Spire Healthcare Case Study

Moving & Handling of People Training

Half Day Practical Skills Courses run by our Moving & Handling Expert Jonathan Taylor observed by our

Training Coordinator & Social Media Manager Emma Farrell (this Case Study is written by Emma)

In March 2019, I (Emma Farrell) attended a 3 Hour Moving & Handling of People Practical Skills Course provided by Osteopathic Solutions for attendees at Spire Healthcare’s Dunedin Hospital in Reading. This intensive Course was run by our Bedford based Moving & Handling of People Expert, Jonathan Taylor.

After having a briefing with Jonathan and meeting the attendees (who all came from varying backgrounds within the care industry) it was time for the 3 Hour Moving & Handling Course to commence.

The first transfer Jonathan decided to cover with the attendees was fitting of a universal sling by rolling the patient both ways. All of the attendees had already attended Practical Skills Courses in the past and were familiar with moving and assisting people on a daily basis so Jonathan initially asked each team member to demonstrate their current transfer method. As each individual displayed their usual sling fitting technique, Jonathan reminded attendees of the following factors: Ensure the bottom edge of the sling is in line with the person’s coccyx, ensure the bed is raised to waist height, and also ensure to pay attention to maintaining good posture to avoid risks of musculoskeletal disorders due to the hazardous forward bent postures.

As a group we then moved on to looking at roller and flat slide sheets and their uses. The application of a roller sheet and unravelling of flat sheets were observed and discussed by Jonathan under the supine patient when they cannot be rolled. Attendees began to demonstrate to Jonathan their usual method of performing the technique. The first method practised was applying the slide sheet underneath the patient’s lower back using the ‘scissor hold.’ The group were reminded to take care when sliding the sheet under the lower back. The performance of this technique was very good amongst the group.

Unravelling of 2 flat sheets under the supine patient was the next technique to cover, before looking at minimal handling of moving the patient up the bed. Each attendee took turns on being the patient on the bed which was beneficial in the learning experience to feel the transfer taking place from a patient’s perspective. It was reminded on this transfer to always unravel the roller sheets on the lower part of the person i.e. across the bottom half of their body as doing this directly across a patient’s waist or upper body can frighten some, especially those with dementia. Jonathan then provided a smaller roller sheet which was used for smooth transfers of patients with feet conditions e.g. a diabetes sufferer. He placed this small slide sheet under the supine person’s feet. A query was raised as to the best arrangement of the pillows with everyone agreeing that the best positioning was at the headboard of the bed. Jonathan once again asked the attendees to show him their usual method of this transfer.

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The two group members in question performed their technique by grabbing a piece of material closest to the supine person’s hip and shoulder before announcing ‘Ready, Steady, Slide.’ The remaining attendees agreed that they also carried out the technique using this method. I wasn’t familiar with every handling method in which course attendees displayed on this course on my previous training days, so it was good for me to broaden my knowledge and learn alternative methods of handling.

Jonathan then demonstrated our best practice transfer of moving the patient up the bed. The attendees were not familiar with this technique so it was great for them to learn a new handling method. This technique is generally done with 2 handlers and involves the following (this transfer can be viewed on the following video):

Adjust the bed to a safe working height, raising the foot end or the knee break.
The person lies flat with one pillow under their head.
Fit a large roller slide sheet under the person either by the rolling method or the unravelling method. The roller slide sheet should be placed under the head and trunk, just below the buttocks.
Instruct the person to bend both knees up, or the 2 handlers work together in bending the person’s knees.
Both handlers adopt a squat position with the furthest foot from the bed in front of the bed in front of the other.
If the person has good cognition, inform them of what the transfer involves especially concerning the contact with the person’s buttocks.
The 1st handler places their right forearm across the person’s buttocks.
The 2nd handler ‘doubles up’ this contact by placing their left forearm across the 1st handler’s forearm.
A team leader is nominated who instructs the other handler to push on ‘push’ with the command of ‘Ready, Steady, Push.’
Both handlers move gently and smoothly using both arm and leg power, sliding the person up the bed.
Handlers perform the movement in 2 stages if necessary.
Remove the roller slide sheet.

Jonathan then questioned the group by asking ‘What bed features can we use to make this technique easier on the handlers?’ Most of the group knew that raising the bottom end of the bed would help slide the supine person easier.

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We then moved on to hoisting. Jonathan explained to us that even when hoists are used there are still risks to the handler of musculoskeletal disorders due to the combination of forward bent postures fitting slings, and the pushing and pulling of mobile hoists. Also discussed was the risk of injury to the patient from falls from the hoist when slings are not used/ fitted correctly. Additionally, it was important to note the following: Always apply the breaks when attaching the sling. Ensure your environment is as clear as possible for your route. Additionally, it is essential that loops are secure and attached appropriately and balanced on each side. Jonathan then raised the bed rail up on one side, allowing attendees to practise turning a patient on their side using the hoist. He kept the group engaged by asking them questions such as ‘When hoisting, should the breaks be on or off?’

The answer he explained to the group was off, as the hoist itself finds the centre of gravity. Once attendees had refreshed themselves with all hoisting techniques and methods, particularly the application of slings, it was time to practise pushing and pulling of the hoist down the corridor aisle. This was a very important part of the training as it was applicable to all items in the care industry with wheels such as wheelchairs, trolleys etc.

Jonathan very clearly broke down the problems associated with natural, unsafe pushing and pulling tasks and their implications on the musculoskeletal system, especially the mechanical strain on the neck, shoulders and lower back. The power in performing a BackSafe pushing technique comes from the legs, mostly from the glutes. Linked with Osteopathic Solutions’ best practice BackSafe Pushing technique from our Manual Handling Instructor Assessor Course booklet, when carrying out pushing of loads, such as hoists, you should position yourself by:

Facing the load with one foot in front of the other.
Feet should be positioned at your normal hip width apart.
Bending both your knees (no more than a semi squat)
Placing your hands safely on the load, wrapping your fingers around its corners or gripping the handles.
Keeping your elbows close to the body, level with the trunk.
To initiate movement of the load forward from a standing start drive your whole body forward with your leg muscles, keeping your elbows in, your spine upright and your head looking forward. The rear foot should step of the ground quickly so to avoid the elbows going away from the body initiating a forward bend of the spine.
For heavier loads taking large steps initially will extract more power from the glutes.
Once the load is moving a normal walking gait should be performed, maintaining the elbows close to the body.

Upon perfecting this technique thoroughly up and down the corridor, until Jonathan felt everyone had fully grasped it, the group and myself returned to the training room to cover hoisting from bed to chair. Jonathan took the brakes off the hoist and allowed attendees to practise their regular method before intervening if he thought he could improve their posture, or method. The group began to hoist the patient up carefully, until the straps were in tension. Jonathan reminded everyone to ensure the patient looks safe and comfortable and also how dangerous the spreader bar can be if not taken control of. When the patient was due to land on the chair, Jonathan raised the query of ´How would you normally assist a person to ensure they are sitting comfortable in the chair?´ Most attendees were aware that to aid positioning of the person, it was beneficial to place your hand below their knee on either side, and push the person into the back of the chair.

One of the last transfers covered on the Course was sitting to standing. Important factors to note for a successful sitting to standing transfer was the material of the chair, height of the chair and also if the patient has good cognitive skills. The group were all very familiar with this transfer and its method. Jonathan discussed best practice hand positioning with the group which was having one hand on the person’s lower back and one hand on the front of the shoulder to support the person. Jonathan lastly took out a handling belt for everyone to experiment with and give their thoughts on.

Jonathan concluded the session by running over the main transfers in which we looked at during the training, asking attendees if they had any questions. It was evident that everyone who took part in this training had refreshed their Moving & Handling knowledge to a high standard and were leaving the training room more confident in their ability as a handler. I enjoyed this highly practical 3 hour Moving & Handling of People Course as I felt it was very direct, intensive and just enough time to give the group a sharp refresher of techniques, myself included (as I have attended and passed our 3 Day Moving & Handling of People Instructor Course accredited with The CPD Certification Service at our Manchester Centre – to view my case study of this Course click this link). I would definitely recommend this course to those looking to brush up their Moving & Handling skills to a high standard, as it is taught by a trainer who has plenty of experience in Moving & Handling and made the group feel very comfortable and engaged in their learning. All in all, I found this to be a great course by Osteopathic Solutions for Spire Healthcare; continuing our growing national relationship with this well known Primary Healthcare Group.