Resident Repositioning in a Nursing Home
Mrs A is an 82 kg resident in a 40-bed nursing home. She cannot weight-bear and needs repositioning up the bed four to six times per day. Two carers-one 5 ft 2 in and one 5 ft 9 in-currently use a flat slide sheet and a 'bear hug' technique. The bed is set at carer hip height for the taller carer and the brakes are sometimes left off. There is a ceiling hoist in the room but it is used only for transfers to the commode; the care plan says 'reposition using slide sheet'. On 2 February, the shorter carer felt a sudden pain in her right shoulder during a reposition. She continued working and did not report it. The home's safety statement lists manual handling as a hazard but the risk assessment is a single sentence: 'Staff trained in manual handling.' There are 30 staff and 4 have attended training in the last 3 years.
1. Carry out a manual handling risk assessment for the repositioning task. Show the steps you would take, the factors you would consider, and the controls you would put in place.
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Start by defining the task: repositioning an 82 kg dependent resident up the bed, four to six times per day, using a slide sheet and bear hug. Consider the load (heavy, unpredictable, unable to assist), the environment (bed height, brakes, space, hoist availability), the individual carers (height difference, training, health) and the task (frequency, posture, force). Assess likelihood and severity: a shoulder or back injury is credible and could be serious. Apply the hierarchy: eliminate the manual lift by using the ceiling hoist or a suitable repositioning aid; engineer the environment by setting the bed at a safe height for both carers and applying brakes; then organise work so two trained carers are available and the care plan specifies the method. Training alone is not a control because it does not remove the load. Record the significant findings and review after any change or incident.
2. The manager says 'we cannot use the hoist for repositioning because it takes too long'. Evaluate this position and explain how you would prioritise controls.
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The manager's time argument does not justify accepting a known injury risk. The ceiling hoist is already installed, so the main cost is time per reposition, not capital. The assessment should compare the time saved with the cost of injury, absence, replacement staff and possible enforcement. The hierarchy of control still applies: use the hoist or a powered repositioning aid first; if a slide sheet is used, it must be the correct type and the bed height and brakes must be set. A trial with staff can establish a realistic routine. The decision should be recorded with reasons, and staff should be consulted. If the hoist genuinely cannot be used for a specific room, the employer must document why and put in place an equivalent control, not simply rely on manual technique.
3. What should be recorded in the safety statement, and how often should the assessment be reviewed?
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The safety statement should record the significant findings: the task, the residents and carers involved, the assessed risk, the controls chosen (hoist, slide sheet, bed height, brakes, two-carer rule), who is responsible, and the review date. It should also record training and instruction given and the system for reporting problems. Review should be at least annually, and sooner if a resident's condition changes, if equipment changes, if staff change or report pain, or after any incident. A single sentence saying staff are trained is not a risk assessment. The record should be practical enough for staff to use and specific enough for an inspector to see that the risk was identified and controlled.