A team approach to manual handling was implemented in a community aged care setting to reduce injuries. The team included managers, physiotherapists, nurses, and other staff who worked together to conduct client assessments, provide training to care staff, perform risk assessments, and develop solutions such as equipment trials and exercise programs. This collaborative approach helped empower staff, improve communication, and lead to early identification and reduction of manual handling hazards and risks. It also provided staff with support and opportunities to develop their skills. Case studies demonstrated how the team worked to develop customized plans to safely handle specific high-risk clients.

1. A TEAM APPROACH TO
MANUAL HANDLING IN A
COMMUNITY AGED CARE SETTING
GENIENE THOGERSEN BAppSc (Phty) Sydney
© Anglican Retirement Villages 2012

2. Overview
• Community North Team / client base
• ARV Community Initiatives
• Physiotherapy Assessment
• Training
• Risk Assessment / controls
• Challenges
• Benefits
• Manual Handling Case Studies

3. The Team:
July 2011 – Feb. 2012
• Manager: Co-ordinators : CACP, EACH & EACH D, CDC
• Physiotherapist Workplace Trainer – Manual handling focus
• Registered Nurse
• Workplace Trainer,
• Chaplain
•Administration assistant/roster co-ordinators
• Access to staff within ARV Health
• Access external health professionals
• Care staff- Certificate 3 in Aged Care

4. Staff and Client Profile
• 44 Care staff
• 38 Extended Aged Care at Home and
Dementia Clients
• 122 Community Aged Care Package
• 1 Consumer Directed Care - high care
client

5. Community
Services, Sydney North
extends from:
-Hornsby to Warriewood -
approx 33 kms
-Warriewood to Gordon -
approx 14 kms
-Gordon to Hornsby -
approx 21 kms.

6. ARV Community Initiatives & Timeline
• Post ‘April Zero Falls’ Month 2011
• Better Balance Program (BB) for at risk Community North CACP & EACH/D
clients planned.
• Small client group of 8 + BB physio, Community physio, guest speakers-
OT, Pharmacist
• Nov. 2011
• Initial 4 week BB program for medium falls risk clients
• 6 clients completed course
• Feb. 2012
• Retested after 10 weeks continued exercise supervised by care staff)
Further 4 groups planned for 2012

7. Better Balance Program & Community North
Team

9. ARV Community Initiatives continued …
The Step Back Program
Step Back Program
When would the step back approach be appropriate?
Aim:
To improve client care & decrease staff injuries due to client
aggression
Initiative:
Prompt staff to calmly assess & determine appropriate action.
Review:
Physiotherapist with MH expertise

10. Step Back – Keep Yourself Safe
1.
•STEP BACK
2
•REVIEW
3
•APPROACH WITH CAUTION

11. Physiotherapy Assessment
Validated testing
• Physical Mobility scale, Berg, TUAG, x 5 chair stands, Quickscreen Falls risk;
Muscle tone, ROM & exercise requirements
Additional
• Client symmetry, mobility, transfers, transport needs, adaptive clothing
needs, assistive devices [OT, sensory loss RN], primary carer’s role in MH
• Substitution of risks
• Causation
• Documentation
• Co-ordinator informs carers of manual handling updates

12. Ask yourself -
‘What will my instructions convey to
the newest, youngest, smallest
carer with potential cultural
interpretations?’

13. Care Staff /Agency advised re equipment position

14. Assessment continued …

15. Assessment continued …

16. Assessment continued …
Manual Handling Instruction Card

17. Clear Instructions

18. The Risk Assessment Approach
1. Historically – near-miss reporting and formal risk assessments low.
2. Result = Frustration at all levels. High incidents of injuries.
3. Action
• ARV Community Risk register developed.
• Risk assessment within the team - New equipment, new clients, changes in
client’s mobility, Manual Handling work practices.
• Risk Assessment Courses offered.
• Equipment trials in client’s home essential.
• Transporting clients – consideration of all factors.
• Policy rewritten to support hierarchy of control.
• Personal risk factors of carers - Each service for a client will be different.

19. Complacency is dangerous.
It does not foster a risk
assessment approach.
To reduce injuries we must take an
assertive and proactive approach
to risk assessment.

20. Manual Handling Risk Factors
Duration
&
Frequency Location of Loads
&
Distances Moved
Workplace
&
Workstation Layout Weights
&
Forces
Actions
& Work
Movements Organisation
Manual Handling
Risk Factors
Other
Work
Factors
Environment
Special
Needs Working Posture
& Position
Clothing Characteristics
of the
Load/Equipment
Skills
&
Experience

21. Risk Assessment Workcover: Guideline to Risk Ax in Aged Care]

22. Training
Manual Handling Induction - Community
Initial training
• Workplace trainer demonstrations of equipment
• Safe work procedures and simulated learning activities
• Minimum 2 day buddy shift
• Review activities
Delayed staff competence
• Buddy with WPT and/or physio and attend client’s service/ home.
Continued poor practice
• Coaching & re-allocation
• Modification of work tasks.

23. Training continued …
•For EACH & EACH D client’s with complex manual handling needs, co-ordinator
will if possible engage preferred Agency staff with appropriate skills.
• Mandatory yearly updates for EACH and EACHD staff for manual handling to
provide opportunity for up skilling and further mentoring. External training if
necessary.
• Ad hoc coaching and mentoring by Physiotherapist / OT, Co-ordinator & or
Workplace Trainer is provided where reassessment identifies altered manual
handling work practices or client’s care/equipment needs .

24. Meeting the Challenges
Challenges Meeting the Challenges
ARV Community clients or their Risk assessment is still required, greater
advocates have a greater awareness of carer support for manual handling hazards
end of life directives, choices in staying at
home [eg Palliative Care] etc
Increased demands on Community Engage CACP clients earlier,education,BB
service providers. classes
An ageing workforce –showing some Rotation of tasks, mentoring & support,
limited physical ability for sustained teaching posture, stance, static
manual handling of high care clients abdominals
Young, new Community staff lacking Best practice buddying, mentoring and
manual handling knowledge and skills. supervision.
Attracting Nursing & Allied Health students
as carers for shared knowledge

25. Meeting the Challenges
Challenges Meeting the Challenges
Communication – client, family and staff Co-ordinator directs the team
all hearing the same message.
Families distress over client’s altered Family Conferences -doctor , client or
cognition or mobility may overshadow advocate, Co-ordinator, OT, RN,
goals for client’s safe manual handling Physiotherapist, ‘Bright Minds’ Team.
and care
Providing ongoing and timely staff Bright Minds team, mental health
education team, RN’s,Palliative Care,Physiotherapy
How to optimise client mobility & Continue 4 week Better Balance
independence and decrease falls risk Programs for small groups
whilst prompting less manual handling Trial equipment
of clients.
Dealing with clients who have a Continue support for use of Step Back
potential for aggressive behaviour. program by all staff .

26. Benefits of a Team Approach
• Empowerment of ARV Community care staff to understand their
responsibilities and the importance of early disclosure of hazards & risks. [Co-ord
.Survey Jan. 2012]
• Early disclosure and reduction of hazards and risks has improved
• Staff feel supported as part of the team by co-
ordinators, WPT, physio, RN, WH&S rep. & manager. [ARV Community North
Standards Review Report Sept.2011- NSW Dept.Health & Ageing.
• Staff in Community North can see a career path for themselves.
• Timely referral to relevant team members for assessment of CACP client with
high risk manual handling needs.

27. References
Journal Articles
• Larsson,B. (2010). Evidenced-based ergonomics. Exploring new directions in people handling. AAMHP. Sydney.October 2010.
• Marras, W., Davis, K., Kirking, B., and Bertsche, P. (1999) A comprehensive analysis of low back disorder risk and spinal
loading during the transferring and repositioning of patients using different techniques. Ergonomics, 42(7), 904-926
• Mitchell, T., O'Sullivan, P.B., Burnett, A.F. and Rudd, C, J. (2008), Low back pain characteristics from undergraduate student to
working nurse in Australia: A cross-sectional survey, International Journal of Nursing Studies. Nov;45(11)
• Naughton,V.and Stafford,D.(2010). Hands off training for health professions in effective mobility management for people with
dementia. Exploring new directions in people handling. AAMHP. Sydney, October.
• Engkvist,I. (2006). Evaluation of an intervention compromising a No Lift Policy in Australian hospitals. Applied
Ergonomics, 37(2).141-148.
Books
• Chaffin, D. & Andersson ,G. (1984), Occupational Biomechanics, USA:Wiley.
• Hignett,S., Crumpton,E., Ruszala,S., Allexander,P., Fray,N. and Fletcher,B. (2003).Evidenced-based patient handling:
Tasks, equipment and interventions. London:Routledge.
Teaching Materials
• A.R.V, (2010), ARV Induction - Manual Handling : Safe Work Practice Summary-Version 5
• A.R.V, (2011),Brightminds-The Step Back Program ,Trainers Guide.
• Lusted, Marcia (2000).Manual Handling Instruction Card. Ergonomics Australia Pty.Ltd
• Rothmore,,Paul and Elix,Gillian.(2004) ,Patient transfers-Forces. ,R.G.H Adelaide & Flinders Medical Centre,S.A
Websites
• National Occupational Health and Safety Commission http://www.nohsc.gov.au/SmallBusiness/BusinessEntryPoint/laws/
• Workcover http://www.workcover.nsw.gov.au/default.htm . Aged Care Risk Control Worksheet,,June 2010

28. CASE STUDY 1
• Client attended in bed –contracted right side, tonic movements left side,
actively assists by turning head only
• Rigid right elbow and right lower limb.
• Wife insists on client being dressed in singlet,button-up pyjama shirt
and pyjama pants,over pull -up continence aid.
• Care staff increasingly complaining of back soreness and shoulder aches
whilst rolling and dressing rigid client.
• PLAN ….

29. CASE STUDY 2
• Palliative care client is now unable to stand but her husband wants to take her
out in wheelchair.
• Stand up lifter was used previously by 2 staff with client when client could
partially weight bear.
• Now sling lifter is more appropriate for all clients transfers into air chair rather
than wheelchair. Appropriate now as client has no antigravity sitting balance and
is rigid in extension due to pain.
• Client’s husband still wants wife to be showered on commode, ‘’wash her hair
etc’.’ To minimise a falls risk staff have been restraining client in wheeled
commode whilst pushing commode to shower.
• PLAN ….

30. CASE STUDY 3
• Client is a high falls risk as has Lewy Body Dementia with poor insight and
Parkinsons Disease,
• EACH D Client is varying in his mobility; morning for 2-3 hours much better
mobility –Physio assessed him mid morning with 4 wheeled walker and stand-by
assistance, short distances-poor turning ,’freezes’ in doorways.
• Client refuses to use newly prescribed four wheeled walker, & due to his cognitive
deficit, staff are providing a 2 hour socialization in late afternoon (discussion, meal
preparation program) x 5 per week. Compliance varies.
• Family do not prompt use of walker. Hip protectors prescribed but not worn.
• Falling frequently in a.m. now as client tries to get up from chair at will, if not
supervised.
• PLAN ….