A Professional’s Guide to Moving & Handling
by Tess Whitehead
This guide has been produced to assist case managers in understanding the mechanics of a moving & handling assessment including; when to commission one, what it involves and what should be delivered by the assessor.
What do we mean by moving & handling?
The Manual Handling Operations Regulations (MHOR) 1992 define it as:
“… any transporting or supporting of a load (including the lifting, putting down, pushing, pulling, carrying or moving thereof) by hand or bodily force.”
Essentially, any activity that requires an individual to lift, move or support a load, will be classified as a manual handling task. For our clients this often translates into their altered movement needs following traumatic injury. The moving & handling of people forms part of the daily living routines in washing, dressing or transfer into chairs or vehicles. Moving & handling can constitute one individual providing physical support to another or a team or solo carer using a variety of equipment in the process. The needs and safety of the client and their carers performing the moving & handling techniques are paramount.
When to commission a moving & handling assessment?
Many of our clients’ moving & handling needs are identified through their INA or ongoing rehabilitation. For some, the needs can be addressed by the assessing or treating occupational therapist. For example we may identify and assess a husband assisting his wife out of her chair or off her bed in an unsafe manner as part of a housing assessment. In these circumstances we would document that we had demonstrated the correct transfer and supporting techniques in our report to highlight it to the case manager but there are unlikely to be any ongoing moving & handling techniques unless the needs change.
Moving & handling assessments and subsequent plans are commissioned for a variety of reasons. Below are some examples of why a case manager would instruct a moving & handling expert:
- A client who was previously managing independently or with minimal support may have a deterioration of their current function and there is a need to introduce equipment and a more formal plan.
- A client with complex needs that is going to be discharged from a rehabilitation setting into their own home with a care package to support them. They are likely to require a full assessment, equipment provision and carer training.
- A client who has a plan in place but the care team has changed or they are moving to a new property. It is always advised that a moving & handling review is completed whenever there are changes in circumstances.
Whatever the reason, the aim is to identify and mitigate risk to both the client and their carers.
What happens during an OT Moving & Handling assessment?
Once a referral for a moving & handling assessment has been received, our OT will contact the nominated person to introduce themselves and arrange the assessment. During this conversation we will discuss the assessment process, answer any questions and advise on who would ideally be present. Depending on the needs of the client, aim of the assessment and instruction from the case manager, we normally ask for the main carer to be present and for the client to be well on the day of the assessment. If they are unwell for any reason, the assessment is both unduly difficult for them and their carers but will also provide the OT with an inaccurate picture of the situation. We provide contact details both verbally and in the email confirmation for assessments to be cancelled if needed.
On the day of the assessment the OT will spend some time talking to all parties to put them at ease and ensure that they are comfortable with the assessment process. This ensures we get the best possible outcome from the assessment. The OT will be analysing the physical environment from when we arrive at the property including structural consideration, layout, furniture and belongings. We will use the INA and referral information to ensure we do not duplicate questions or information but will gather a medical history, diagnosis and prognosis as well as discussing stamina, pain, fatigue, muscle strength and pressure care.
Providing the client is well and able to proceed with the assessment the OT will ask to observe their current transfers, handling tasks and care routines.
In order to gain an accurate picture of the carers situation and provide advice and guidance pertinent to them personally, the OT will ask about any pre-existing conditions or physical limitations that they may have; this information given will be treated in confidence.
The OT will use the moving & handling legislation, best practice and guidance to form a framework around their assessment. They will use the five facets of manual handling activities in their analysis.
- The TASK: does the task involve twisting, stooping, bending, excessive travel, pushing, pulling or precise positioning of the load, sudden movement, inadequate rest or recovery periods?
- The INDIVIDUAL: We will look at the height, weight, physical abilities and limitations, experience and skill level all parties involved.
- The LOAD: This involves assessing the client themselves. We will look at their weight, height, skin integrity, muscle tone, medical conditions and features such as seizures, spasms, likely prognosis, fatigue patterns, medication, current transfer abilities.
- The ENVIRONMENT: are there space constraints, uneven, slippery or unstable floors, variations in floor levels, extremely hot, cold or humid conditions, poor lighting, poor ventilation, limited access through doors, up/down stairs, dirty floors/carpets?
- OTHER: factors: does clothing affect the task, have the client’s views/wishes been taken into account, does the carer feel the client is making an inappropriate handling choice, are carers using technciques they are not happy with. Does the task require additional skills/training. Are there communication/language barriers?
Once the above has been ascertained, in addition to the client’s dally routine, goals and any other considerations, the OT will evaluate the risks. The aim is to reduce the risks to the lowest level reasonably practicable.
The Moving & Handling Assessment report
The report
The OT Practice Moving & handling assessment report is a bespoke document that pulls together all of the considerations identified in the assessment. There should be sections highlighting the client’s level of physical and cognitive ability, pressure care, current transfer abilities, medical conditions and associated symptoms such as spasms or seizures. The document should also contain sections on the environment, current equipment and transfer techniques used and any carer’s considerations. There should be a detailed risk analysis and assessment and recommendations for training, equipment trials and reviews.
Equipment recommendations
When commissioning a moving & handling assessment you are asking an expert clinician for their opinions and clinical recommendations based on their knowledge and experience. The report should conclude with a detailed list of recommendations to address any issues that have been identified. It is more than likely that equipment will be part of these recommendations and if so there is a question of where to source it, what specific make and model and costings? On occasions, a moving & handling assessor will be able to make equipment recommendations based on the information gathered at the first assessment. In which case they should detail the exact make, model, cost and suggested supplier to make the funding request and purchase as easy as possible for you.
When a client has more complex needs, lives in a challenging environment or may require bespoke solutions, the OT may recommend trials with certain pieces of equipment to ascertain their suitability for the individual client’s needs. The OT’s experience will provide them with a provisional knowledge of the equipment they wish to trial and who to contact to arrange this. They will recommend a time to arrange and attend the equipment trials and ascertain quotes to review before passing these onto the case manager with their approval or comments.
The OT Practice is a modern and innovate practice and our team are extensively knowledgeable on the range of moving & handing equipment available. Through robust continueing professional development we ensure our equipment recommendations are effective in reducing care costs whilst enabling all parties to carry out effective moving & handing.
Moving & handling plan
A moving & handling assessment report should be supported by a comprehensive handling management plan that remains with the client to facilitate a consistent moving & handling approach. This document should be shared with all relevant professionals and carers involved with the client as it provides concise and easy to follow instructions on how to move the client. The document is often accompanied by pictures or photographs to illustrate equipment use and transfer techniques.
Training
It is considered best practice that when any equipment is provided it is followed up with a review to assess suitability and any necessary training to the client or carers on appropriate use or techniques. This is never truer than in the prescription of moving & handing equipment. Whilst formal carers have basic moving & handling training, they will not have been provided with bespoke training for each client’s individual needs. Family members or informal carers are not likely to have had any training at all. Providing this training, support, reassurance and increased confidence is a vital part of the occupational therapy role.
Through the assessment, the OT will ascertain the level of foundation knowledge of the carers for them to build on. The OT will recommend training once the new equipment has arrived to ensure they know how to use and store it safely, when to use it as part of a rehabilitation program and, most importantly, how to mitigate any risks whilst maximising the client’s independence, function, dignity and safety.
Training can take many forms depending on the needs of the situation. With a large care team and a client with complex needs, training may consist of several smaller workshops and then practical demonstrations around the client’s daily routine and carer rota. Or, for an individual carer, it may be an individual one to one session going through the moving & handing plan together.
It is essential that training is kept up to date and reviewed at least annually. The plan is a working document and a review is recommended whenever there are changes in the client’s condition, the general environment or the tasks being performed. Reviews and updates of training should be in-line with moving & handing plan reviews, which the OT will advise on as part of the recommendations in the report and in the provided plan.
Maintenance of Equipment
If equipment or ‘assistive devices’ are provided they must be adequately maintained to ensure that they continue to be suitable and safe for use. The responsibility for maintenance generally lies with the employer if paid carers are involved. In these circumstances, the Provision and Use of Work Equipment Regulations 1998 (PUWER) will apply. Depending on the type of equipment. The Lifting Operation and Lifting Equipment Regulations 1998 (LOLER) may also apply. As part of the training and risk mitigation carers should be educated on what to look out for in the use of the equipment and how to identify signs of equipment failure. This may include wear and tear that they may not immediately identify as posing a risk such as signs of sling fabric weakening, fraying or stiching becoming loose on a sling.
To discuss how The OT Practice might assist your clients in the areas of moving & handling please contact one of our dedicated Client Managers on 0330 024 9910 who will be able to discuss in detail how we can support you in delivering the best possible service to your clients.
Useful web links
For further details on the Manual Handling Operations Regulations 1992 (MHOR), you can view their website (www.hse.gov.uk). Additionally, for further information on vocational rehabilitation please visit the Vocational Rehabilitation Association website, where you can download their free Standards of Practice document (vrassociationuk.com).
Suggestions for further reading
Smith, J. (Ed). 2011. The guide to handling people (6th Ed). Middlesex: Backcare/Royal College of Nursing
Alexander ,P & Johnson C (2011) Manual Handling of Children, National Back Exchange, Towcester, UK
Phillips J, Mellson, J, Richards N, (2014) It Takes Two: Exploring the Manual Handling Myth’ HFH Consulting/Salford University/Prism Medical, March 2014
