Consistent heavy manual lifting of patients causes many carers to suffer from musculoskeletal disorders. The nursing home Abberley House invested in a Molift patient lifter in order to prevent back strain injuries to members of staff.

The task

Abberley House is a nursing home looking after patients suffering from either Alzheimer’s or Parkinsons disease or simply old age. Owing to the nature of these illnesses, depending on the stage of development, walking is either very difficult or impossible for these patients.

Carers therefore have to assist the patients in everyday activities such as getting out and going to bed in the morning and evening, toileting, feeding etc. These tasks require the carer to move and handle the patient in a way that causes discomfort to both carer and patient.

The carer is subjected to repeated heavy lifting in the natural activities of providing full care. They regularly work for as much as 12 hours a day, with scheduled toileting, feeding etc.

The risks

Repeated heavy lifting causes damage to muscles and joints. Manual handling injuries are part of a wider family of musculoskeletal problems. They are often caused by poor working conditions: awkward or static posture; high levels of strain; frequent repetition; difficult manual handling tasks; excessive bending, stretching or effort. The back, neck shoulders and upper limbs are particularly at risk. A combination of the above means musculoskeletal disorders are increasingly a reality in service industries such as the care home sector.

The solution and the methodology

In line with the recommendations issued by the Royal College of Nursing and the National Back Pain Association, Abberley House recognises that the manual lifting of patients causes back injuries and therefore has a ‘no-lifting’ policy in operation; the patients needing more than minimal assistance are moved using mechanical aid.

Risk Assessments are carried out for all residents within 24 hours of admission. This involves assessing not only the resident but also the task, the individual, the load and the environment. Below is a typical risk assessment form from Abberley House. As you can see they have identified: the hazard and the people at risk; whether the risk is adequately controlled; what further actions are necessary to control the risk; and then they have given the hazard a priority.

Example of a typical risk assessment form on manual handling

Hazard	Who might be harmed?	Is the risk adequately controlled?	Priority	What further action is necessary to control the risk?
Task (Manual Handling) · Twisting · Stooping · Excessive lifting · Strenuous pushing and pulling · Positioning · Major vertical movement · Unpredictable movement · Repetitive handling	Carer and patient	No	A	Use electric hoist to lift patient
Load (Patient) · Heavy, bulky · Difficult to grasp · Unstable or unpredictable	Patient	No	A	Use electric hoist to lift patient
Environment (bed, chair, toilet, floor etc.) · Constraints on floor · Variations in levels	Carer and patient	No	A	Use electric hoist to lift patient
Individual (Carer) · Requires unusual skill · Is the carer pregnant?	Carer	No	A	Use electric hoist to lift patient

Priority
A – Immediate Action
B – Medium Term
C – Low level

The risk assessment form above applies to the natural lifting activities in providing complete care for the patient. This involves lifting the patient to and from bed, transferring patient from one chair to another (e.g. wheel-chair), bathing, toileting and walking.

As you can see the risk assessment has prioritised the above activities as an ‘A’ rating hazard. This means immediate action is necessary owing to the potential seriousness of the injury to the carer and patient when carrying out either of these activities. To eliminate this risk, Abberley House use a mechanical aid to lift the patients which is called the Molift patient lifter. The Molifter lifts the patient to and from the bed, the floor, transfer from chair or wheel chair, bathing and toileting. This device eliminates the carer from repetitive heavy lifting in the natural activities of providing complete care. See figures 1 to 7 overleaf.

Risk assessments are reviewed monthly or sooner if patient conditions altars. Staff are given training on the use of the hoist within six weeks of commencing employment and do not work using the hoist until they have been trained.

Fig 1 – Lifting from Bed A B C A – The Molifter is rolled under the bed locating the sling over the patient. The sling must be centred over the patient before lifting. B – The four hoops located on the sling are hooked onto the lift itself, with the carer raising the patient slowly. C – The carer lifts the patient until the patient is hovering above the bed. The patient's legs are lifted and turned so s/he faces the lifting column. The patient can then be easily manoeuvred into a wheelchair, chair (see fig 7).

Fig 2 – Lifting from floor The lifter is positioned behind the patient with a pillow over the base to support the user’s head and neck. Again the sling and lifter should be positioned over the centre of the patient. The sling is then lowered and the four hooks are attached to the lift. Lift the patient up above the floor. Position the patient using the handle on the back of the sling. Again the patient can be easily manoeuvred into a chair (see fig 7).

Fig 3 – Lifting from chair The lifter arms are lowered to chest height. The feet of the patient are placed on the platform of the lifter and is lifted forward until the knee support is in contact with the patients upper shins just below the knees (The knee supports are adjustable in height and width).

Fig 6 – Assisting the patient to walk The Molift lifter can also be used as a walking aid. The patient is lifted into a standing position using the sling. The walker provides the user with good and comfortable support and is appropriate for people with some strength in their arms and legs.

Fig 7 – Transferring patients in the lifter When either lifting a patient from bed or of the floor (figs 1 and 2 above), the patient is fully suspended in a comfortable position for the patient to be transferred.

Figures 1 to 7 above describe how the Molifter assists both the carer and patient in the natural activities of providing complete care. The design of the Molifter means the risks identified in the risk assessment under the heading 'task' (e.g. manual handling) have been eliminated. The list of hazards identified in manual handling has been dramatically reduced and in some cases eliminated. For example, the carer does not need to stoop, perform excessive lifting, strenuous pushing and pulling etc.

When identifying the hazards under 'load' (patient) in the risk assessment, the weight, bulk, instability and unpredictability factors have either been dramatically reduced or eliminated. The Molifter will lift a patient easily, with stability, and in a predictable manner.

With regard to identifying the hazards under 'environment' the Molifter can create new hazard types, following risk assessment . For example the Molifter rests upon castors, which do not run so easily on carpet. There is also variations in floor level rendering the Molifter useless due to imbalances. Where the Molifter cannot be used because of the environment, Abberley House will manual handle. However, the nature and environment of the nursing home means this is at a minimal level.

With regard to the carer, all risks identified in the risk assessment have been eliminated due to the Molifter lifting the patient.

The effectiveness of results

The Molift patient lifter has proven extremely effective in tackling the problem of back pain caused by repetitive manual handling of patients. When speaking to the carers about their day-to-day lifting activities, they explained that in addition to bulk and load being problems, there also faced problems relating to unpredictability. For example, a patient who can bear some weight on their legs (although limited) may be assisted manually by two carers on either side. If the patient feels they cannot walk anymore their legs will give way exerting an instant extreme pressure on the spines of the carers as they try to keep the patient upright.

The above case is only one example of how the Molift patient lifter eliminates this problems. As mentioned earlier the Molifter will lift a patient easily with stability in a predictable manner.

If we refer back to the risk assessment form the Molifter addresses all of the hazards identified.

The employee participation

Staff are given training on the use of the hoist within six weeks of commencing employment and do not use the hoist until they have been trained.

Staff are given training on Manual Handling on an annual basis. It is obligatory for the staff to attend these sessions.

Abberley House Manual Handling Policy is: AVOID if you cannot then MECHANISE if not appropriate then ASSESS the risk involved and take ACTION to reduce the risk of injury MONITOR and REVIEW

Entrepreneur’s Testimony "As an employer, in terms of the law and good practice, we are responsible for providing safe and healthy working conditions, equipment and systems of work for all our employees, contractors, visitors and others. This policy and its implementation will be kept up to date, particularly as we change, improve or add to our systems of work or arrangements. Any amendments will be brought to the attention of all employees. As a framework for this, the content of the policy and the way in which it has operated will be reviewed regularly (at least once a year)."