Getting to grips with hoisting people

HSE information sheet Health Services Information Sheet No 3

A short guide from the sling. For example, access/toileting slings give a great degree of access but very little support This information sheet explains the problems and their use should therefore be restricted to associated with hoisting people and sets out guidance toileting purposes, where appropriate.* to deal with them. It covers fixed, mobile and ■■ Incompatibility of the hoist and sling – resulting overhead hoists. The advice is intended for health and in insecure attachment between the two. For social care providers or other organisations who move example, incorrectly attaching a loop on a sling and handle people and will help them to comply with to a spreader bar designed for a clip attachment, their legal duties. or attaching a clip on a sling to a spreader bar designed to take a loop attachment. Follow the manufacturer’s advice and refer any concerns What are the issues? about sling/hoist design, supply, manufacturer’s instructions or compatibility claims to the MHRA, The use of hoists has become an integral part of the regulator for medical devices delivering health and social care services. Although (www.mhra.gov.uk). the use of hoists can reduce musculoskeletal risks, ■■ Failure of equipment due to poor maintenance, you should consider the other risks associated with lack of inspection, inappropriate laundering hoisting people. Each year a significant number of processes or as a result of inadequate repair or incidents are reported in which people have been modification. injured while being moved using hoisting equipment. ■■ Leaving a vulnerable person unattended in a hoist, Between April 2001 and December 2007 there were or in a position where they might be at risk of falling 163 hoisting accidents reported to the Health and from the bed or chair. Safety Executive under the Reporting of Injuries, ■■ Hoist overturning when manoeuvring over difficult Diseases and Dangerous Occurrences Regulations surfaces, transporting an individual over a long (RIDDOR). An average of 120 incidents per year are distance on a hoist, or not following manufacturer’s reported to the Medicines and Healthcare products instructions for use or safe systems of work. Regulatory Agency (MHRA). ■■ Not using the safety harness/attachment (if the sling specified for the individual has one). The degree of injury varies, depending on the vulnerability of the hoisted person, the nature and consequences of the fall and what the falling person makes contact with. Falls during hoisting have resulted in severe injuries, from broken bones through to fatalities. * Note: Sling sizes and coding varies between manufacturers. There is a risk of using an inappropriately sized sling if you make assumptions without checking the suitability of a specific sling for the individual. What can go wrong? For example, two large slings from different manufacturers may be different sizes – the body of the sling may be a different length or People can fall during hoisting for a variety of reasons. the number of loop attachments may differ, resulting in a different lifting position. Additionally, sling designs can alter over time, so a Problems include: new sling from a manufacturer may differ in size or attachment strap length from one previously purchased. Some slings come with a ■■ Selection of the wrong size sling – resulting in range of different length loops for attachment to the hoist. These discomfort if the sling is too small and a risk of the can be used to increase the comfort of the individual or put them person slipping through the sling if it is too large.* in a more reclined or upright position. However, you should take great care to choose the correct loops for the individual so that they ■■ Selection of the wrong type of hoist or sling for are not at risk of slipping from the sling, and to use the same loop the individual, or for the specific task – resulting in configuration on both sides to reduce the risk of the person falling inadequate support and increased risk of falling from the sling sideways.

■■ Instability when moving someone on a mobile Examples of a patient moving and handling hoist – resulting in them striking objects. This assessment form and safer handling plan can be is likely to cause injury, especially to those with found in the All Wales NHS Manual Handling Training vulnerable skin, and will increase the risk of a fall Passport and Information Scheme: or overturn. In many cases, assessment will show http://www.wales.nhs.uk/documents/NHS_manual_ that two handlers are required: one to operate handling_passpor.pdf the hoist; the other to help steady things and, where needed, support the person’s lower legs to The equipment keep them in a safe position when moving from one place to another. Importantly, they can also Lifting equipment is subject to additional requirements, provide direct reassurance to the person being including a thorough examination by a competent hoisted to maintain their co-operation and reduce person. Hoists and slings are medical devices and the the likelihood of them contributing to unstable equipment manufacturer is required to provide suitable movement. instructions for use, including compatibility information and guidance on the checks you should carry out Case example: Mrs W had been resident in a before each use. nursing home for two years. She was unable to weight bear or move independently. While being The staff hoisted from a bath by a new care assistant who had not received training, and had not used that Share the handling plan with all those involved to particular type of hoist and sling before, Mrs W ensure that workers know how to handle each slipped from the sling and fractured her shoulder. individual. They may also be able to contribute to She died as a result of a subsequent pneumonia the development of the handling plan to ensure the infection. The hoist and sling used required active chosen options are workable. Make sure that staff participation of the resident and was not suitable are trained in the specific equipment and techniques for Mrs W, or for hoisting from a bath. Risk so that they have the skills and competence to carry assessments and procedures for manual handling out the handling plan and understand the risks and and bathing had, in general, not been brought to measures to control them. The Management of the attention of care assistants and supervision was Health and Safety at Work Regulations 1999 require inadequate. The company was prosecuted and fined employers to have access to competent persons who £90 000. can assist them in the measures needed to comply with health and safety requirements. Employees have duties too; they should: What should I do? ■■ follow appropriate systems of work, as identified The person for individuals in their handling plan, and use the equipment provided; Consider whether a hoist is the most suitable handling ■■ co-operate with their employer and let them know aid and, if so, devise a handling plan to match the of any problems; and individual’s ability and meet their needs and those of ■■ take care to ensure that their activities do not put the workers involved. It should specify the appropriate others at risk. hoists and slings for the individual and the type of transfers required. It should also take into account the The lift views and preferences of the individual being hoisted. If in any doubt, seek competent advice. Before hoisting, undertake an assessment of the risks, taking account of the individual’s handling plan, The handling plan should cover the range of and put in place actions to reduce the risk of injury. activities where a person may require assistance Lifting operations should be properly planned and with moving and handling, eg transfers bed to chair, carried out in a safe manner in accordance with the into bath etc. The plan should be easy to read and Lifting Operations and Lifting Equipment Regulations clearly state the control measures for moving and 1998 (LOLER). The Workplace, Health, Safety and handling the individual, including: Welfare Regulations 1992 require those in control of workplaces to make sure that floors and traffic ■■ specific equipment needed; routes are maintained in good condition and free from ■■ techniques to be used; obstructions, and that there is suitable lighting and ■■ number of handlers required; ventilation in the workplace ■■ sling attachment loops to be used; and, where applicable ■■ leg configurations etc.

Maintenance It is important that supervisors also receive training so that they are able to monitor, identify and correct Ensure there are adequate systems in place for poor practice. There is no firm rule about how maintenance and inspection of hoists and slings in line often training should be given. However, skills will with the manufacturer’s instructions, the Provision and inevitably deteriorate over time. Provide update or Use of Work Equipment Regulations 1998 (PUWER) refresher training periodically, or when competency and LOLER. The MHRA device bulletin on managing assessment identifies the need for further training. medical devices, DB2006(05), gives some guidance You will also need to provide training when new lifting on this topic. aids are introduced, or there are changes to the method of work.

LOLER: Where lifting equipment, including hoists and slings, is used by people at work the Lifting Case example: An immobile, 90-year-old patient, Operations and Lifting Equipment Regulations apply. Mrs B, suffering from dementia, had been on a In addition to routine maintenance and servicing, rehabilitation unit for some time following a fall. LOLER requires lifting equipment to be inspected She was assessed by a nurse as needing a small- and thoroughly examined. Thorough examination sized full-body sling for all transfers in hospital. No by a ‘competent person’ is required either at six- other patients on the ward at that time required monthly intervals or in accordance with a written the small sling and the sling was usually found in scheme of examination drawn up by a ‘competent her wardrobe. The sling had not been detailed on person’. A competent person is someone with her moving and handling risk assessment or care the relevant technical knowledge and practical plan, which simply stated ‘hoist for all transfers plus experience of lifting equipment to enable them to two people’. When two staff, who had not been on detect defects or weaknesses and to assess their duty for some weeks, were getting the dependent importance in relation to the safety and continued patients up and washed, they found the small sling use of the specific equipment being examined. in Mrs B’s room. Mrs B protested that it wasn’t the right sling and that the sling had hurt her. So, instead, they used the large full-body sling, which Monitoring was draped over the hoist, to lift her from the bed to a commode. During hoisting, Mrs B slipped down Check that handling plans are being followed, and through the access aperture in the sling and rapidly revise and update if the needs of the individual or fell, striking her head. Mrs B died and the hospital other factors affecting the plan change. was subsequently prosecuted and fined £20 000 plus costs for failing to ensure her safety because the correct sling size had not been communicated Training to staff, nor did they know how to correctly size and select a sling for this individual. Employers need to make sure that staff receive adequate training and information on people moving and handling. Practical training has an important The annexes to this guidance provide safety checks role to play in ensuring that staff have the skills and and other measures for employers and those hoisting confidence to hoist people safely. In addition to people to consider to help them ensure safe handling. practising equipment selection and use, staff need Figure 1 provides a checklist for using a mobile hoist in to understand the principles of hoisting, the potential the form of a useful flowchart. risks, how to use the specific equipment they have in their workplace and how to implement individual handling plans.

Annex 1 Checklist to help with hoisting they are being lifted to obtain sufficient clearance. ■■ Check attachments remain secure and the person The following checklist, compiled by a group of is comfortable before proceeding further. manual handling professionals, represents safe ■■ If there are any problems, lower the person into a handling practice and will remind those hoisting safe position and seek further advice. people of points to consider to reduce the risk. ■■ Follow manufacturer’s instructions and local The list does not aim to cover every individual policies and procedures with regard to care and circumstance and assumes that the handler has cleaning of the hoist. received relevant and current training in the transfers ■■ Place battery-powered hoists on charge, as and equipment used. identified in the instructions, when not in use or ensure back-up battery is charged. ■■ Do not leave the person unattended in a hoist. Checklist Additional guidance for mobile hoists All hoisting tasks ■■ Avoid using the hoist to transport over distances, ■■ Read the handling plan and ensure it is current thresholds or different surfaces unless otherwise and relevant. stated in the handling plan. ■■ Review the person’s condition prior to each ■■ Do not apply brakes during hoisting with transfer to ensure continued suitability for hoisting mobile hoists (unless otherwise stated by the and the use of the equipment. manufacturer and handling plan). Note: This does ■■ Ensure the person’s weight does not exceed the not apply to certain types of equipment where the SWL of both the hoist and sling. brakes need to be applied, for example standaids. ■■ Do not use the hoist/sling unless you have had the ■■ Ensure hoist legs are in the most stable position. necessary training. ■■ Store the hoist in a safe place with boom/jib ■■ Check the correct hoist and sling specified in in lowest position and with brakes on when the handling plan are available and servicing and not in use. thorough examination are in date. ■■ Ensure the equipment works and is free from Additional guidance for ceiling track/overhead observable defects before starting. hoisting systems ■■ Hoists and slings must not be adapted or misused. ■■ Before each use, check the hoist and sling in ■■ The motor should be directly overhead, and make accordance with the equipment manufacturer’s sure the lifting tape is vertical to the lift to avoid guidance on inspections and pre-use checks. wear and tear and/or malfunction. ■■ Familiarise yourself with the hoist’s emergency ■■ Elevate the spreader bar to its highest possible lowering systems. position when not in use. ■■ Check there is a sufficient number of handlers to ■■ Return the hoist to its docking station, where carry out the task safely in accordance with the appropriate, for charging when not in use. handling plan. ■■ Ensure the tracking and pathway is clear of ■■ Ensure the environment is free from obstacles and obstructions. the floor free of slip and trip risks. ■■ Be familiar with how freely the motor moves on ■■ Ensure the support surface is ready and safe to the tracking. receive the person. ■■ If using a portable lifting pod/motor, develop, ■■ When manoeuvring the hoist into position to implement and follow guidance for a safe way of connect to the sling, bring the spreader bar/carry transporting and attaching. bar down slowly, holding where necessary, to avoid ■■ Do not drag the pod/motor using the lifting tape as contact injuries with the individual. it may cause damage to the hoist. ■■ If there are any concerns about the equipment, task, person, environment etc, handlers must Additional guidance for standing hoists follow organisational procedures immediately. ■■ Communicate with everyone involved in the task ■■ The person must be able to consistently and at all times. reliably bear weight through their legs and have ■■ Ensure safety and comfort of the person at sufficient upper body muscle strength/sitting all times. balance. ■■ Reassure the person at all times and involve them ■■ The person must be able to co-operate and as much as possible. physically participate in the hoisting process. ■■ Prior to raising, check the sling is positioned ■■ Some standing hoists need using with care if the correctly and double check the sling attachments. person has knee problems, sensitivity or vulnerable ■■ Hoist the person just above the surface from which skin on their legs.

Additional guidance for slings

■■ Ensure the sling is compatible with the hoist. ■■ Double check the loops/clips are attached to the spreader bar throughout the hoisting procedure. ■■ Use the correct loop/clip configurations as identified in the handling plan. ■■ Ensure the sling and attachments are not caught/ stuck on any equipment when starting the lift.

Additional guidance for bath hoists

■■ Make sure staff are fully trained on the specific bath hoist and with the equipment in the bathrooms. For example, height-adjustable baths etc. ■■ Ensure the environment is safe. For example, floors not slippery/wet, sufficient space. ■■ Using bath oils, bubble bath, lotion, talc etc may make the surfaces slippery and affect the use of the equipment. ■■ Check the temperature of the water. ■■ Ensure correct fitting of lap strap (also known as safety belt/seat belt/safety harness) unless otherwise risk assessed. ■■ Mobile and ceiling track hoists may also be used for bathing – see mobile and ceiling track hoist guidance.

Annex 2 Equipment safety checks prior Environment to each use Ensure: ■■ Is the equipment as specified in the handling plan? ■■ Do the hoist and sling have a ‘CE’ mark on them? ■■ the environment is prepared for the task; ■■ Is the person’s weight below the SWL of both the ■■ there is sufficient space and access around and hoist and sling? under furniture to use the hoist safely; ■■ Are hoists and slings within LOLER thorough ■■ the floor is clear of obstacles, eg trailing cables; examination dates? and ■■ Has the hoist been serviced in accordance with