Manual Tasks Guide For Carers - Department Of Commerce

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Manual Tasks Guidefor CarersTips for Carers on PreventingMusculoskeletal Injuries fromPerforming Manual TasksWORKSAFE

ContentsCarers can get injured 3How do musculoskeletal disorders develop?4Where do risk factors come from? 5How can musculoskeletal disorders be prevented?6Ensuring you can care for someone at home safely7Training 8Reducing the risk of injury 9Handy Tips14Manual Task Examples17Useful resources/contacts222

Carers can get injuredThis booklet is for people who care forother people with varying types and levelsof disability in a home environment. Itprovides tips on how to prevent injuriesassociated with manual tasks.Manual tasks, such as lifting, carrying,lowering, pushing, pulling, twisting,reaching, moving repeatedly and holdingpositions are the most common hazardsfor carers. These are closely followedby slips, trips and falls. These hazardsusually lead to conditions that affectmuscles, bones and joints, known asmusculoskeletal disorders. Commonmusculoskeletal disorders includesprains and strains, spinal disc problems,tendonitis and osteoarthritis. The mostcommon injuries for carers affect the lowerback and shoulder.This booklet is designed to help carersidentify and minimise the risk of injury. Itcontains information on: How musculoskeletal disordersdevelop How to prevent injuries whenperforming manual tasks The risk management approach Manual tasks that are known to be ofhigh risk to home carers Some examples of high risk manualtasks and ways of minimising the risks3

How do musculoskeletal disorders develop?Musculoskeletal disorders usually developas a result of gradual wear and tear of thebody after frequent, prolonged or longterm exposure to certain types of forces,movements, postures and vibration. Theseconditions may also present as suddeninjury as a result of intense, strenuous orforceful activity.What are the risks?There are a number of things that mayincrease the risk of injuries, which arecommonly referred to as risk factors. Someimportant risk factors associated withmusculoskeletal injuries include: 4 Awkward postures: working withyour limbs or joints in an unnatural oruncomfortable position. Static postures: holding positions fora long period of time without a changein position. Repetitive movement: moving acertain joint/limb over and over again inthe same manner. Overexertion: the force required bythe person is greater than their abilities,therefore putting stress on their body. Vibration: from hand-tools (affectingthe hands and wrists) or from sittingfor prolonged periods on vibratingsurfaces, such as the seat of a car(affecting the whole body).

Where do risk factorscome from?Risks can come from a variety of differentsources including: Area and layout: eg. the house maynot be designed for wheelchairs orpeople requiring assistance. Equipment: eg. lack of equipmentor limitations of equipment suchas weight ratings, inappropriatewheel types for environment or load,lack of adjustability or inadequatemaintenance Capacity of the person you carefor: eg. inability to support their ownweight due to muscle weakness,inability to understand instructions,have involuntary movements or haveside effects from medication such asdrowsiness. Nature of loads handled: eg.overloaded shopping bags. Environment: eg. poor lighting or wetfloors. The way you do something: eg.working alone,working for long hoursor lack of training.5

How can musculoskeletal disorders be prevented?The risk of injury can be minimised by:Being AwareEveryone involved with a manual taskshould be aware of the different ways toreduce the risk of injury, including:6 People who provide the care - you andother carers. The person you care for. Owner or head of the household whohas control over home where the carehappens. Employers of any support workers. Those who provide funding,assistance and/or equipment eg.Disability Services Commission (DSC),Department of Veteran Affairs (DVA),Community Aids and EquipmentProgram (CAEP), Home andCommunity Care (HACC). Those who provide assessmentsand recommendations forequipment (eg occupationaltherapists, physiotherapists, AgedCare Assessment Team (ACAT),Independent Living Centre (ILC). Those who train others how to useequipment (eg ILC, occupationaltherapists, physiotherapists, suppliers).

Ensuring you can care for someone at home safelySome of the key questions thatshould be considered before caringfor someone at home are: What can the person do forthemselves and how are care tasksusually performed? For example, canthe person stand independently or rollindependently in bed? Is the current home environmentsuitable for the mobility level of theperson being cared for and theequipment being used? For example, ifthe person is in a wheelchair, can theyaccess all areas? What equipment is available to you, asa carer? For example, does the personneed a hoist and has that been madeavailable? Is all equipment regularly maintained? Do you know how to use all equipmentprovided? For example, what are therisks associated with the equipmentbeing used? Do you have the necessary skills andphysical ability to provide care in thehome? As the person's condition maydeteriorate over time, you shouldcontinually consider whether you areable to provide sufficient care at home.Good communicationIt is vital that everyone involved withyour family member’s care is able tocommunicate clearly and freely with theothers involved so that everyone’s needsand requirements are considered.7

TrainingTraining is essential for all carers. Thetraining should be task specific andinclude: Identifying and assessing risk factors. Improving your skills in problemsolving so that you can work out anappropriate solution to each problemyou come across. The use of manual task aids andequipment if used. Awareness of postures and actionsthat may reduce the risk of injury.Due to differences in equipment andbetween brands it is important thatyou know how to use each piece ofequipment. All mechanical equipmentshould be regularly maintained. Thesupplier will often provide instructions, andsometimes training, on how to use theequipment. However, further training by ahealthcare worker may also be needed.Refer to pages 22-23 for a list of usefulorganisations which can provide furtherinformation.8

Reducing the risk of injurySpot the hazard: Which manual taskshave the potential to cause injury?There are many manual tasks performedby carers that have the potential to causeinjury when assisting people with physicaltransfers, mobility and activities of dailyliving.Here are some manual tasks which areoften performed by carers and have beenassociated with musculoskeletal injuries:Activities of DailyLiving TransfersMobility Bed (rolling,moving up anddown the bed)Bed to chair(and reverse)Chair to chairBed to bed/trolleyVehicle accessGetting off thefloorEquipment(slings, hoists,slide sheets) StandingWalkingWalking withaidsWheelchairStairs Support Tasks LaundryShoppingCookingCleaning9

Assess the risk: Understand theproblem.An important step is to understand whypeople can get injured when performing amanual task. Some risk factors have directeffects on the body and the risk of injury,including: Actions and postures (eg awkward,static or repetitive movements andpositions). Overexertion (Heavy, awkward orunstable loads). 10 Vibration both whole-body (egsitting in certain vehicles) andhand-arm (eg using certainpowered tools).

Other factors contribute to the risk of injuryby making the task more difficult, including: The environment, such as rough orslippery floors, uneven or variations inlevel (eg steps/ramps), poor lighting,the weather and loud noises.The risk of getting injured will be greaterwhen: The way things are done such as thetiming and order of manual tasks. Individual characteristics such asexperience and/or physical limitations.It is not uncommon for manual tasks tohave several risk factors at a time. Thiscan further increase the risk of injury. A risk factor is at a high level (eg.lifting loads that are very heavy):intensity of risk factor. There are many risk factors presentat the same time (eg. lifting aheavy load in an awkward posture):number of risk factors. The carer is carrying out riskymanual tasks for long periods:duration. The carer is carrying out riskymanual tasks frequently: frequency.11

Control the Risk: Provide solutionsThere are a variety of different ways toreduce the risk of injury. The best way isto eliminate the problem altogether. Somesolutions may include: Changing the way the work isorganised or carried out so that thereis less risk eg. doing things in smallsteps to reduce fatigue, carrying outmore strenuous activities during theday when the person’s medication iseffective. Changing the layout or other aspectsof the environment, so that the task iseasier and safer eg. improve lighting,move objects out of the way. Changing the load or getting theperson to help more so less forceis needed to complete task eg. getthe person to cooperate more with atransfer so they do not resist or pull inthe opposite direction. Provide simple and clear instructionsto the person so they understandthe task and can help as much aspossible. Provide or improve the equipment andtools used so that the task is easier todo or less strength is needed eg. usehoists, slings, slide sheets.12 Follow-up and reviewReview how the task was performed afterthe solutions were put in place. Checkthat the solutions have not created newproblems or risks.

TrainingReceiving training or guidance canreduce the risk of injury. However, evenwith training there may still be a risk ofinjury. If help is required in providingskills and knowledge, seek supportfrom an appropriate professional suchas a physiotherapist or an occupationaltherapist. Training should include skills onhow to manage risks and how to performdifficult manual tasks safely.Support workers who are employed shouldrefer to WorkSafe WA’s Code of Practice:Manual Tasks 2010 for further informationon the duties of the employer andemployee (listed under ‘Useful Resources’at the back of this document).Injury ManagementDiscomfort like pain, numbness, tinglingor weakness should be attended to early.Review by a health professional for adiagnosis, information and treatment (ifrequired) is important. Early treatment oradvice about a musculoskeletal disordermay reduce the severity of the conditionand length of recovery.13

Handy TipsThese tips may help carers with a taskonce a risk assessment has beencompleted.Before the taskPLAN: Plan to do difficult tasks when youhave most energy or when the person hasthe most energy, so they can help too.Consider: Ensure places for rest breaks along theway if needed. Set up equipment in an easy to accesslocation eg adjust bed/chair to the bestheight for the task, footplates off, bed barsdown.PREPARE THE PERSON Tell the person what you are doing andensure they know what you want fromthem. medication side effects. normal sleep patterns of the person. meal times. Position the person in the best positionfor them to do as much as they canindependently. fatigue.PREPARE YOURSELFGET WHAT YOU NEED FOR THE TASK: Mentally- concentrate on the task. Have all the appropriate aids/equipment ready eg wheelchair, commode,hoist, towels, toiletries, slide boards. Think through the task and the positionsthat you need to be in. Seek assistance if needed. Test the ground surface for grip andstability before stepping onto it.PREPARE THE ENVIRONMENT ANDEQUIPMENT: Position feet apart to improve stability.(adopt wide base of support) Clear the path. Open doors. Use a posture which will help avoidbending, over reaching and twisting. Check the destination. Get a good grip. Check the floor for slip and trip hazards. Test the load where possible. Turn lights on if needed. Get further assistance if needed.14 Check your posture – keep the naturalcurves in your spine.

During the taskAfter the task Communicate with the person andanyone else assisting. Review how the task was done – wasthere anything you did really well, is thereanything you could improve? Get the person to do what they can toassist. Use safety devices eg. brakes andequipment. Keep arms and load close to your body. Keep the load in line with the bodywhere possible. Put away equipment and ensure area issafe. Consider if it will be safe for you toperform this task again with the currentcontrols in place - do you need moreequipment or assistance? Stop if it feels uncomfortable. Look where you are going. Avoid twisting (keep your body facingthe one direction). Where possible try to use your legs forpower. Consider posture (keep the naturalcurves in your spine) and foot placement. Avoid awkward postures such as overreaching and twisting by moving yourself toa better position. Don’t rush - prepare to do themovement in small steps if appropriate. Try and keep movements smooth andsteady. Breathe normally throughout the task.15

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Manual Task ExamplesThis next section provides examples of manual tasks that may lead to musculoskeletalTask 1: Showering a clientdisorders.Risk FactorsPossible SolutionsActions and Postures Avoid holding the shower head for longperiods - place it in a bracket wherepossible. Get the person to hold the showerhead for more directed water stream,where possible. Place objects in an easy to accesslocation. Communicate with the personthroughout the task. Using awkward and static postureswhen reaching and holding the showerhose and when reaching around theperson.Bending repeatedly when helpingwash the person’s feet.Forces and Loads Comprehension of instructions andmobility will vary between people. Ability to obtain a good grip may belimited.Get the person to help as much asthey can. Use appropriate mechanical aidsand equipment to reduce the loadwhere possible eg slide boards, and acommode with larger wheels. Move unnecessary equipment andfurniture out of the way. Use of a shower bench over the hob/step if appropriate. Dry the floor before walking over it. Apply non-slip matting on floor ifappropriate. Turn on the lights. Turn on exhaust fan to remove steam. People that are immobile may beheavy or large.Environment Lack of space in the bathroom maylead to adopting awkward positions. Slip trip and fall hazards may bepresent because the floor is wet, thereis a step into the shower or loose matsare on the floor. The task may be difficult to dobecause the lighting is inadequate orsteam has reduced visibility.17

Risk FactorsPossible SolutionsWork organisation and systems Do more difficult tasks when energylevels are high. Shorter showers to reduce time spentin awkward postures. Do tasks at a comfortable pace andmethodically.Individual characteristics Know your own physical abilities. Age related changes affect peopledifferently. Seek education and training to learnmore. We all have differing abilities. Our abilities change with experienceand training.Be aware of limitations to movementsand your ability to grip when you weargloves, aprons or special footwear. Workloads may be high. Assistance may be required. 18

Task 2: Transferring from Bed to ChairRisk FactorsActions and Postures Awkward and static postures may beadopted when reaching across thebed to help the person sit up, andthen helping them across into thechair.Forces and LoadsPossible Solutions Get the person to help get themselvesup – eg. rolling onto side and pushingup, using a hook or a rail. Set the bed and chair at the rightheight Keep the person close to avoidreaching and stretching. Position your feet to allow for weighttransfer and stable base of support. Position the chair at an angle tominimise the amount of movementneeded. Get the person to help as much asthey can. Comprehension of instructions andmobility will vary between people. Ability to obtain a good grip may belimited.Coordinate the transfer with the personusing clear and simple instructions. People that are immobile may beheavy or large.Take the load away from your bodyby using mechanical aids and otherequipment where possible eg.standing or cradle hoists. Ensure the lay-out of the room issuitable for manual tasks, such astransfers in the room. Move unnecessary equipment out ofthe way. Ensure that all slip (eg wet floors)and trip (eg mats or clothing on floor)hazards are removed. Open the curtains to let in natural lightor turn on the light.Environment There may be limited space to assisteasily. Slip and trip hazards may be present. Lighting in the room may be limited.19

Risk FactorsPossible SolutionsThe way we do things Do more difficult tasks when energylevels are high. Do tasks at a comfortable pace andmethodically. Ensure that not all heavy tasks aredone together. Undertake training where necessary inhow to perform the task and operate/use any equipment provided. Try different techniques to see whatworks best for you. Seek assistance where needed - docertain tasks when there is someoneelse at home or visiting to help. Make use of carer respite serviceswhere appropriate. Physical demand of several manualtasks in a row may lead to fatigue. Training may not be adequate.Individual characteristics Age related changes affect peopledifferently. We all have differing abilities. Our abilities change with experienceand training. 20

Task 3: Walking with one assistRisk FactorsActions and PosturesPossible Solutions Where possible, adopt a posturewhich maintains the natural curvaturesof the spine, such as standing directlynext to the person, supporting theirarm and elbow to prevent twisting. Keep the person close to avoidreaching and stretching. Arrange for rest stops. Encourage use of handrails/walkingaids. Explain to the person what you aredoing and what you want them to do. Get the person to help as much asthey can. Use walking belts to provide bettergrip. Set realistic goals.Environment Prepare the environment. Narrow corridors and doorways. Obstacles on the floor.Prepare for glare and changes inlighting levels. Variations in ground level. Awkward postures and inability toadopt desired postures due to lack ofspace.Dry/sweep/clean the floor beforewalking. Ensure all floors are covered with anon slip surface. Clearly mark changes in surface levels. Warn the person when coming tochanges in surface levels. Awkward and static positions whenreaching and holding the person’s armto support them, twisting around toprovide support.Forces and Loads Movements may be unpredictable. Holding onto clothing may not allowadequate grip.21

Arthritis & Osteoporosis WA:www.arthritiswa.org.au17 Lemnos Street, SHENTON PARK WA 6008Ph: (08) 9388 2199 Fax: (08) 9388 4488Email: general@arthritiswa.org.auAustralian Physiotherapy Association:www.physiotherapy.asn.auWA OfficeHampden House, 174 Hampden Road,NEDLANDS WA 6009Ph: (08) 9389 9211Fax: (08) 9389 9221E-mail: wa.branch@physiotherapyCarers WA:www.carersaustralia.com.au182 Lord Street, PERTH WA 6000Ph: 1300 CARERS (1300 227 377)Centrelink Carers Information:www.centrelink.gov.auUseful resources/contactsAged Care Assessment Team (ACAT):www.agedcare.health.wa.gov.auMultiple sites across WA including:Royal Perth Hospital Ph: (08) 9370 9900Sir Charles Gairdner HospitalPh: (08) 9346 2078Osborne Park HospitalPh: (08) 9346 8111Swan HospitalPh: (08) 9347 5423Bentley HospitalPh: (08) 9334 366622Community Aids and EquipmentProgram (CAEP):www.disability.wa.gov.auPh: 9426 9200TTY: 9426 9315Freecall: 1800 998 214Email: caep@dsc.wa.gov.auDepartment of Health WA:www.health.wa.gov.auPh: (08) 9222 0200Email: healthpolicy@health.wa.gov.au

Department of Veteran Affairs (DVA):www.dva.gov.auLevel 5, AMP Building, 140 St GeorgesTerrace, PERTH WA 6000Ph: 133 254 or 1300 55 1918Regional callers: 1800 555 254 Back to Basics (a useful resource on howto perform some specific care tasks whilstminimising th

Assess the risk: Understand the problem. An important step is to understand why people can get injured when performing a manual task. Some risk factors have direct effects on the body and the risk of injury, including: Actions and postures (eg awkward, static or repetitive mo

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