other handler grasps the patients legs. Simultaneously, both handlers lift, carry and lower the patient from the chair to the bed.
Procedure
The chair is positioned next to the bed with the near side arm removed or lowered. If appropriate, the slide board or other aid (slide sheet) is placed under the patients near side buttock and across onto the bed ensuring the bed height is slightly lower than the chair. Encourage the patient to push up from the chair, lift their buttocks and move across to the bed. An aid such the overhead bar or xed bedstick may also be used by the patient to assist during the transfer. Remove the slide board (slide sheet) and instruct the patient to transfer legs onto the bed.
RISK
Method B Reaching, awkward postures Not able to assist The handler transfers the patients legs onto the bed using a sling hoist 2 Position the sling behind the patients body and under the patients legs. Position and lower the hoist over the patient and attach the sling to the hoist. Using the hoist mechanics, transfer the patient up off the side of the bed or out of the chair. Using the hoist mechanics, transfer the patient onto the bed. Detach the sling. Roll the patient and remove the sling. 1 Not able to assist E
Code
Patient
Able to assist
Description
The handler assists the patient to transfer their legs onto the bed using a towel or other aid
Number of handlers
Procedure
Encourage or assist the patient to place a towel or other aid around their feet/legs.
Encourage the patient to use the aid to lift their legs onto the bed.
25
26
INCrEaSED riSk: NOT prEfErrED HiGH riSk: vErY LikELY TO CaUSE iNJUrY - NOT rECOmmENDED praCTiCE
Electric standing hoist Electric sling hoist Standing aid Manual lift standing pivot transfer e Awkward postures, exerting high force, uneven loading, reaching Not able to assist The patient is manually lifted from a chair to another chair (or toilet) using a standing pivot transfer with or without a walk belt f Awkward postures, exerting high force, uneven loading, reaching Not able to assist The patient is manually lifted from bed to chair using hook arm lift Hook arm lift Top & tail lift C Reaching, low working height, awkward postures Reaching, low working height, awkward postures Awkward postures, uneven load c d g Awkward postures, exerting high force, uneven loading, fast movement, reaching Not able to assist The patient is manually lifted from bed to chair using a top and tail lift Able to assist Using the electric standing hoist, the handler assists the patient to transfer from a chair to another chair (or toilet) Using the electric ceiling mounted or mobile electric sling hoist the handler assists the patient to transfer from a chair to another chair (or toilet) 2 Instruct the patient to lean forward and position the sling behind the patients back and under the legs. Attach the sling to the hoist. Using the hoist mechanics, transfer the patient up off the chair and lower into the second chair. Detach the sling from the hoist and remove the sling by encouraging the patient to lift own legs and lean forward. 1 The second chair is positioned at right angles to the chair. The handler instructs/assists the patient to stand up using the standing aid and transfer so that they are positioned in front of the second chair. The handler then instructs/assists the patient to lower themselves onto the chair. 1 This dangerous practice includes the following: The second chair is at right angles to the rst chair. The handler is in front of the patient. The patients arms are crossed in their lap or around the handlers body. The handlers knees are positioned on either side of the patients knees. The handlers near hand is positioned under the patients near buttock and the far hand around the patients waist or the handler holds the patient with a walk belt. The patients chin is positioned on the handlers far shoulder. The handler then leans back, bringing the patients body forward, and lifts, pivots, carries and lowers the patient from the chair into the second chair. The handler assists the patient to transfer from a chair to another chair (or toilet). The patient uses a standing aid Not able to assist Able to assist 2 Encourage/assist the patient to lean forward. Position the sling across the patients small of the back and under the patients arms, and attach the sling to the hoist. Using the hoist mechanics, transfer the patient off the chair and lower into the second chair. Detach the sling from the hoist and remove the sling by encouraging the patient to lean forward. 2 This dangerous practice includes the following: The second chair is positioned at right angles to the rst chair. Both handlers stand on either side of the patient, bend forward and place their near arms under the patients arm/shoulder. Both handlers then lift, carry and lower the patient into the second chair. 2 This dangerous practice includes the following: The second chair is positioned next to the rst chair. One handler slightly lifts the patients upper body and positions his/her arms from behind, under the patients upper body grasping hands across the patients chest. The other handler grasps the patients legs. Simultaneously, both handlers lift, carry and lower the patient from the chair to the second chair.
RISK
Method
Code
Reaching
Patient
Able to assist
Able to assist
Description
Using an aid such as a slide board, the handler assists the patient to transfer from a chair to another chair (or toilet)
The patient transfers from chair to chair or toilet using ceiling mounted track with walking sling
Number of handlers
Procedure
The second chair is positioned next to the chair with the near side arms on both chairs removed or lowered. If appropriate, the slide board or other aid is placed under the patients near side buttock and across the second chair. Position the patients feet. The patient grasps the far arm of the second chair. Encourage the patient to lift their buttocks up and across onto the slide board, and move their body over to the second chair. The slide board is then removed and the arms of the chairs reinserted or raised into position.
Attach the walking sling to the patient and overhead tracking hoist. Instruct the patient to position buttocks to the edge of the chair and hands on the arm rest of the chair. Instruct the patient to push up into a standing position, using their legs and arms for strength and support. Once the patient is stable, re-adjust walking sling and provide mobilising aids as appropriate such as wheely walker, crutches. Instruct the patient to walk to the chair or toilet and position self with back of legs to the edge of the chair/toilet and sit down by leaning forward and grasping arms of chair or hand rail. Detach and remove sling.
RISK
Method
Patient transfers self or uses aid B Reaching, low working height, awkward postures Reaching, low working height, awkward postures Awkward postures, exerting high force, uneven loading, reaching, low working height Not able to assist The patient is manually lifted from the oor using the canvas and poles or a stretcher frame 5 or more This dangerous practice includes the following: The canvas is positioned under the patient by rolling patient onto both sides, or the stretcher frame is positioned around the patient and the slats inserted underneath the patient. The bed or trolley is positioned close to the patient and the bed lowered. Handlers lift the canvas or stretcher frame (and patient) up off the oor, and carry and lower onto bed/trolley. Instruct/assist the patient to roll over and remove the canvas or remove the slats and the stretcher frame. 2 This dangerous practice includes the following: The handlers assist the patient to sit up. Both handlers squat on either side of the patient and place their near arms under the patients arm/shoulder. Lift and carry the patient from the oor and lower the patient onto the side of the bed. The handler at the head end of the bed positions his/her arms under the patients upper body and lowers the patients upper body into the lying position. Simultaneously, the handler at the foot end of the bed grasps the patients lower legs and swings them on to the bed. Able to assist The patient is manually lifted from the oor to bed using hook arm lift Awkward postures, exerting high force, uneven loading, reaching, low working height C E F G
Code
Awkward postures, exerting high force, uneven loading, reaching, low working height Not able to assist The patient is manually lifted from the oor to bed using top and tail lift
Patient Not able to assist The handlers transfer the patient from the oor using an electric sling hoist The handlers transfer the patient from the oor using an electric hoist with stretcher frame 2 Position the frame around the patient. Position the slats under the patient and attach to the frame. Position and lower the hoist over the frame and attach to the frame. Use the hoist mechanics to lift the frame (and patient) off the oor. Lower the frame onto the bed and detach from the hoist. Remove the slats and dismantle frame. Not able to assist
Able to assist
Description
The handler verbally instructs the patient to transfer themselves off the oor using an aid such as a chair
Number of handlers
Procedure
Place a chair next to the patient and instruct the patient to roll on their side. The patient is then instructed to push up into a sitting position and then kneeling position through their near hand and elbow. The handler then places the chair in front of the patient and instructs the patient to push down on the chair seat and stand up or swing around to sit on the chair.
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HiGH riSk: vErY LikELY TO CaUSE iNJUrY - NOT rECOmmENDED praCTiCE
Slide board and slide sheet b Awkward postures Awkward postures, exerting high force, uneven loading, reaching E F Awkward postures, exerting high force, uneven loading, reaching Slide board and bed sheets Top and tail or other lift Not able to assist The handlers transfer the patient from bed to trolley using a pat slide and slide sheets The handlers transfer the patient from the bed onto the trolley using a pat slide and the bottom sheet, draw or incontinence sheet 3 or more Position the slideboard under the patient and sheet by rolling the patient. Position the trolley adjacent to the bed with brakes on and with the slideboard as a bridge between the bed and trolley. Handler on the bedside pushes patient at hip and shoulder, while handler on the trolley side leans over the trolley and pulls the sheet at hip and shoulder, transferring the patient from bed to trolley. The slideboard is removed by rolling the patient slightly. Not able to assist Not able to assist The patient is manually lifted and held using a scoop lift while the bed and trolley are changed over 3 or more Position the slideboard and wide slide sheet under the patient and top sheet by rolling the patient once (slide sheet is positioned on top of the slideboard with the majority of the sheet in the direction of the move). Position the trolley with a slide sheet on top adjacent to the bed with brakes on, with the slideboard as a bridge between the bed and trolley. Handler on the bedside pushes patient at hip and shoulder, while handlers on the trolley side pull the slide sheet at hip and shoulder, transferring the patient from bed to trolley. Tuck the slide sheet under the patient and remove the slideboard and slide sheet by rolling the patient once. 3 or more This dangerous practice includes the following: Each handler positions arms underneath supine patient at shoulders, hips and legs. The handlers lift and hold the patient whilst the bed is removed and replaced with trolley. The handlers lower the patient onto the trolley.
TraNSfEr 11: TraNSfErriNG THE paTiENT frOm BED TO TrOLLEY (iNCLUDES raDiOLOGY, EmErGENCY, SHOwEr TrOLLEY, mOrGUE, OpEraTiNG THEaTrE TaBLE)
RISK
Method
Code
Awkward postures
Patient
Description
The handlers transfer the patient from bed to trolley using the hover mattress or slippery mattress
Number of handlers
2 or more
Procedure
Handlers are positioned either side of the bed. Roll the patient and position the hover mattress underneath the patient. Secure the patient. Inate the hover mattress. Transfer the patient from bed to trolley push/ pulling the hover mattress. Deate the hover mattress and roll the patient to remove the mattress. If a slippery mattress is being used, the mattress will already be positioned under the patient/resident. Push/pull the patient/resident across on the mattress. Leave mattress in situ.
RISK
Method
Electric hoist with immersible sling and height adjustable bath B Reaching Awkward postures, uneven loading, reaching, low working heights D G
Code
Awkward postures, exerting high force, uneven loading, reaching, low working heights
Patient
Description
The handlers transfer the patient into and out of a height adjustable bath using an electric hoist with an immersible sling
Number of handlers
2 or more
Procedure
Raise bath to appropriate height. Position the sling under the patient. Attach the sling to the hoist. Using the hoist mechanics, transfer the patient into the bath. Detach the sling from the hoist and remove the hoist. The handler may leave the sling under the patient during the bath or remove the sling and reapply when the bath is completed. To transfer the patient from the bath, reverse the procedure.
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fUrTHEr iNfOrmaTiON
INDUSTrY pOLiCiES ON NO LifTiNG, fOr EXampLE, AUSTraLiaN NUrSiNG FEDEraTiON (ViC BraNCH) NO LifTiNG POLiCY, 2006
DEparTmENT Of HUmaN SErviCES ImpLEmENTaTiON FramEwOrk fOr THE INTrODUCTiON/ MaiNTaNENCE/EXTENSiON Of NUrSE BaCk INJUrY PrEvENTiON PrOGramS-NUrSiNG.viC.GOv.aU
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fUrTHEr iNfOrmaTiON
WORKSAFE VICTORIA WorkSafe offers a complete range of OHS services, including: emergency response; advice; information and education; inspections and audits; licensing and certification; publications; and web-based guidance. WorkSafe publications can be downloaded from worksafe.vic.gov.au RESOURCES Casual workers and labour hire Placing workers in safe workplaces, WorkSafe Victoria, 2006. Consultation Talking safety together, WorkSafe Victoria, 2005. Consultation: A users guide, WorkSafe Victoria, 2005. Information for employees, WorkSafe Victoria, 2005. General OHS Guide to the OHS Act 2004, WorkSafe Victoria, 2005. Summary of the Occupational Health and Safety Act 2004, WorkSafe Victoria, 2005. Manual handling Ballarat District Nursing and Healthcare Inc Safety Development Fund Project Final Report Musculo-skeletal injury prevention program for district nurses, Ballarat District Nursing and Healthcare Inc, January 2003. A guide to designing workplaces for safer handling of people, WorkSafe Victoria, 3rd edition, September 2007. No lifting policy, Australian Nursing Federation (Victorian Branch), 2006. Victorian nurses back injury prevention project evaluation report, Department of Human Services, Victoria, 2004.
Copies of the Victorian Acts and associated regulations can be obtained from Information Victoria by phoning 1300 366 356. The No lifting policy and Implementation guide and checklist can be obtained from the Australian Nurses Federation (Victorian Branch) by phoning 9275 9333.
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aCkNOwLEDGEmENTS
This guide was developed by consultants Louise OShea, OShea and Associates No Lift Systems and Mark Hennessy, Hennessy Services Pty Ltd in conjunction with the Patient/Resident Handling Working Party as part of WorkSafes Health and Aged Care Industry Project in 2002. Acknowledgement is made to the contribution of: The Health and Aged Care Consultative Committee Jeanette Sdrinis (Australian Nursing Federation), John Brooks ( Aged Care Association of Victoria), Michelle Holian and Sarah Creane (Department of Human Services), Elizabeth Langford (Injured Nurses Support Group), Kerry Shearer (Private Hospitals Association of Victoria), Fleur Limpus (Victorian Association of Health and Extended Care), Frank Mielke and Matthew Casey (Victorian Health Care Association), Andrea Argirides, Margaret Best and Greg Haywood (WorkSafe Victoria) The Risk Assessment Working Party Janet Casey (Aged Care Association of Victoria), Angela Quero (Aged Care Standards Accreditation Agency), Lynn Nicholas (Australian Hospital Care), Katy Marshall and Jeanette Sdrinis (Australian Nursing Federation), Sally Lutter and Sarah Creane (Department of Human Services), Rosemary Paterson (Montefiore Homes for the Aged), Judy Falla (Peter James Centre), Bill Fitzgerald (Southern Health Care Network), Jeanette Kamar (Northern Hospital Care Network), Andrea Argirides and Judith Farrell (WorkSafe Victoria), and Carmel Browne (Dandenong Hospital), Danielle Taylor (Karingal Manor), Sue Bartelman (Ballan District Health), Matthew Casey (Caulfield General Medical Centre) and the Royal Melbourne Hospital for the trial of tools in the workplace, feedback to the authors and support with photographs.
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WorkSafe Victoria
Advisory Service 222 Exhibition Street Melbourne 3000 Phone Toll-free Email Head Office 222 Exhibition Street Melbourne 3000 Phone Toll-free Website Local Offices Ballarat Bendigo Dandenong Geelong Melbourne (628 Bourke Street) Mildura Mulgrave Preston Shepparton Traralgon Wangaratta Warrnambool 03 5338 4444 03 5443 8866 03 8792 9000 03 5226 1200 03 9941 0558 03 5021 4001 03 9565 9444 03 9485 4555 03 5831 8260 03 5174 8900 03 5721 8588 03 5564 3200 03 9641 1555 1800 136 089 worksafe.vic.gov.au 03 9641 1444 1800 136 089 [email protected]
WSV542/04/03.10