Manual handling Techniques in Care

What is manual handling in care?

Manual handling is the transportation or support of a load using bodily force. A load could be an object, a person or an animal.

Manual handling (also referred to as ‘moving and handling’) is a regular task within the health and social care sector. This includes people who are delivering care in a dedicated facility, such as a care home, as well as those delivering care to people in their homes.

People who require care may have limited mobility due to being elderly or having an illness or disability. This means that the people caring for them may have to routinely physically intervene to move them around, support them or help them with tasks, for example:

• Helping them to get into or out of bed
• Turning them in the bed if they are bedridden to prevent bed sores
• Sitting them up in bed
• Moving them from one place to another (for example, from the bed to the toilet)
• Assisting them with getting into or out of the bath or shower
• Helping them to go up or down stairs
• Helping them to sit down in a chair
• Lifting them from a wheelchair to another place
• Helping them to stand up or walk
• Getting them up from the floor after a fall
• Helping them to get into or out of a vehicle

In care, the loads associated with manual handling are usually people, however, manual handling covers a range of other activities that take place within the sector, for example:

• Moving beds or turning mattresses
• Changing bedding
• Carrying bags of linen and towels
• Moving equipment around the building (for example vacuum cleaners, meal trolleys or mobile hoists)
• Carrying or moving boxes of office related items (for example stationery)
• Handling boxes or pallets that contain stock for the kitchen or cleaning cupboard
• Taking deliveries of medication or medical supplies

Although some manual handling tasks are more hazardous than others, it is essential that all types of manual handling are done safely to reduce the chance of an accident or injury, this applies to both residential facilities and to people who provide home care services.

What is the Legislation Associated with Manual Handling?

There are various pieces of legislation that relate to workplace health and safety and manual handling, for example:

• The Health and Safety Act at Work 1974 states that employers have a duty to protect people at work from harm
• The main piece of legislation that covers manual handling at work is the Manual Handling Regulations 1992

Use of lifting equipment (including hoists and slings) in the workplace, is covered by the Lifting Operations and Lifting Equipment Regulations 1998 (LOLER). The basic principles of LOLER outline that all workplace equipment used for lifting operations must be:

• Safe for use
• Fit for purpose
• Appropriate for the task
• Clearly marked

LOLER inspections are a legal requirement for lifting equipment that is used in care homes. All workplace equipment used for lifting should be periodically examined and any issues or defects noted down and reported. Unsafe equipment should not be used until it has been repaired or replaced.

In most cases, lifting equipment is also covered under the Provision and Use of Work Equipment Regulations (PUWER). All lifting operations that are done using a piece of lifting equipment must be:

• Properly planned out by a competent person
• Appropriately supervised
• Done in a safe manner

Some moving and handling equipment in care may also be classed as a medical device and, as such, their supply and design may be regulated by the Medicines and Healthcare Products Regulatory Agency (MHRA).

The Correct Procedure for Manual Handling

The correct procedure for manual handling will depend on the task in hand, including the load being handled and the skills and capabilities of the people carrying out the task.

The basic procedure for safe manual handling includes the following:

1. Plan the lift/ task – think about the logistics of the manual handling task, how many people are needed to perform it safely and what equipment is available to help.
2. Plant the feet in a stable position – feet should be around hip width apart to allow for a balanced and stable base. Be prepared to move your feet during the move rather than twisting your body.
3. Keep a good grip on the load – loads should be held close to the body with a good grip and supported equally with both hands, as far as possible. Using strong stable grip is important rather than squeezing the load, especially if the load is a person, as this could hurt or injure them.
4. Maintain a good posture – avoid twisting or bending the back and try to use the power in your legs to lift the load. Avoid stooping, deep squatting or leaning sideways whilst manual handling as this can put too much stress on parts of the body and lead to an accident or injury.
5. Move smoothly – avoid twisting, jerking or snatching the load. Take a moment to rest and breathe when needed, rather than overexerting yourself.
6. Never handle more than you can safely manage – ask for help when needed from a colleague or make use of mechanical aids or lifting equipment
7. Don’t rush or overexert – if needed, place the person you are handling back down and readjust yourself if necessary, rather than performing a risky manoeuvre.

Weight limits

There are no specific weight limits set out in law relating to manual handling, instead the HSE provides guidelines on safe limits. These guidelines are based on assumptions about the lifting capacity for men and women, therefore the actual weight an individual can safely lift may be more or less than the guidelines suggest.

HSE guidance states:

• The maximum weight limit for men is 25 kg (55 lbs)
• The maximum weight limit for women is 16 kg (35 lbs)

These weight limits refer to loads that are held close to the body at around waist height. The HSE has different weight limits for handling at shoulder, elbow or lower leg height.

Types of Moving and Handling Equipment in Care

Moving and handling equipment is used in the care sector to make moving and handling someone safer and easier. Using a piece of equipment to lift, move, transfer or support someone’s weight takes some of the physical burden away from carers and reduces risk.

In England, the Care Quality Commission (CQC) is the regulatory body that deals with patient safety matters.

Any equipment used must relate to the findings of a risk assessment and be safe and fit for purpose. It is essential that and moving and handling equipment is used safely, carefully and as instructed.

The type of moving and handling equipment required in care will vary depending on environmental factors (for example available space) and the specific needs of the individual who is being cared for. When thinking about what moving and handling equipment to use, employers should consider:

• The needs of the individual and how to uphold their independence, as far as possible
• The safety of both the individual and care workers

Some examples of the equipment that may be used to help with moving and handling in care include:

• Hoists
• Stand aids
• Transfer boards
• Slide sheets
• Stair lifts
• Wheelchairs
• Emergency evacuation equipment

Hoists are some of the most frequently used pieces of equipment that are used to move patients in the care sector. Using a hoist helps to reduce risks to carers when a person needs to be lifted or lowered as the hoist takes the weight of the person rather than them being picked up and moved using bodily force alone.

Common types of hoists include:

• Mobile hoists
• Standing hoists
• Bath hoists
• Hoists to help raise people from the floor after they have fallen

Whilst they can be valuable pieces of equipment that may help to reduce the risks from manual handling, as with any piece of equipment, they can be dangerous if used incorrectly.

Problems with the use of hoists include:

• Using the wrong size sling, which may mean the person being moved is uncomfortable if the sling is too small and may fall out or slip down if the sling is too large
• Selecting the wrong type of hoist or sling for the task in hand, for example a toileting sling offers access but limited support
• Using a sling with an incompatible hoist which can result in an unsecure attachment and increase the risk of an accident or incident
• Equipment failure due to a lack of inspection and maintenance
• Vulnerable people being left unsupported or unattended whilst in a hoist
• Insufficient or incompetent staff operating the equipment
• Failure to use a safety harness, belt or attachment properly which can lead to people slipping out or falling sideways

Risk assessments should be done for manual handling tasks and each piece of equipment that is used.

A risk assessment for hoisting should include information about:

• Which hoist is appropriate for which task
• The type and size of sling a person needs (include specifics such as which type of loops or attachments should be used)
• Use of any additional safety devices
• Now many carers are needed to safely carry out the task
• Other relevant information relating to the individual who requires hoisting

Information from the risk assessment should be recorded and communicated to anyone who is responsible for caring for and managing the patient. Detailed findings should be included in a patient’s individual care plan, with key information displayed somewhere clearly accessible.

What is the risk from poor manual handling?

Poor manual handling can result in accidents and injuries occurring and is a leading cause of workplace ill-health. When you are caring for another person, poor manual handling can also have an impact on them.

Risks from poor manual handling in care include:

• Musculoskeletal disorders
• Back injuries
• Sprains
• Pulled muscles
• Broken bones
• Crushed hands or feet

A manual handling injury can occur from a one-off event or from using poor techniques over time.

The effects of poor manual handling on carers include:

• Pain
• Swelling
• Fatigue
• Reduced mobility
• Time off work
• Financial loss
• Poor mental health

The consequences of poor manual handling for patients may be:

• Discomfort
• Bruising or cuts
• Pulled muscles
• Dislocations
• Broken bones or other injuries from being dropped
• Feelings of panic and anxiety
• Less likely to cooperate when manual handling is needed in future 
• Loss of dignity

The consequences of poor manual handling may be short or long term depending on factors such as the type of injury incurred, the person’s general health and the quality of treatment and aftercare received.

Some of the most common causes of manual handling injuries in care include:

• Lack of training and supervision
• No understanding of the consequences of poor manual handling
• Insufficient numbers of staff to perform tasks safely
• Tight deadlines and people rushing
• Workers feeling under pressure to perform tasks quickly rather than safely
• Lack of, or improper, assistive equipment, not enough equipment for the number of patients or inadequate training on use of moving and handling equipment
• Staff regularly using poor manual handling techniques, such as poor postures and stooping and modelling this behaviour to others

To reduce risks from manual handling it is important to:

• Only perform tasks that you have been trained for
• Use any equipment or aids as instructed and for their intended purpose
• When using lifting aids always adhere to safe weight limits
• Know your limitations
• Ask for help when needed

What are the principles of manual handling?

The basic principles of safe manual handling include:

• Working safely, including using the correct techniques and having a good posture
• Being cooperative
• Working in a way that reduces risk to all parties
• Being compliant with law and legislation

Sometimes, people refer to the principles of manual handling as the five P’s; this builds on the seven steps we outlined earlier in the article, relating to the correct procedure for manual handling.

The five P’s are:

• Plan
• Position
• Pick
• Proceed
• Place

Plan

The planning stage involves thinking about the task in hand, including the characteristics of the load, where the load is and where it needs to go. It also involves thinking about how many people are needed to safely handle the load and what equipment is available to help.

Planning may also include thinking about hazards, including the physical characteristics of the area that may affect manual handling operations, for example:

• Narrow corridors
• Tight spaces
• Stairs

Planning a lift allows workers to think about different ways to approach a situation and to select the safest way of working to avoid hazardous manual handling.

Position

A secure, stable position reduces strain on the body and allows for a better hold. A good position for manual handle looks like:

• Strong, stable stance
• Neutral spine
• Equal distribution of weight between the feet
• Engaged core
• Bending using the legs/ knees rather than the back
• Keeping a straight back

Pick

Manual handling requires the holding or picking up of a load and to do so safely means having a secure grip. Loads should be gripped securely but not grabbed or squeezed (this is especially true in care settings to avoid hurting anyone).

Proceed

Once a load has been grasped and is ready to be moved it is helpful to proceed in accordance with the original plan:

• Walk at a steady pace and do not rush
• Maintain core strength and a good posture
• Maintain balance and avoid twisting or over reaching

When the load is a person is it especially important that they are moved using deliberate, controlled movements. This gives a feeling of safety and security and reduces the risk of them experiencing discomfort.

Place

The final principle of the five P’s refers to placement of the load. Placement should be secure and precise.

• Bend with the knees rather than the back
• Avoid sudden drops
• Stay controlled and avoid leaning
• Ensure that everyone who is helping with manual handling knows where the load is to be placed and works in tandem
• Reduce your grip slowly

Once a load has been released it may need to be secured in place. If you are placing a vulnerable person into bed, you do not want them to roll back out. You can ensure they are secured by raising the bed guard or ensuring they are placed away from the edge of the mattress.

Dignity and manual handling operations

In the care sector, it is vital to act in a person-centred way that upholds the dignity of the person being cared for – this includes during any moving and handling activities. Dignity is one of the key principles outlined in The Care Act 2014.

Carers should explain how they are planning to move or transport a patient prior to commencing a such an activity. It is important to obtain consent from patients before handling them, as far as possible.

Everyone has the right to feel safe and supported at work. Additionally, both employers and employees in the care sector have a duty to protect their vulnerable service users. It is important that all parties work collaboratively to ensure that no one is put at risk due to hazardous manual handling.

Employer responsibilities

Employers have a legal duty to provide a safe working environment for their staff. This includes providing proper training and appropriate equipment. Under manual handling regulations, employers must:

• Avoid hazardous work activities (for example handling that can cause back pain) as far as reasonably practicable
• When such activities cannot be avoided, a risk assessment should be carried out to find ways to control risks, including back pain
• Apply control measures to protect workers
• Monitor and review controls to make sure they are working properly
• Take instances of work-related ill-health from manual handling seriously and make changes to work activities to avoid repeat occurrences
• Consult carers and nurses to get feedback on how manual handling affects them at work and resolve any concerns that are raised

Employee responsibilities

• Follow safe systems of work and safe operating procedures
• Use all lifting and handling equipment safely and as directed
• Work in cooperation with management and in line with manual handling legislation
• Report any concerns about moving and handling procedures, equipment or patient safety
• Work in a manner that does not put themselves, their colleagues or service users at risk

Care homes should have a manual handling policy that is written to comply with The Health and Safety Act at Work 1974, The Management of Health & Safety at Work Regulations 1999 and The Manual Handling Operations Regulations 1992.

The manual handling policy should cover the following:

• Policy objective and scope
• Legislative requirements
• Employer’s duties
• Management duties
• Employee duties
• Following safe systems of work
• Training and information
• Elimination of hazardous manual handling
• Risk assessments
• How to report incidents of workplace ill health
• Use of PPE
• Emergency procedures
• Use of equipment and machinery
• Any other relevant information

Having a manual handling policy can help to provide clarity, establish a framework for manual handling activities and help everyone to understand their individual responsibilities.