Moving and handling people safely

Cue 1 MHOR hierarchy as three descending blocks with avoid at the top.

AMARA 00:00 Moving and handling. Be honest with me, is this the most skipped training in care?

NADIA 00:06 It is the most skipped and it is the one that ends careers. Musculoskeletal disorders are the largest single cause of sickness absence in this sector. People leave with backs that never come right.

AMARA 00:19 Start with the law. What is the actual duty?

NADIA 00:23 The Manual Handling Operations Regulations 1992. Three steps, in order. Avoid hazardous manual handling so far as is reasonably practicable. Assess what you cannot avoid. Reduce the risk so far as is reasonably practicable.

Cue 2 Filter value myth buster: 25kg crossed out with no legal maximum written beside it.

AMARA 00:36 And most people go straight to lift carefully.

NADIA 00:40 Which is the last resort dressed up as a technique. And there is something I want to clear up, because it is quoted at me constantly. There is no legal maximum weight you are allowed to lift.

AMARA 00:54 Really? Everybody says twenty five kilograms.

NADIA 00:57 That is a filter value in HSE guidance for assessment purposes. It is not a permitted limit and it is not a legal threshold. Every task is assessed on its own facts, and a light person in a bad position is more dangerous than a heavy one in a good one.

Cue 3 TILE assessment wheel with the person's wishes added as a fifth segment.

AMARA 01:17 What do I assess?

NADIA 01:19 Remember it as TILE. Task, how far, how often, twisting, stooping, holding. Individual, meaning you: your training, your health, whether you are pregnant, your own back history. Load, which is the person, their weight, condition, pain, cooperation and unpredictability. And Environment: space, floor, lighting, obstructions, bed height.

AMARA 01:38 You would add something to that.

NADIA 01:40 The person's own abilities and wishes. A handling plan written without the person produces resistance, and resistance gets written down as challenging behaviour when it is actually a reasonable objection to being moved in a way nobody discussed.

Cue 4 Sling check sequence: fraying, loops, LOLER date, configuration.

AMARA 01:55 Equipment. What goes wrong?

NADIA 01:57 Slings, mostly. They are person specific and size specific, and the wrong sling is the commonest reason somebody slides out of a hoist. Check for fraying. Check the loops. Check the LOLER date, which for a sling is at least every six months and for the hoist itself at least every twelve. And check the loop configuration matches the plan.

AMARA 02:21 Are there techniques that are simply banned now?

NADIA 02:24 Several. The drag lift under the arms. The Australian or shoulder lift. Lifting somebody under the arms from the floor. And allowing a person to put their arms around your neck.

Cue 5 Prohibited techniques montage, each crossed out, including arms around the neck.

AMARA 02:36 That last one sounds harmless.

NADIA 02:38 It is the single most common route to a permanent neck injury in care work. And it happens precisely because it feels affectionate, so nobody wants to be the person who says no. Say no.

AMARA 02:52 Right, the hard situations. Somebody has fallen. What do I do?

NADIA 02:57 Not rush to lift, which is everybody's instinct. Assess for injury. Ask what happened and whether they hit their head. Check for pain and deformity. Do not move anyone with a suspected spinal injury or fracture. Keep them warm, keep them comfortable, and use the right equipment, usually a lifting cushion or a hoist.

Cue 6 Fallen person decision tree ending at equipment rather than a manual lift.

AMARA 03:18 Even if they say they are fine and want to get up?

NADIA 03:23 Especially then. And record every fall, including unwitnessed ones, because the pattern is the clinical information. One fall is an event. Three falls is a diagnosis waiting to be made.

AMARA 03:35 Second situation. It is a two person hoist and I am alone.

NADIA 03:40 Then it does not happen. There is no version of this where you improvise safely. Escalate it, and record the staffing shortfall as an incident.

AMARA 03:50 And if my senior tells me to do it anyway?

NADIA 03:54 You may decline, and you are lawfully entitled to. Say what you are willing to do, state the specific risk in one sentence, and put the exchange in writing afterwards.

AMARA 04:06 In writing. That feels confrontational.

NADIA 04:08 It feels confrontational for about a day. It is decisive on the day somebody is injured and everyone is asked what was said. Write it down.

Cue 1 Correct sling beside one too large, with the person sliding through.

AMARA 04:18 Hoists frighten me more than anything else in this job.

NADIA 04:22 Then here is something reassuring and something not. Hoists themselves very rarely fail. Slings fail constantly.

AMARA 04:29 Why slings?

NADIA 04:30 Because they are the part people improvise with. A sling is person specific and size specific, prescribed in that individual's handling plan. And the commonest failure in the country is somebody grabbing a different size because the right one is in the wash.

AMARA 04:47 What happens then?

Cue 2 Universal sling against an access sling, with the unsupported back highlighted.

NADIA 04:48 Too large and they slide through it. Too small and it cuts in, restricts breathing and puts the load in completely the wrong place.

AMARA 04:58 And types? A sling is a sling.

NADIA 05:00 It really is not, and this is the dangerous one. A universal or hammock sling supports the whole body. An access or toileting sling leaves the back open and gives far less support.

AMARA 05:14 So the toileting one is only for?

NADIA 05:16 Somebody with genuine trunk control who can hold themselves upright. Fit one of those to a person who cannot, and you have suspended somebody with almost nothing supporting their back. It is one of the most dangerous single errors anybody makes with this equipment.

Cue 3 Illegible label with size, safe working load and inspection date all unknown.

AMARA 05:34 What do I check before using one?

NADIA 05:37 Fraying, cuts, stretched stitching, and the label. And if the label is illegible, that sling is out of service.

AMARA 05:44 Out of service over a label?

NADIA 05:47 Over a label. Without it you cannot confirm the size, the safe working load or the last inspection. And a sling that fails does so with a human being suspended in mid air.

AMARA 06:00 And the hoist itself?

Cue 4 Ninety second hoist check as a six point sweep.

NADIA 06:02 Ninety seconds. Battery charged. Emergency lowering understood and reachable, which people never check until they need it. Castors and brakes. Legs opening and closing. Spreader bar and hooks. LOLER dates on both.

AMARA 06:14 Anything about the room?

NADIA 06:16 Clear the route first. A hoist transfer over a rucked rug is how a hoist tips, and it takes four seconds to look.

AMARA 06:25 Right. Somebody is on the floor. What do I do?

NADIA 06:29 Not what your instinct says, which is to get them up. Assess before anybody touches them.

Cue 5 Shortened, externally rotated leg flagged as a suspected fractured neck of femur.

AMARA 06:36 What am I looking for?

NADIA 06:38 Did they hit their head. Are they on anticoagulants, because a head injury on a blood thinner is a different situation entirely. Pain, deformity, and particularly a leg that looks shortened and rotated outwards.

AMARA 06:51 Which means?

NADIA 06:52 Classic fractured neck of femur. Move that person and you have made a bad injury much worse. Keep them warm, keep them comfortable, call for help.

AMARA 07:02 And if they are genuinely uninjured?

Cue 6 Three separately recorded falls assembling into a pattern.

NADIA 07:05 If they can assist, a supervised assisted rise using furniture is fine. If they cannot, lifting cushion or hoist with a floor recovery sling.

AMARA 07:14 Never manually?

NADIA 07:15 Never. Lifting somebody off the floor by hand is precisely where carers destroy their backs, and it is a completely avoidable injury.

AMARA 07:24 Do I record a fall where nobody was hurt?

NADIA 07:28 Especially those, and this is the bit people skip because it feels like paperwork about nothing. One fall is an event. Three falls is a diagnosis waiting to be made, and the pattern only exists if somebody wrote down the two where nothing happened.