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The key points to be considered are summarized in Box 7.1.

Box 7.1 Risk assessment

1 Assess the patient clinically.

2 Consider realistic clinical goals and functional outcomes in discussion with the patient and ascertain the level at which the patient will be able to participate in the task.

3 Consider whether the proposed intervention involves hazardous manual handling and reduce the hazard by:

a adapting the technique

b introducing equipment. Studies advocate the use of assistive devices to promote safer patient handling for patients with complex needs following assessment (Nelson et al. 2006, Rockefeller 2008), with a positive impact on patient outcomes with no detrimental effect on staff handling following assessment (Nelson et al. 2008)

c seeking advice/assistance from appropriately skilled colleagues.

4 Risk assessment should be an ongoing process and be constantly updated.

5 After the procedure, document the risk assessment in the communication section of the patient’s care plan, being sure to include the date, the number of staff involved and the equipment needed to perform the task. Also document any changes in the patient’s condition, such as skin redness. It is important to also document the intended duration of time for which the patient should be maintained in this new position.

(CSP 2008)

Effective use of therapeutic handling in the context of use of a comprehensive competency-based training tool can benefit patient outcome, enabling balance and motor training in early rehabilitation with minimal risk to staff (Mehan et al. 2008). Where there is any doubt about patients with complex needs, seek advice from the PT or the occupational therapist (OT) for assessment.

Consent must be obtained before any intervention is started. Consent is the voluntary and continuing permission of the patient to receive a particular treatment based on an adequate knowledge of the purpose, nature and likely risks of the treatment including the likelihood of its success and any alternatives to it. Permission given under any unfair or undue pressure is not consent (NMC 2008).This is discussed in more detail in Chapter 1.

Legal and professional issues

For recommendations and further information on safe manual handling refer to professional guidance, government, local trust policy (HSE 1992) and the manual handling advisor or the physiotherapist.

Preprocedural considerations

Before positioning or moving the patient consider the following factors.

Assessment

Pressure/skin care

The risk of skin damage when the patient is positioned or moved will be increased by factors including incontinence, profuse perspiration, poor nutrition and obesity (Hickey 2003a). Direct pressure to the skin and friction during movement of patients are two of the most common causes of injury to the skin that can lead to pressure ulcers. Correct moving and handling of the patient will minimize the risk of pressure ulcer formation (see Chapter 4).

Skin integrity should be assessed using the Waterlow Scale (see Chapter 4) prior to positioning and vulnerable areas protected with specialist pressure-relieving equipment or additional use of pillows/towels. Use of special beds or cushions may be required depending on individual assessment.

Minimize contact with other surfaces where possible to ensure optimum skin condition. Care should be taken when lying the patient directly over the greater trochanter as this increases pressure at this interface and the risk of developing pressure sores (Hawkins et al. 1999).

Wounds

Consider the location of wounds and injuries when selecting a comfortable position. Ideally positions should avoid pressure on or stretching through any wounds and consideration should be given to the timing of dressing changes, which should be done before positioning to avoid disturbing the patient twice.

Sensation

Take extra care in positioning patients with decreased sensation as numbness and paraesthesia* may result in skin damage as the patient is unaware of pressure/chaffing. These patients may not be able to