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A 4-step process
Managing the risks of moving and handling people is a 4-step process. The steps are as follows.
- Identifying hazards associated with hazardous manual handling.
- Assessing, where necessary, any risk of musculoskeletal disorders (MSD) associated with hazardous manual handling.
- Controlling the risks of MSD associated with hazardous manual handling.
- Monitoring, reviewing and, where necessary, revising risk controls.
Consultation with employees and any health and safety representatives (HSRs) takes place throughout the process.
The risk management process
The continuous cycle starts with consultation, followed by 4 steps:
- Identify hazards.
- Assess risks.
- Control risks.
- Review and revise risk control measures
Consultation continues throughout each step.
1. Identifying hazards
Employers must identify any work – current or planned – that involves hazardous manual handling. Hazard identification helps reveal the care-related tasks that create a risk of MSD. It is the first step in the risk management process. Handling people is considered hazardous manual handling where it involves the use of force to lift, lower, push, pull, carry or move, hold or restrain someone.
Employers need to make it easy for employees to report problems, hazards or risks immediately. They should also encourage employees to do so. This helps ensure risks are managed before an injury occurs.
Consultation with employees and any HSRs is crucial to identifying risks arising from hazardous manual handling. Employees doing the work have first-hand experience of the tasks and potential risks and hazards.
Other ways to identify hazards associated with moving people include the following.
- Surveying employees.
- Consulting the people being moved.
- Observing how employees work, with a focus on factors such as:
- posture
- movements
- forces
- the use of mechanical aids or assistive devices.
- Reviewing available information such as:
- discomfort surveys
- workplace inspections
- hazard, incident and injury reports from employees and people handled
- maintenance and repair records
- records of risk controls
- investigation findings
- compensation claims
- staff absentee data
- documents provided by industry associations or unions
- WorkSafe publications and webpages.
- Looking for trends to common problems.
WorkSafe’s Hazardous manual handling identification tool and Discomfort survey can help with hazard identification.
Discomfort survey
2. Assessing risks
Risk is the possibility of harm when someone is exposed to a hazard. Risk assessment involves working out:
- what levels of harm can occur
- how harm can occur
- how likely it is that harm will occur.
Just as they do when identifying hazards and risks, employers must consult with employees and any HSRs when assessing risks. Employers must consult so far as is reasonably practicable.
Leaders and employees should be trained in how to assess risks from handling people. You’ll find guidance on the WorkSafe website about how to carry out a risk assessment.
Risk assessments should be done regularly, particularly when a new person is admitted or a person’s condition changes.
What to consider when assessing risks
A risk assessment should consider the following factors.
- Physical environment
Physical environment includes the following elements.
- Limited space, for example:
- size of the room
- bathroom
- doorway entrances
- elevator size.
- Mechanical aids and assistive devices, particularly their type and availability. This can include, for example:
- the number of mechanical aids and devices
- appropriateness for the task
- requirements for the use of aids and devices
- requirements for where they are stored in relation to where task is taking place.
- Entry and exit routes.
- Floor surfaces, including the presence of uneven surfaces that can make it difficult to push wheelchairs and other equipment with wheels. For example, carpet or raised lipping between bedroom and bathroom.
- Condition and design of furniture, for example:
- low couches for elderly people
- fixed cabinetry that cannot be moved.
Lighting, temperature and noise.
- Limited space, for example:
- Psychosocial hazards
Psychosocial hazard means any factor or factors in any of the following:
- work design
- systems of work
- management of work
- carrying out of the work
- personal or work-related interactions
that may:
- arise in the working environment, and
- cause an employee to experience one or more negative psychological responses that create a risk to their health or safety.
Psychosocial hazards that may increase the risk of harm from work that involves moving people include the following.
- Poor support, for example, inadequate rostering and staffing.
- High job demands, for example:
- excessive hours of work
- high workload
- inability to rotate tasks
- inadequate breaks
- high-paced work.
- Remote or isolated work, for example, working in a patient’s home.
- Low job control, for example, inability to adjust tasks.
- Inadequate information, instruction, training and supervision.
- People factors
Assess how much help the person needs with their move. Consider the following factors.
- Cognitive ability, literacy and understanding. The person may:
- be from a non-English-speaking background
- have trouble understanding verbal instructions
- have a cognitive impairment
- be unable to help because they cannot follow instructions or are unpredictable.
- Behaviours such as:
- resistive, unpredictable and uncooperative behaviours
- behaviours of concern
- work-related aggression or violence.
- Physical signs such as the person’s:
- weight and weight distribution, including whether they require bariatric care
- height
- lying width
- seated width
- girth
- mobility
- fragility
- skin integrity
- amputations
- fatigue
- rigidity
- medical diagnosis and condition.
- Clinical constraints, such as:
- treatment or post-surgery care plan
- pain
- inability to lie flat
- intravenous lines
- drainage bags
- intubation
- medication-induced reactions, for example, paralysed and sedated state.
- Cognitive ability, literacy and understanding. The person may:
Bariatric
The term ‘bariatric’ is an internationally accepted term. It applies to people with a Body Mass Index (BMI) that exceeds a range where body size restricts mobility, health or access to services and equipment. Generally, the height and shape of people who require bariatric care varies.
Weights may range from 100 kg to more than 400 kg. People who require bariatric care may also exceed the weight and size limits for available furniture and person-handling mechanical aids.
When assessing the risk of handling people, employers need to know the:
- weight and dimensions of the people they handle
- dimensions and safe working load of the working environment, furniture and equipment.
- Funding and other supports
Funding and other supports include:
- funding of appropriate built environments and furniture
- funding of appropriate systems
- funding for appropriate equipment
- funding for appropriate staff
- established carers, support networks, guardianship and family
- self-funded care.
- Workplace design
Safe handling of people starts with good design. Architects and builders should think about people-handling tasks when designing and building healthcare and social assistance facilities.
When facilities are built, it is important to check each space supports safe handling practices.
Managers, employees and any HSRs should inspect and assess each room of the facility. This will help work out whether changes are needed to ensure the buildings, fixtures, fittings and mechanical aids support the organisation’s handling principles and techniques.
For example, an overhead room-coverage hoist system is a better option than a single-track or mobile hoist. Overhead room-coverage hoists have the following benefits.
- They require less force to move.
- They are more efficient and increase the functional treatment area.
- They are more acceptable to people being lifted and reduce the time needed to move a person.
- They are better for carpeted rooms where it is difficult to manoeuvre mobile hoists, hygiene chairs and wheelchairs.
Evidence suggests that using ceiling hoists to move people reduces:
- injuries for employees and those being moved
- workers compensation claims.
Overhead room-coverage hoists should be installed in all new and refurbished facilities where the handling and moving of people takes place.
Tools and guidance are available to guide physical environment and workplace design. They include the following:
- Australasian Health Facility Guidelines Resource Part C: Design for Access, Mobility, Safety and Security
- Compliance code: Hazardous manual handling 2019, including Appendix B – Hazardous manual handling identification sheet and Appendix D – Risk assessment and control worksheet
- Hazardous manual handling identification tool
- Hazardous manual handling and return on investment: Scoping review.
3. Controlling risks
Employers must control any risks associated with moving and handling people, so far as is reasonably practicable. They must do this in line with the hierarchy of control.
Employers must start with the hierarchy’s highest level of control – elimination. They must only move to the next level of the hierarchy if the higher level is not reasonably practicable. This process continues until the risk is eliminated or reduced so far as is reasonably practicable. Often a combination of risk control measures is needed to control the risk.
Factors to consider when choosing controls include:
- physical environment and workplace design
- system of work
- psychosocial hazards
- hazardous manual handling tasks needed for the person in care
- behaviour and physical needs of the person being moved and their ability to help with the move
- knowledge, skill and experience of employees in relation to safe handling of people
- how employee rostering can affect the availability of staff for the move
- number of employees required to complete the task
- equipment or mechanical aids available.
Employers may only rely solely or primarily on information, instruction or training to control risks if higher order control measures are not reasonably practicable.
Risk control examples
Below are examples of risk controls for moving and handling people. These controls should be combined as part of a system of work, rather than applied in isolation.
- Using mechanical aids such as overhead or wall-mounted tracking hoists and air-assisted devices.
- Positioning the person so employees can move them safely.
- Moving the person to a place with room-coverage overhead tracking.
- Specifying quality management in the contract with the slide sheets provider. The contract should ensure that damaged or poor functioning slide sheets are eliminated from the supply stock.
- Storing mechanical aids and assistive devices somewhere easy to access and with appropriate charging points.
- Ensuring the floor surface is flat and the workspace is free from clutter.
- Ensuring rostering systems provide enough employees for tasks. This includes ensuring resources are available to reduce the risk of employees being under pressure or working on their own.
- Ensuring appropriate rostering so employees have regular breaks and can take those breaks.
- Allocating tasks in a way that ensures employees do not have long periods of people handling. For example, staggering the hygiene times of people in care so employees can provide care in a more balanced and less physically demanding manner.
- Providing information, instruction, training and supervision on how to use control measures. This includes the safe use of mechanical aids and assistive devices.
- Providing visual aids of how to move the person safely at the point of transfer; for example, photographs or diagrams.
Consultation
Employers must consult with employees and any HSRs when controlling risks on matters related to health and safety that directly affect or are likely to directly affect them. They must consult employees and HSRs, so far as is reasonably practicable.
Employers can also benefit from consultation with stakeholders. This can help to develop effective controls and encourage support from everybody involved. As well as employees and HSRs, consult with:
- the people being moved, such as patients
- subject matter experts
- relatives
- suppliers
- designers
- industry bodies and associations.
Consultation gives stakeholders the opportunity to:
- share and develop ideas
- participate in trials for new risk control measures.
Consultation can also improve the uptake of risk control measures.
4. Monitoring, maintaining, reviewing and revising risk controls
Employers must provide and maintain safe systems of work, so far as is reasonably practicable. This includes systems of work associated with handling and moving people. Safe systems of work include ensuring that risk controls can be properly applied, used and maintained.
Maintaining risk controls ensures they perform as originally intended and continue to prevent or control the risks of MSD. Employers must review their risk controls and, if necessary, revise them in the following situations.
- Before changes to any thing, process or system of work involving hazardous manual handling. This includes a change in the place where the hazardous manual handling happens.
- If new or extra information about hazardous manual handling becomes available.
- If an employee reports an MSD at a workplace, or someone else reports it on an employee’s behalf.
- After a notifiable incident that involves hazardous manual handling.
- If, for any other reason, the risk control measures do not adequately control the risks.
- After receiving a request for review from an HSR.
WorkSafe has more guidance on its website about controlling hazards and risks in the workplace.