8 minute read
HOP7
BackCare was formed in 1968 as the National Back Pain Association, when Stanley Grundy (the founder) suffered a back injury and felt that he had nowhere to turn for support. His mission was to set about creating a charity dedicated to educating the public in ways of preventing or alleviating back pain.
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While back pain might reasonably be considered a side effect of being human, it is generally understood that there is an association between certain tasks, activities and exposures at work, in sport or at home, and the development of musculoskeletal (MSK) symptoms, including back pain. The Health and
Safety Executive (HSE) offers a list of workplace risk factors that can contribute to the development of MSK symptoms including:
l lifting heavy or bulky loads l carrying loads awkwardly, asymmetrically or possibly one-handed l pushing, pulling or dragging heavy loads l manual handling in awkward places, such as during delivery work l repetitive tasks, such as packing products l bending, crouching or stooping l stretching, twisting and reaching l being in one position for a long time l working beyond your capability or when physically overtired.
Other external factors such as work organisation, for example, high workloads, tight deadlines, lack of control over the work and working methods may also be relevant.
The exposures listed above are typically associated with construction, heavy manufacturing and production work, but for many workers in the health and social care sectors, the “load” is a human being; and humans can also be heavy, bulky and awkward to move loads if they have limited or no ability to move themselves.
Consequently, the delivery of care, in hospitals, by the emergency services and in the community, can also involve almost all of the
risk factors listed above.
The prevalence of low back pain in nursing, and the consequent cost to the NHS, has long been recognised and in 1979 the Royal College of Nursing (RCN) published their first guide, Avoiding Low Back Injury Among Nurses, that made a number of recommendations aimed primarily at prevention strategies including the avoidance of lifting. Recognising a need, the (by then) Back Pain Association (BPA), working in conjunction with the RCN, set about gathering a multiprofessional group of relevant experts to produce best practice guidance on recommended methods of assisting or moving patients, emphasising the importance of skills development so that, once trained, nurses could “accurately assess each situation and make the correct decision about patient movement, even in an emergency, to protect not only the nurse but also the patient”. The dual aims of managing risks to the worker, whilst also meeting the assessed needs of the patient, remain as relevant today.
The resultant guidance document was published by the BPA in collaboration with the RCN in 1981 as The Handling of Patients (HOP), a Guide for Nurse Managers. It was quickly established as the gold standard guidance for the moving and handling of patients at a time when almost all care was delivered within the NHS. include and address all relevant sectors.
It seems appropriate that the latest revision in this established series, the seventh edition of the HOP series will be published in the summer of 2021, 40 years since the first, and 10 years since the last, publication. The approach and content of this new edition will focus on two significant aspects. The first is the ever closer focus on person-centred care that takes full account of the needs, choices, dignity and comfort of the person, and that takes an enabling approach to promoting the function and independence of the person being cared for as a clearer inclusion in the decision making process. This applies as much to meeting a person’s moving and handling needs as to any other aspect of personal and/or clinical care, including rehabilitation. Second, this edition has taken the step to underpin all of the guidance included with as much supporting evidence as is currently available. This includes other sources of practical guidance, academic literature and, where appropriate, equipment manufacturers’ recommendations.
Over the past 40 years, the hazardous lifting of patients/people has been all but eradicated (except in dire emergency where there may be no reasonable alternative) due to greater understanding of the risks to both the handler and the person being handled, the growing evidence base for the safer handling methods set out in the publication (some of which are illustrated in this article) and also due to an ongoing evolution in equipment/technology development. Nevertheless, real, and sometimes new, challenges remain.
Some examples of equipment designed to substantially avoid or reduce the risk from moving and handling include:
Further editions followed in 1987, 1992, 1997, 2005 and 2011 as best practice manual moving and handling methods evolved and the range of moving and handling aids and equipment extended and became more readily available, accessible and user friendly. These developments, alongside the enactment of updated legislation and emerging case law, the latter influenced by the guidance set out in the HOP series, have ensured that each edition in its turn has become the gold standard of its time, each providing a historical record of “where we were then”. By 2005, the 5th and later the 6th (2011) editions moved significantly towards a more evidence-based and peer reviewed approach and have been endorsed by leading relevant organisations including the HSE, National Back Exchange, RCN, NHS Employers, Chartered Society of Physiotherapy and the College of Occupational Therapists.
Since that first edition, there has been a paradigm shift in care delivery from the NHS to community care, so that now there are arguably more workers delivering care that may involve moving and handling in the community (in care facilities, supported living and people’s own homes) than in the NHS, and not everyone who needs help is a “patient”. To reflect that shift, the fifth and sixth editions of the publication were retitled The Guide to the Handling of People to
Image: iStock/ alvarez
Electric profiling beds (EPBs) have bases that are sectioned so the mattress can be profiled to achieve various positions, the height can also be adjusted. Movement is powered and controlled via a bedside handset by care staff, or by the user to facilitate independence. These beds enhance comfort, facilitate repositioning, reduce the risk of pressure
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area breakdown and reduce the amount of moving and handling required of attending carers.
Multipositional aid is designed to provide supportive seating, tilt in space, lateral rotation and passive standing as part of an early in-patient rehabilitation programme such as patients recovering from prolonged ventilation in ICUs and avoids potentially high-risk moving and handling by critical care/rehabilitation professionals.
Using a ceiling track hoist can reduce the number of carers needed for specific tasks and reduce the overall moving and handling load for the carer(s) in that they do not require pushing across carpets and manoeuvring around other environmental obstacles such as cables, rugs, furniture etc. For individuals assessed as suitable, self-hoisting can facilitate independence.
Emergency lifting chair is used for lifting a fallen person from the floor which is a hazardous physically demanding task. The emergency chair is lightweight and can be assembled by one care giver around the fallen person. It is battery operated and raises them to a seated or semi-standing position, significantly reducing the strain and risk to both the carer(s) and the person being retrieved from the floor. An alternative forearm hold once the person is standing or walking. The handler’s right arm remains across the person’s back.
A non-powered device to assist the person who is able to stand with assistance, but unable to take steps, to transfer between horizontal surfaces (bed, seating, toilet etc). Note the posture of the handler.
Starting position to assist a person who needs assistance to stand up. The handler’s right arm is across the persons back. The handler offers verbal prompts and encourages the normal pattern of movement. TALKBACK l SPRING 2021
A powered device can assist a person who is unable to stand even with handler assistance. It can have an important role in rehabilitation and also assists in care transfers between horizontal surfaces.
In January 2020, the World Health Organisation (WHO) announced the outbreak of Covid-19 as a public health emergency. Of those critically ill Covid patients admitted to intensive care units (ICU), more than 50% developed Acute Respiratory Distress Syndrome (ARDS). ARDS in itself is nothing new and it had previously been established that oxygenation in these patients can be improved when ventilated in the prone (face down) position for periods of time. Manually manoeuvring a patient from lying on their back to lying prone is therefore an essential task aimed to increase the likelihood of survival in patients with ARDS. It is also a potentially hazardous task involving typically, six or seven appropriately trained ICU staff. It requires teamwork, timing, skill and the exercise of great care, to turn on to their front (or on to their back again) what is typically a heavy, unconscious and difficult load (patient) who may be intubated and be attached by lines and tubes to various pieces of medical equipment. From the ICU workers’ perspective, it involves force exertion, holding awkward postures, pushing and pulling, reaching and stretching, stooping and twisting on a repetitive basis with many patients over a long shift when the workload is high, the staff overtired and also wearing layers of restrictive and uncomfortable PPE. Many of you will have seen images of ICU staff involved in proning critically ill patients on your TV screens over the past many months. There is therefore a significant driver for identifying appropriate safer methods and equipment/materials for moving a patient between supine and prone and back to supine, and for disseminating that information to NHS Trusts and relevant workers, and the publication of HOP7 will be a significant contributor to that process.
Ultimately it is the responsibility of the employer to implement safe systems of work aimed to protect workers from the risks of developing work related MSK symptoms/ back pain as far as reasonably practical. In relation to the moving and handling of people in health and social care, the best practice standards to which employers should aspire, and that balance worker safety and person-centred care, have been set out in the HOP series of gold standard publications published by BackCare over the past 40 years. The seventh (2021) edition will represent a further step in that evolutionary process.
Jacqui Smith MCSP (ret), MSc (Human Factors), Editor 5th, 6th and 7th editions of The Handling of People. 5.4.2021. To preorder copies: media@backcare.org.uk
