Contents
1 Aim
The use of safe moving and handling techniques and equipment is an essential part of falls management. This procedure details the techniques and equipment available for colleagues to use to enable patients to be handled safely in relation to falls. This training forms part of mandatory training for clinical colleagues and a yearly update is required to maintain competence. This procedure is in line with the Health and Safety at Work Act (1974) for the protection of both colleagues and patients.
2 Scope
This is a trust wide procedure which is applicable to all patients under our care. It focuses in particularly on the needs of those patients who are in the higher falls risk groups or who already have a history of falls (over 65’s and, or patients with pre-existing health conditions which means they are at a higher risk of falling).
3 Link to overarching policy
4 Procedure
The causes of falls are multi factorial and diverse and include both intrinsic and extrinsic factors. The use of appropriate manual handling techniques and equipment in the management of falls is imperative from a safety perspective both for the patient and colleagues involved.
4.1 Assisting people following a fall
When a person has fallen the handler should always check the following:
- danger, response, airway, breathing, compressions (if needed)
- check for injuries, bruising, possible fractures, pain and behaviour, if handlers are not competent in checking for fractures and injuries, they should always ask for medical assistance
- if there was any obvious reason for the fall
- if there is any doubt, the person should be left safe on the floor and handlers should request medical assistance
- the environment for obstacles and space
- the patients functional independence measure score (FIM) as this will determine which equipment is most appropriate for the task
- the number of handlers required for the task
- if the handler has been trained to undertake the task
- in a confined area such as a toilet, it can be difficult getting the hoist in place. Most toilets are very limited in space. If this is the case, emergency transfer sheets should be inserted under the patient and the patient should be slid out of the toilet
- if a patient has fallen between a bed and a chair or bedside locker, wherever possible, these items should be moved away to allow access
- at all times, the safety of the patient and colleagues should not be compromised. The weight of the patient should be considered before using equipment to ensure it’s within the safe working limit
- where appropriate, equipment should be up to date with servicing and LOLER inspections
4.1.1 Assisting a patient from the floor using 1 chair (1 or more handlers)
- A backwards chaining technique is suitable for a patient who has the physical ability to roll onto their side and is also be able to kneel.
- The patient should be able to follow instructions.
4.1.2 Description
- The handlers should undertake a risk assessment of the person and the environment and be competent at using this technique.
- Handlers should prepare the environment before commencing task, for example, position a chair at the head end of the patient.
- Handlers should kneel to the side of the patient and explain what will happen.
- Instruct the patient to turn their head.
- Instruct the patient to bring their arm across their chest (same direction).
- Instruct the patient to bend their knee (same direction).
- Instruct the patient to move their other arm away from their body.
- Instruct the patient to roll onto their side into side lying.
- Once on their side, instruct the patient to bring their arm over their body until the hand is flat on the floor.
- Instruct the patient to push up on their hand and at the same time push up on their forearm that is resting on the floor until they are in half sitting.
- Instruct the person to keep pushing up until they end up on all fours and until they are facing the chair.
- Instruct the patient to position lower arms onto the chair and ask them to lean on the seat of the chair.
- Instruct the patient to raise their strongest leg and place the foot flat on the floor.
- Instruct the patient to push up to straighten legs and turn to sit onto the chair.
4.1.3 Perceived exertion for the handler
The handler should be of good fitness and be able to kneel in high and low kneeling positions.
4.1.4 Comfort for the person
Patients with knee and hip problems may find the task difficult and uncomfortable.
4.1.5 Dangers and precautions
If assessed inappropriately, the patient may lose their balance.
Note: If there is a suspected hip fracture or spinal injury following a fall patients need to be transferred flat to reduce the risk of displacement of fractures. These patients will need to be nursed on the floor until ambulance attends.
4.2 Raizer
The Raizer is now widely available for use within the trust, the Raizer has a back support is quieter so less likely to cause added distress. The ELK is primarily used by adult mental health services on inpatient areas but not exclusively and can be found in other departments including community services.
Raizer guide (opens in new window).
Use of the Raizer with back support to assist a person up from the floor. (2 handlers or more) suitable for patients with a FIM score of 3 or above.
- This technique is useful when a person is unable to maintain sitting balance independently but is still able to stand or transfer onto other seating.
- The person should be compliant able to follow instructions and where possible assist with the transfer, for example, by following safety instructions and assist with rolling when the equipment is being assembled.
- The patient must not exceed the safe lifting load of the Raizer (see product info).
4.2.1 Description
- The handlers should undertake a risk assessment of the person and the environment and be competent at using the equipment.
- Handlers should prepare the environment before commencing task for example, have a chair or wheelchair close by so that the patient can transfer when back into standing.
- Handlers should kneel on either side of the person and explain to the patient what will happen and that they will be given instructions to follow.
- Encourage the patient to assist the handlers who will assemble the equipment whilst the patient remains in the lying position.
- Once assembled, safety check to the equipment and the patient should be completed, the patient should be encouraged to put their chin to their chest and feet placed close together, one handler to operate handset, the other handler to observe the patient and support where necessary, usually at the head.
- Patient will be transported from lying to sitting or almost standing, but still have their feet on the floor.
- Patient can then independently or with assistance from the handlers transfer to a chair or wheelchair.
- Handlers should only use equipment they have been trained to use as part of their mandatory manual handling training.
- After use, equipment should be de-contaminated and returned to storage ensuring it has been placed back on charge.
4.2.2 Perceived exertion for the handler
The handler should be of good fitness and be able to kneel in high and low kneeling positions.
4.2.3 Comfort for the person
During the transfer, the patients head should be protected with either a pillow or cushion.
4.2.4 Dangers and precautions
- The equipment may not be suitable for all users, particularly if the patient is distressed, agitated or exceeds the safe working load (SWL).
- Should a hip fracture or spinal injury be suspected the patient should not be moved but managed on the floor until emergency assistance has arrived.
- If the patient has sustained a brain injury they may not be able to cooperate safely with this procedure.
4.3 Emergency lifting cushion (ELK)
The ELK is an alternative solution to assisting a patient from the floor into a sitting or standing position (2 handlers or more).
Fallen patient video guide (opens in new window).
There are several of these products within the trust.
- This technique is useful when a person is able to maintain sitting balance independently and is able to stand or transfer onto other seating when the cushion has been inflated.
- The person should be able to follow instructions and where possible assist with the transfer, for example, shuffling their bottom onto the cushion prior to lifting.
- The patient should be in a sitting position before the cushion is inflated.
4.3.1 Description
- The handlers should undertake a risk assessment of the person and the environment and be competent at using the equipment.
- Handlers should prepare the environment before commencing task for example, have a chair or wheelchair close by so that the patient can transfer when back into standing.
- Encourage the patient to assist the handlers who will assemble the equipment whilst the patient remains in a sitting position.
- Handler 1 should kneel behind the patient and have contact with them by placing a hand on the patient’s shoulder or forearms for support and reassurance. Handler 2 to kneel to the side of the patient and explain to them what will happen and that they will be given instructions to follow. If appropriate a chair can be placed on the other side of the patient so they can rest their arm whilst providing additional stability.
- Patient will be transported from low level sitting to sitting at chair seat height. The patient should be assessed after cushion 3 has been inflated as depending on the height of the patient, cushion 4 inflation may or may not be needed. The patients’ feet should remain on the floor.
- Patient can then independently or with assistance from the handlers transfer to a chair or wheelchair.
- Handlers should only use equipment they have been trained to use as part of their mandatory manual handling training.
- After use, equipment should be de-contaminated and returned to storage ensuring it has been placed back on charge.
4.3.2 Perceived exertion for the handler
The handler should be of good fitness and be able to kneel in high and low kneeling positions.
4.3.3 Comfort for the person
The handler should ensure that the patient is sat central on the cushion before inflating to ensure a comfortable and safe lift.
4.3.4 Dangers and precautions
- The equipment may not be suitable for all users, particularly if the patient is distressed or agitated.
- Should a hip fracture or spinal injury be suspected the patient should not be moved but managed on the floor until emergency assistance has arrived.
- If the patient has sustained a brain injury they may not be able to cooperate safely with this procedure.
4.4 Management of a patient who has fallen in a confined space, using the emergency transfer sheet (2 handlers or more)
- The patient may be able to assist with the transfer (description 1).
- The patient may not be able to assist with the transfer (description 2).
- This is a useful technique when there is limited space to bring in manual handling equipment.
4.4.1 Option 1
- Following an assessment of the environment, the handler should be kneeling whilst verbally instructing the patient to roll onto their side.
- Ask the patient to turn their head and face the direction of the turn.
- If some support is needed the handler can assist the patient to roll onto their side by, bringing the patients furthest arm across their chest and bring the nearest arm away from their body, to prevent entrapment during turning. The furthest knee should be bent.
- The handler supports the patient’s shoulder and hip.
- The patient should be rolled onto their side.
- The second handler should bring in the emergency transfer sheet and position it lengthways and half rolled under the patient.
- Lower the patient onto their back and repeat other side.
- To add comfort, a pillow can be offered to the patient if available.
- Handlers to come into standing (one on each side of the patient) and take hold of the long handles on the transfer sheet at either the patients head or feet- this depends on the environment.
- One handler to be responsible for coordinating the move.
- Handlers to adopt a stable base, one foot in front of the other and use weight transfer, moving from front leg to back leg to safely move the patient on the transfer sheet from the confined space. As the weight is transferred, the sheet will slide. Please note the sheet is only to be used for transferring out of the immediate confined space, not from room to room or along corridors.
- From the open space, the handlers should then access whether the patient can get up independently or requires assistance from manual handling equipment that is available.
4.4.2 Option 2
- The handler should be kneeling whilst preparing the sheet under the patient.
- The handler can gather and position the transfer sheet under the patient starting at the head or feet.
- As the sheet unravels under the patient, the handler must ensure that it is positioned correctly covering the body head to foot.
- To add comfort, a pillow can be offered to the patient if available.
- Handlers to come into standing (one on each side of the patient) and take hold of the long handles on the transfer sheet at either the patients head or feet- this depends on the environment.
- One handler to be responsible for co- ordinating the move.
- Handlers to adopt a stable base, one foot in front of the other and use weight transfer, moving from front leg to back leg to safely move the patient on the transfer sheet from the confined space. As the weight is transferred, the sheet will slide. Please note the sheet is only to be used for transferring out of the immediate confined space, not from room to room or along corridors.
- From the open space, the handlers should then access whether the patient can get up independently or requires assistance from manual handling equipment that is available.
4.4.3 Perceived exertion for the handler
- The patient may have fallen in a very tight space resulting in the handlers working in a very tight space.
- The handler should be of good fitness and be able to kneel in high and low kneeling positions.
4.4.4 Comfort for the person
- Use option 2 if the patient is unable to roll from side to side.
4.4.5 Dangers and precautions
- Depending on the fall, the patient may become wedged. for example, toilet or bath.
4.5 Using a mobile hoist (from the floor, 2 handlers or more)
This technique may be suitable for a patient that has fallen to the floor and has been assessed as safe to move.
4.5.1 Description
The technique for hoisting a patient from the floor will depend on the type of hoist and the ability for the boom to lower to the floor.
Hoist and sling safety checks must be carried out prior to any handling.
- The patient may be able to assist with the transfer for example, roll onto side.
- Ask or assist the patient to position the furthest arms across the chest, bend one or both knees, ensuring feet are flat on the floor.
- Bring the nearest arm away from the body and leave flat on the floor, to prevent the patient from rolling onto their arm or hand.
- Ask the patient to turn their head and face the direction of the turn.
- If some support is needed the handler can assist the patient to roll onto their side by, bringing the patients furthest arm across their chest and bring the nearest arm away from their body, to prevent entrapment during turning. The furthest knee should be bent.
- The handler supports the patient’s shoulder and hip.
- The patient should be rolled onto their side.
- The sling should be fitted, roll the patient onto their back, and repeated on the other side. A sling with head support would be most comfortable for the patient. If not, the head should be supported where needed.
- The angle that the hoist is brought in depends on its style, type, and size in addition to the environment it is in.
- Introducing the hoist diagonally to the patient or directly in front of the patient are the two options. The patient’s leg may need to rest over the leg of the hoist to enable the hoist to be close to the patient and allow the boom and spreader bar to be positioned centrally. Using pillows or blankets around the patients’ legs will allow more comfort.
- With the sling in, hook up, check, and transfer onto the appropriate furniture for example, Bed or chair. This should be in proximity.
4.5.1.1 Variations and options
- The patient may need to be propped up with pillows or an upturned chair if the boom does not lower far enough (3 handlers will be required)
4.5.2 Perceived exertion for the handler
- The handlers should be of good fitness and be able to kneel in high and low kneeling positions.
4.5.3 Comfort for the person
- Extra pillows will be needed to protect the patient from any sharp or hard surfaces of the hoist.
- Care should be given around the patient’s head.
4.5.4 Dangers and precautions
- The hoist will be in close contact to the patient. The handlers should ensure the patient is protected from injury at all times.
Please see patient falls manual (prevention and management) webpage for appendices attached to this procedure.
Please see appendix F Falls equipment and locations within RDaSH.
Document control
- Version: 1.1.
- Unique reference number: 1055.
- Date ratified: 1 August 2023.
- Ratified by: Clinical policies review and approval group.
- Name of originator: Clinical team leader.
- Name of responsible individual: Executive director of nursing and allied health professionals.
- Date issued: 23 August 2023 (minor amendment).
- Review date: 31 August 2026.
- Target audience: Clinical staff.
- Description of change: Procedure to a manual.
Page last reviewed: April 23, 2024
Next review due: April 23, 2025