Display screen equipment (DSE)

1 Introduction

The use of display screen equipment (DSE) is not generally a high-risk activity, but it is widely used by a large number of staff in the trust. Failure to meet the minimum requirements of the Health and Safety (DSE) Regulations 1992, as amended by the Health and Safety (Miscellaneous amendments) Regulations 2002, can lead to musculoskeletal problems, eye strain, fatigue or mental stress. These problems can be overcome by good ergonomic design of equipment and furniture, a good working environment and careful planning of the tasks performed. The regulations provide guidance on the correct setup of a workstation and require employers to carry out a suitable and sufficient workstation risk assessment.

A workstation typically includes a DSE device such as a personal computer, monitor, keyboard, mouse, desk and computer chair.

Portable DSE, including laptops, mobile phones and notebook or tablet computers are also subject to DSE regulations when in prolonged use. Portable DSE carries the same risks as full-sized equipment, but also has added risks due to the lack of screen and keyboard separation and very small keypads. This can give rise to poor working postures and lead to repetitive strain, particularly in the wrist, fingers, neck and shoulders.

2 Purpose

The purpose of this policy is to highlight awareness of the risks associated with DSE with a view to reducing these as low as is reasonably practicable, to comply with the requirements of the DSE regulations and to provide staff with a simple tool for conducting a basic DSE self-assessment, see appendix B.

3 Scope

This policy applies to all staff who regularly use DSE equipment daily for more than an hour at a time and are employed by the trust. This includes bank, agency or volunteer staff and covers basic DSE equipment, as well as laptops, tablets, iPads and other handheld devices, such as mobile phones and associated equipment such as roller balls, mouse or any other devices supplied by the trust in connection with DSE work.

Health and safety executive (HSE) guidance states that it will generally be appropriate to classify the person concerned as a regular DSE ‘user’ or ‘operator’ if they normally use DSE for continuous or near continuous periods of an hour or more at a time on a daily basis.

The policy applies to DSE users who work at a fixed workstation, mobile workers, those who ‘hot desk’ and those who work at home.

Staff who use DSE infrequently or for a short time are not covered by the policy.

4 Responsibilities

4.1 Chief executive

The chief executive has specific accountability to ensure that responsibilities for health and safety are effectively assigned, accepted and managed at all levels in the trust, consistent with good practice. In practice the chief executive will discharge these responsibilities by delegation to executive directors and then through the line management structure.

4.2 Managers

Managers are responsible for ensuring that staff who use DSE complete an initial DSE self-assessment (see appendix B), complete training using the trust on-line DSE e-learning package and ensure that any furniture or DSE equipment that is recommended by the trust back care advisor advice or Health and Safety Team is provided.

Arrangements must be in place to inspect any area where DSE is located to ensure the DSE is being used as advised and formally followed up if it is not. DSE assessments should be reviewed due to staff changes, office reorganisations, pregnancy and health conditions.

4.3 Back care advisor or health and safety lead

The trust back care advisor or health and safety lead will assist and advise managers regarding staff DSE self-assessments and in some instances will conduct further assessment if there are circumstances such as pre-existing health conditions or in cases of pregnant or nursing mothers.

The trust back care advisor or health and safety lead will develop and review relevant policy and guidance in relation to DSE.

4.4 IT department

The trust IT department will ensure equipment specification and software packages are suitable and meet the criteria outlined in the DSE regulations. To that end they will pre-approve all orders for IT equipment and software to ensure:

compatibility with existing systems
capacity and speed of operation are optimal for the specific requirements of the trust and department
that installed programmes are suitable and supported by the IT department for maintenance
ensure service managers are informed of new developments etc. designed for improved ergonomics by liaising with the back care advisory service

4.5 All staff who use DSE

Staff should adopt best practice, as detailed in the E-Learning and illustrated in the self-assessment form (appendix B) when using DSE. They should make full and correct use of any additional DSE support equipment provided by the trust and report any health conditions they consider they have developed through their use of DSE to their line manager as soon as practicable.

Where staff use hot desks, they should adapt the workstation so that it meets the DSE requirements and is setup so that it meets their individual requirements. Homeworkers should also set up their workstation in line with guidance provided in this policy and complete a homeworking risk assessment.

Every employee who uses DSE, including those with a disability or special needs, should complete the trust on-line DSE training and self-assessment or, in exceptional circumstances where the on-line DSE training cannot be accessed, using the pro-forma in appendix B and forward to their line manager.

5 Procedure or implementation

5.1 DSE assessment

Staff should be provided with information and guidance on the potential health risks associated with the use of DSE. These include:

upper limb disorders (including pains in the neck, arms, elbows, wrists, hands and fingers), often referred to as Repetitive Strain Injury (RSI)
backache
fatigue and stress
temporary eye strain (not damage)
headaches

On commencing employment with the trust all staff who will regularly use DSE equipment should access and undertake DSE E-Learning training available on the trust’s electronic staff record (ESR) system. This provides information on ill health conditions that may develop if equipment or the workstation are not used correctly and how to minimise any risks in order to work safely with DSE. It contains the following content:

the risks of working with DSE
the importance of good posture and changes of position
the availability of suitable furniture
how to adjust the furniture to avoid the risks
the availability of ancillary equipment, for example, foot rests, wrist rests
the avoidance of reflections and glare
adjustment of contrast or brightness
the risk assessment process and their contribution to it
the need to report the onset of related aches and pains
the entitlement to eye and eyesight tests and the provision of spectacles which are required specifically for DSE work

A workstation self-assessment must be completed by every DSE user (see appendix B). This will identify any issues with the work equipment, working environment (such as heat, noise or screen glare) and the interface between the user and the equipment (ergonomics). The assessment must be reviewed if there is any reason to suspect that it is no longer valid. This includes changes in position of the work equipment, such as a desk move, development of any related health issues or pregnancy, particularly in the later stages.

Although there has been concern regarding ill-health among new and expectant mothers using DSE the results of scientific studies do not indicate any link between miscarriages or birth defects and working with DSE.

A record of the DSE assessment and training and details of action taken in response to the DSE assessment should be kept in the individual’s personal file.

It is the responsibility of all staff to make a judgement on whether the workstation they are using is conductive to ensuring that their on-going health needs are met. If any issues are identified these should be reported to their manager.

The use of portable equipment such as laptops must also be assessed or reviewed where extensive use within an office environment is identified to ensure that ancillary equipment, for example, raised plinth’s, auxiliary keyboards and lap top docking stations are used to minimise health risks (see section 5.3).

It is important to ensure that workstations are designed to meet the needs of users including those with disabilities.

Wheelchair users may have special requirements for chairs and work surfaces (for example with regard to height). In practice some wheelchair users may need a purpose-built workstation but others may prefer to use existing work surfaces. The HSE’s guidance states that the needs of individual employees should have priority over minimum compliance with the standards set out in the Regulations. The Equality Act 2010 also applies, requiring reasonable adjustments to cater for the needs of disabled employees.

Arrangements must be agreed for staff with existing health conditions to be monitored and as necessary provided with specialist equipment such as seating, ergonomic keyboards etc.

5.2 Risk controls

Any equipment or DSE furniture identified as the result of a DSE assessment must be obtained in a timely manner.

Users should take regular breaks away from their workstation. For example, after every hour of continuous DSE work take a 5 to 10 minute break or change work activities to alternate tasks away from the DSE.

Human resources (HR) can be contacted for further information regarding eye tests and the cost of spectacles.

5.3 Use of laptops

The portability of laptop computers is their main advantage. Some staff may however still find them too heavy. Staff should also recognise that carrying a laptop in a designated laptop bag may constitute a security risk. Using an ordinary bag may help to disguise what it being carried and so deter thieves.

Laptops have to be compact enough to be easy to carry, resulting in design compromises such as smaller keyboards and screens. Laptop work is therefore less comfortable than work at standard sized equipment during prolonged use. Careful consideration needs to be given to where and how laptops are used. It is possible to purchase regular-sized keyboards to attach to these computers. The regulations state that screen and keyboard need to be separate for periods of use of over an hour and set up as for desk top use.

Staff who spend a lot of time at home working on their work laptop computer should consider these factors, although staff should not feel that there is an expectation to spend excessive amounts of time in this way. Staff who use computers for work-related purposes at home should follow the same principles of use when at work. Staff should also ensure they have completed a workstation self-assessment on their home environment prior to use. Whenever there is change to the home working environment it should be re-assessed and reported to their manager.

Specific training and information should be given for laptop users on minimising risks, including sitting comfortably, angling the screen to minimise reflections and, wherever possible, placing the laptop on a firm surface and at the right height for keying.

The HSE has suggested that the following ergonomic factors be taken into account when choosing portable computers:

choose a lighter weight model of 3kg or less, with a large and clear screen (14 inch diagonal or more)
select one with the longest battery life possible
choose a lightweight carry case with handle and shoulder straps
consider using a trolley bag

5.4 Notebooks, iPads and mobile phones

The main hazards inherent in such equipment are:

repetitive strain injury (RSI). The small size of the keyboards on such devices can lead to RSI problems such as ‘Blackberry thumb’
musculoskeletal disorders arising from the posture adopted when using such mobile devices
eye strain and visual fatigue caused by squinting to view the small screen
stress, arising from the fact that the device is always on, so the user feels that they are always at work

Other hazards stem from the locations in which such portable devices are used. Back pain and general musculoskeletal disorders can arise from their use in unsuitable places such as trains and cafes. In such environments consideration must also be given to ensuring the security of any trust or patient sensitive information. Working for long periods with the head slumped in a forward position and the neck flexed can cause pain. It is recommended that users change posture every 20 minutes and use a case that doubles as a tablet stand.

Fears of theft of the equipment lead to stress and anxiety about personal safety, whilst for those who use such technology ‘on the move’ there is the very real risk of injuries arising as a result of slips, trips and falls.

Small communications devices are also subject to the DSE regulations if they are in use for prolonged periods as part of someone’s work. The HSE is aware of anecdotal reports of wrist and thumb pain, and neck pain arising from the heavy use of thumbs in typing words onto such handheld devices, and advises that any such risks should be managed in the normal way, for example, carrying out a risk assessment as they would for a laptop computer. The HSE also recommends that users of such devices should avoid heavy usage of the equipment in poor working environments, such as where the conditions are cramped or there is inadequate lighting.

When away from traditional DSE equipment and using mobile portable equipment users are advised to take more frequent breaks to compensate for the ergonomic disadvantages inherent in the use of this technology. Meanwhile, on return to the office or staff work room, where full-sized DSE equipment is available, there is no need to continue to use such devices.

The HSE states that people who habitually use portable DSE equipment should be trained in how to minimise risks, for example by sitting comfortably, angling the screen so it is easy to read and taking frequent breaks. Wherever possible, portable DSE devices should be placed on a firm surface at a comfortable height. Where portable equipment such as tablets are in prolonged use at the user’s main place of work, additional steps can be taken to reduce risks, for example, by using a docking station. Appendix A provides further guidance on the use of portable devices.

6 Training implications

Managers should ensure staff are aware of the contents of this policy at local induction and whenever a DSE self-assessment is required and to ensure that staff complete the trust e-learning DSE training.

Records of any information, instruction or training provided should be maintained in personal files.

7 Monitoring arrangements

7.1 DSE self assessments

How: Review of completed documents.
Who: Line managers, health and safety lead and back care advisor.
Reported to: Health, safety and security forum.
Frequency: Initially for all staff and as required.

7.2 Staff with existing health conditions and pregnancy

How: Monitoring as necessary.
Who: Managers and occupational health.
Reported to: Health, safety and security forum.
Frequency: On-going.

7.3 Injuries or illness associated with DSE use

How: Review of incident reports.
Who: Health and safety lead.
Reported to: Health, safety and security forum.
Frequency: Ongoing and annual report.

8 Equality impact assessment screening

To access the equality impact assessment for this policy, please email rdash.equalityanddiversity@nhs.net to request the document.

8.1 Privacy, dignity and respect

The NHS constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, ‘not just clinically but in terms of dignity and respect’.

As a consequence the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided).

8.1.1 How this will be met

There are no additional requirements in relation to privacy, dignity and respect.

8.2 Mental Capacity Act 2005

Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals capacity to participate in the decision making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.

Therefore, the trust is required to make sure that all staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005) to ensure that the rights of individual are protected and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.

8.2.1 How this will be met

All individuals involved in the implementation of this policy should do so in accordance with the guiding principles of the Mental Capacity Act (2005) (section 1).

9 Links to any associated documents

10 References

The Health and Safety at Work Act 1974
The Health and Safety (Display Screen Equipment) Regulations 1992 as amended in 2002
The Management of Health and Safety Regulations 1992
The Workplace (Health, Safety and Welfare) Regulations 1992

11 Appendices

11.1 Appendix A portable computer guidance

This guidance provides advice to those members of staff who use portable devices as part of their work. Where a member of staff is provided with a portable device it is important to ensure they familiarise themselves with user manuals and this guidance and adherence to the recommendations.

Some portable devices are designed to be lightweight and carried in one hand. They are thus easier to use and handle than a laptop which normally requires a surface to set the computer down on while in use.

Tablets with a display screen of less than 15 inches (diagonally) should not be used for prolonged periods of time or for detailed graphical work unless the software package allows for magnification.

11.1.1 Temporary or transient office use

Whenever working with portable devices, the important factor is to avoid poor posture. When used in an office environment, some points to remember in order to achieve best practice include:

11.1.1.1 Configuration

Connection to peripheral equipment (height adjustable monitor, keyboard and mouse) must be provided and used.
Where Tablet only devices are supplied, they must be ‘docked’ in their docking station and peripherals again used.

11.1.1.2 Sitting

Adopt a good sitting position in order to avoid straining your arms and back.
Try not to slouch. Do not sit forward and crouch over the tablet.
When reading from a hard copy, keep it as close to the tablet as possible.

11.1.1.3 Correct pen usage (where provided)

Hold as for a normal pen applying light pressure.
Experiment with using the pen in different applications and take time to get used to how the pen works so that you are able to make the most of your tablet PC.
Do not ‘stab’ at the screen as this may damage the screen.

11.1.1.4 Reading the screen

Avoid glare. Glare and reflected light can affect screen clarity.
If glare occurs, adjust your screen, either by means of programmed menu controls or to another position within the room, in order to reduce reflections.
Position the screen directly in front of you.
Do not work with the screen at any angle other at right angles to your line of sight.
Do not sit with your back towards a window.
Adjust screen brightness to suit surrounding light levels.

11.1.2 Hot desking

Work areas used for hot desking should, where possible, incorporate different desk heights in their office design. For example, high tables to stand at to input data on a short time period. Easily adjustable chairs should also be provided. Advice can be sought from the Manual Handling team.

11.1.3 Working away from the office or using portable devices in vehicles

Tablets and laptop PC’s should not be used in cars or other vehicles. However, on occasions this may be unavoidable in which case:

never use your tablet or Lap top PC when driving
for short durations only, for example, to check emails, it is preferable to sit in the passenger seat if you have to use portable IT equipment, adjusting the seat to provide legroom
the engine should be switched off and the vehicle parked in a safe place
remain aware of the immediate area around your vehicle and lock the doors for security

11.1.4 Working with a portable device in a service users or patient’s home

When meeting service users or patients in their own homes and where no suitable flat surface is available, if applicable, portable devices should be used in the tablet configuration, but if a suitable hard surface and chair is available, the portable device should be reconfigured and used as a laptop if possible.

Try to compromise by using an appropriate chair that gives good postural support.
If using a tablet whilst sitting on a sofa or easy chair, place a cushion on your lap to act as a platform.
If handing to the client to gain their signature or show them relevant information, again use a cushion on their lap to protect their skin from any potential bruising.
If held in the hand, work with the tablet close to your body.
For longer periods of use whilst standing use a neck strap and holder if available.

11.1.5 Working with a portable device on trains

Avoid working in seats with tables attached to the rear of seats in front of you.
Try to book and use the more spacious communal tables when travelling, with the PC in the laptop configuration (if convertible).
Be aware of sensitive confidential information and safeguard it from prying eyes.

11.1.6 Personal safety

Always be conscious of your personal safety when carrying or using your tablet. Take sensible precautions such as:

planning tasks to avoid situations where you are likely to be lone working in circumstances where theft is likely
taking extra care in public places, or in other situations (or at times) where the risk of theft may be greater
not carrying the tablet in luggage with a computer manufacture’s branding
never leaving devices on view in an unattended vehicle and never leave them overnight in an unattended vehicle

11.1.7 Manual handling

Tablets vary in size and weight but are generally smaller than laptops, typically 2kg.

In many instances these are accompanied by the use of peripherals such as portable printers, spare batteries etc. Whilst the tablet and any associated items will usually have a carrying case of some description, the overall weight and methods of transportation need to be considered.

Carrying cases of the type with single shoulder straps can put strain on the back and neck muscles if equipment is carried for any distance or for any long period of time. If a briefcase is also carried then the overall weight plus the awkwardness of the resulting load can be a problem, even though you appear to be balancing the load.

The use of a backpack is more advantageous to cut down strain on your arms and distribute loads evenly across the body. This is also more effective for personal safety reasons.

If used alone an alternative lightweight shoulder bag could be used or use a trolley bag.

The Manual Handling team has a range of bags and trolleys and can be contacted for advice.

The aim is to try to reduce the amount of weight you intend to carry by:

not carrying equipment unless they are really likely to be needed
minimising the amount of hard copy documents you take. Store them electronically on the tablet or on a disk or memory stick (if of a non-confidential nature), or consider sending them in advance (by post or e-mail) to your destination
encrypting all computer work that caries personal identifiable data.
regularly checking your batteries and following the recharging instructions in order to avoid carrying extra batteries. Also make use of an in-car charger if fitted (for example, most tablet PC batteries will only last for approximately 3 hours, however newer generation tablet PC’s may last up to 5 hours, depending on settings and usage)

11.1.8 Mobile communications

It must be accepted that where provided for use, mobile communications devices may not operate in some locations due to poor transmission paths or levels. Such problems should be report and alternative arrangements considered

11.2 Appendix B DSE self-assessment checklist

Appendix B DSE self-assessment checklist

Document control

Version: 6.1.
Unique reference number: 299.
Ratified by: Corporate policies approval group
Date ratified: 11 January 2024.
Name of originator or author: Health and safety lead or Manual Handling team.
Name of responsible individual: Executive director of nursing and allied health professionals.
Date issued: 12 January 2024.
Review date: July 2024.
Target audience: All staff who use DSE.

Page last reviewed: April 30, 2024
Next review due: April 30, 2025

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