1. Object Handling & Patient Minimal
Mobility Assistance
Module A: Introduction
Module B: Inanimate load handling and postural
awareness
Module C: Mobility assistance and use of equipment
East Midlands SS
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Barrow Upon Trent
Derby
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B Brought to you by Trust Interventions Ltd
2. T.I.L.E.O
Manual Handling Operations Regulations 1992
The task
The individuals capacity
The load
The environment
The other factors, such as attire, systems of work and equipment
The acronym TILEO may be used as a reminder of these key factors. Whilst it may not be
relevant to consider all factors in every situation, a conscious recognition of the range of
influence is needed. The reason for using an ergonomic approach is to try and match the job
to the worker and not vice versa as tradition has often dictated. An effective match between
a worker and their job provides improved levels of:
Work efficiency (performance, productivity etc.)
Health and safety
Job satisfaction
The human body The human mind
Fitting the job
to the person
Design of work
Examples of ergonomic solutions include:
The provision of equipment to eliminate or reduce handling e.g. a profiling bed, hoist
Changing the layout of the workplace to eliminate/reduce postural stress e.g. rearranging a
bedroom to allow access to both sides of a bed, creating space between chairs in an older
person’s home
Reorganisation of work e.g. rotation of staff to vary activities and balance workloads
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3. Risk Assessment
Risk assessments are simply a formal method for weighing up a situation to ensure safety.
We all make risk assessments regularly e.g. to cross the road. If you think about it you will
probably be surprised how many risks that you assess in your everyday life. It is a legal
requirement for employers to identify hazards and assess the risk of injury that employees
face and eliminate them if possible or minimise them as far as reasonably practicable. (A
hazard is something that might cause harm, a risk is the chance, great or small, of a person
being harmed by the hazard). Where risks are associated with manual handling the
assessment must be done in a particular way. Your manager/ supervisor is responsible for
ensuring that this happens. The information and instructions you are given about how to work
will be based upon these and it is important that you comply with them.
As an employee you have a legal duty to assist in the identification of hazards and control of
risks. Frequently you will recognise hazards that you can make safe e.g. a spillage. If the
hazard cannot be removed, avoid the activity if possible. If this is not possible, report the
hazard to your manager as soon as you can so that they can ensure a proper risk assessment
is carried out. In an emergency situation, the emergency procedure must be followed. Even
when a proper risk assessment has been carried out it is important that you always do an ‘on
the spot risk assessment’ to check for new hazards before every activity, this only takes a few
seconds. Try to remember the acronym TILEO
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4. S.E.C.S
Since all activities that involve assisting people to move carry some degree of
risk, steps should be taken to avoid them wherever possible through the
encouragement of self help or the provision of equipment. This does not mean
that an inferior service should be delivered but that assistance must be
provided in a safe manner. To help ensure that this happens the following key
areas to consider are included in each guideline.
Self help Gives suggestions on how a person may be encouraged to
move independently. It reminds carers of the importance of
verbal encouragement and of the positions to advise people
to adopt that may facilitate movement.
Ergonomics Gives ideas on steps to take to ensure that the
environment is suitable for the manoeuvre. It also lists
equipment that may be used to give the person independence
or that make the activity safer plus other relevant factors
relating to planning a safe manoeuvre.
Communication Reminds carers of the importance of checking handling plans
and communicating with the person and anyone else involved
so that all are properly consulted and understand what is going
to happen. Sometimes appropriate verbal prompts are useful to
encourage independence or ensure that actions will be
coordinated.
Safety Highlights factors associated with the activity known to affect
safety e.g. inappropriate attire, tripping hazards, lack of
space etc
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5. Potentially Harmful Postures
Aggravated by:
Sustaining
Repeating
Twisting
Loading
Jerky/sudden
movement.
Hoist Checklist (Pre Use Check)
SWL and inspection date
General wear and tear
Spreader is firmly attached
Sling clips
Wheels move freely
Brakes work
Emergency stop and lower
No hydraulic leak
Battery charged plus spare
Legs open and close
Handlers are trainer
Instructions are available
Sling Checklist (Pre Use Check)
Suitable for the person
size, SWL
handler is trained
instructions are available
general wear and tear
label is legible
date of last inspection
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6. Touch, holds and working positions
Before providing mobility assistance it is necessary to:
check the assistance needed e.g. talk to the person, check their handling plan
agree with the person and any other relevant people how assistance will be given
explain what you are going to do
Touch
For most human beings, touch is of vital importance and yet its influence is often ignored or
overlooked when providing mobility assistance. Touch can reassure, give confidence or
comfort but can also convey any negative feelings. Appropriate touch ensures respect for a
person’s feelings, and encourages trust and cooperation. Touch is a method of
communication that we use instinctively and subconsciously which others can usually read
with great accuracy. Just as we all speak in a slightly different way, so each of us uses and
responds to touch differently. This is influenced by many factors including:
Gender and age
Culture & religion
Beliefs and values
Previous experiences
Expectations
Understanding
levels of pain and certain medical conditions
Carers should always seek permission before touching a person. They should also use
touch in a professional, sensitive and appropriate manner that respects the person’s
feelings and is also safe for the particular manoeuvre.
There are two basic ways of using the hands when touching or moving anyone or anything:
gripping with the fingers and thumbs; or using an open palm hold.
Gripping with fingers and thumbs
Gripping or holding with the fingers and thumbs is often associated with stooping forward
e.g. lifting a person’s arm from the bed when washing. A gripping action quickly creates
muscle tension in the carer’s hands, arms, shoulders and back, a fact that can easily be
observed by changes in colour in the hand as blood flow is reduced, and by the tiredness
experienced after a few seconds. When a gripping hold is used on a human being the
body’s neuromuscular system perceives it as an imposing hold, or “threat” and there is a
natural reflex to withdraw from the touch. This withdrawal indicates that the hold is
perceived by most people as less than pleasant but for those with certain conditions e.g.
learning disability, dementia etc. the reactions may be far more obvious and result in
excessive resistance.
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7. Open Palm holds
When a lifting action is performed with the flat palm of the hand with the fingers relatively
relaxed there is more efficient use of muscles than when gripping with just the fingers and
thumbs. A carer using this type of hold will not fatigue so quickly and there will be a greater
area of contact with the person, which avoids pressure points. People usually perceive this
type of hold or touch as enabling and generally respond to it in a more positive manner than
when gripping type holds are used. Open palm holds may be used to support any part of a
person’s body provided that it is safe to assist the person to move and the person’s feelings,
gender and medical condition are respected.
Warning
In some situations there may be no alternative to using a direct grip e.g. when a child is
about to run into danger or by trained staff who need to use certain physical intervention
strategies. This is relatively rare and once the reasons for not using this type of hold are
understood they can be limited to situations where there is no other option available.
When taking an open palm hold:
Position close and at an oblique angle where possible
Stay in balance and relax down
Reach a little further than you need to allow your arm to come back to a relaxed position
Support the person with as much of your body as you can e.g. arm, shoulder, trunk
Do not cling to the person but adjust your hold as appropriate
When working with a colleague it often helps if the shorter one takes their hold first
Check that the person feels secure and comfortable
Long Low Hold
A long low hold may be used to give good support around a person’s trunk. It may be used
around a person’s back or across their front, by a carer who is standing or kneeling at an
oblique angle to them. Use an open palm and reach as long and low as is comfortable
around the person, and allow your arm to settle where comfortable. The aim is to maximise
the contact between your arm, shoulder, trunk and hand with the person.
Forearm hold
Position close at an oblique angle and take an open palm hold under the person’s forearm
and support it close to their body. Take care not to elevate their shoulder.
Upper arm hold
Position close at an oblique angle and take an open palm hold to support the person’s
upper arm in a relaxed position close to their side.
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8. Shoulder hold
Position close at an oblique angle and take an open palm hold in front of the shoulder. The
heel of your hand should gently ‘mould’ into the hollow of the person’s shoulder.
Trunk hold
An open palm hold may be taken on any part of a person’s trunk provided that you respect
their gender, and medical condition e.g. under the rib cage, side of the rib cage.
Ankle/leg hold
Position close at an oblique angle and take an open palm hold of a person’s leg or foot to
raise or adjust it. Avoid direct ankle holds since these are very uncomfortable.
Working Positions
In most situations it is best to work at an oblique angle (approximately 45º) to the person
being assisted. This allows them to be as close as possible to your line of gravity
(plumbline) and is perceived by most people to be more pleasant than when being square
on to them since it gives as much personal space as possible whilst providing good support.
Stop and think
Keep close
Stable position
Avoid stooping
Use a secure hold
Avoid twisting
Lead with the head
Move smoothly
Vary positions
Adopt and adapt the principles according to you!
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9. For further information and references
http://www.wales.nhs.uk/documents/NHS_manual_hand
ling_passpor.pdf
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