This is the second of two articles that summarises the proceedings of an Educational Workshop on the subject of Spinal Injuries. The first article identified some Moving and Handling problems; this article aims to identify some solutions and equipment.

A number of Moving and Handling problems and issues were identified by delegates who attended Chiltern Invadex' educational workshop on Spinal Injuries. These may be summarised as:

• Addressing the safety of clients and staff during moving and handling activities
• Ensuring moving and handling equipment and techniques are compatible with clinical procedures and interventions
• Facilitating transfers for clients who need to be maintained in a flat position
• Avoiding tissue damage and cross infection
• Identifying equipment that is suitable for the domestic / home environment

Each of these areas will now be briefly discussed in relation to any practical solutions that may be applicable along with equipment requirements and possibilities.

Safety

The safety of spinal injured clients may be compromised when moving and handling because of the need for them to be moved or maintained in a flat position. They may also need to be immobilised for treatment and/or clinical investigations. Hence there is a need to ensure a client remains stable and secure during manoeuvre, to avoid jerky movements and to minimise the number of transfers they have to undertake.

Where staff are concerned, they are presented with need to maintain their own safety at the same time as facilitating treatment for their clients. It is likely that more than one member of staff will be involved in transferring a client and it is widely recognised that all manual handling presents risks. The requirement for a client to be transferred in a flat position means that staff undertaking the task manually may be unable to adopt an appropriate lifting position, are likely to be dealing with heavy loads and/or bending and stretching excessively.

There are a number of approaches that may be employed to minimise the risks to the safety of clients and staff during moving and handling. A thorough and accurate assessment of the moving and handling needs of individual clients is required to formulate a clear care plan detailing appropriate methods, equipment and clear procedures. The assessment will also need to account for any inanimate loads associated with moving the client, for example ventilators and monitors. Risks to clients will be fewer if an informed, consistent approach is taken to their moving and handling needs. Any moving and handling equipment that is identified in a care plan needs to be readily available to staff and simple to use. This may be achieved by having equipment permanently installed, easily portable or on rental. Staff should receive training in the use of equipment and instruction manuals/user guides made available to them. Staff will need to be made aware of how they can protect their own backs and be aware of the risks posed by handling loads. Regular moving and handling training and updates are essential.

Compatibility of Equipment and Techniques

It is likely that a spinally injured client will be exposed to a vast number of different procedures and interventions throughout a hospital admission and period of rehabilitation. This will demand that the client be moved between different departments or different pieces of equipment within departments. Diagnostic and treatment techniques may require the client to remain in a particular position. It will also be necessary for everyday activities of daily living, such as personal hygiene, to be facilitated whilst the client is in position.

To allow these various activities to be undertaken, there is a need for the equipment and techniques that are used for moving and handling to be compatible with the different activities and environments. If a client is being hoisted, then it may be necessary for the same hoisting system to be used in different departments or environments. If a client needs to adopt a particular posture, then it will be necessary for the sling or surface on which they are hoisted to accommodate that posture. If there are pieces of equipment that need to accompany the client, then the means used to transfer the client will also need to accommodate the equipment. If a client is to be exposed to X-ray machines or scanners, the surface on which the client is transferred will need to be compatible with this equipment. The need to minimise the number of times a client is transferred has already been raised as a contributory factor to client safety. Consistency of moving and handling methods is also relevant. The selection of versatile equipment that can be used in a variety of clinical settings, as well as accommodate activities of daily living, will assist in this area.

Transferring Clients in a Flat Position

The issue of ensuring that some clients remain in a flat position has already been mentioned as an important element in client safety, as this minimise the risk of further injury and also aid recovery. This position may need to be maintained for long periods of time and the client may require immobilisation at the same time. The need for personal hygiene, clinical investigations and interventions to be facilitated is still apparent. If a client is bed-bound, a method of raising the client from the bed in order to change the bedclothes will be required. It is therefore important that a means to safely transfer the client in a flat position, as well as provide support, is established. It may be possible to achieve this by using slings that are designed to facilitate hoisting in a flat position or by using a stretcher or tray transfer system.

Avoiding Tissue Damage and Cross-infection

Clients who are immobile for long periods of time may be at risk of developing pressure sores, especially if they are not supported on pressure-relieving surfaces. Regular changes to a client's position may help to reduce the risk of pressure sores. Appropriate moving and handling can therefore serve as a preventative measure. However, moving and handling can itself lead to tissue damage if it is not carried out correctly, especially if a client has reduced sensation and does not feel or express pain if their skin is injured. Broken tissue may lead to cross infection in vulnerable clients.

Approaches that may be used to minimise tissue damage and cross infection include selecting appropriate moving and handling techniques, facilitating changes of position and/or reducing the number of transfers a client undergoes. Choosing equipment that may be applied easily and reduces the likelihood of shearing forces on fragile skin is important. If a client is to be hoisted, a well-fitting sling that is easy to apply and remove, as well as comfortable against the client's skin, is vital. A client who is prone to pressure sores may benefit from a sling having additional padding or quilting built into it. All equipment that is selected will need to be compatible with the agreed procedures for the control of infection.

Equipment for the Domestic / Home Environment

Clients who have experienced a spinal injury may return home following treatment, for short periods between interventions or as part of the rehabilitation process. The same principles for moving and handling may apply as in the clinical setting, but it is likely that the domestic environment presents challenges in terms of space, storage and ease of use for carers or other home users. There is a risk that in the absence of all the equipment and facilities that are available in a purpose built clinical setting, a client may find them self to be less independent when they return home.

Considerable thought needs to be given to the selection of equipment and techniques in order to facilitate a smooth discharge to a domestic environment. It is useful for the client if there is some familiarity with techniques and this may be achieved by using the same equipment at home as was available in hospital. It may also be appropriate for the clinical setting to reflect the domestic environment, perhaps by having bathroom facilities of a domestic type, rather than institutional ones. This will enable the client and future carers to develop techniques and approaches in preparation for discharge.

Once it is agreed that a client will return home on a permanent basis, there may be a requirement for equipment to be installed in the client's home. Care needs to be taken that equipment is aesthetically pleasing as well as functional for the client. It must also be acceptable to others who share the household. The ability for functional equipment to be provided speedily can contribute to a safe and effective discharge as well as allay clients' and carers' anxieties. The ease with which equipment can be installed and the facility for equipment to be rented may make the difference between community and institutional living.

Debra Hall
Moving and Handling Specialist
September 2001

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