Moving and handling and patient safety: analysis of clinical incidents
Jocelyn Cornish and Anne Jones
Abstract
Aim: The aim of this study is to identify the potential contribution of moving and handling practice to clinical incidents through an analysis of incident data. Background: Previous studies focusing on moving and handling have highlighted potential harm to patients through poor practice, and have suggested that this might be an issue for patient safety. However, this has not been identified in studies analysing clinical incident reports, where the potential contribution of moving and handling has not been recognized. This study reports an analysis of clinical incident data from the specific perspective of moving and handling. Design: Survey of clinical incident reports in hospital in-patient care settings Method: A random sample of 500 incident reports was analysed using descriptive statistics and thematic analysis of qualitative data. Results: There is an indication that some staff are not following recommended moving and handling policy through a lack of risk assessment; for example, in the selection of appropriate actions to assist patients, and in the prevention of further occurrences of incidents where patients had fallen. The limited detail within the reports affected consideration of the causes of the incidents and actions that could be taken to prevent a further occurrence. Conclusions: Some of the reported staff actions may contravene policy guidelines. Missing detail in the incident reports inhibited investigation of incidents that could lead to appropriate and safe systems of work being identified.
Key words: Manual handling n Moving and handling n Patient safety
Nursing n Risk assessment
n
A
key tenet of current UK manual handling policy is that patients should not be physically lifted by nurses (Health and Safety Executive
(HSE), 1992). Patients who are unable to move independently will require assistance, ranging from verbal encouragement to the use of electric hoisting equipment.
Decisions about the most appropriate interventions are made following individual patient risk assessment in accordance with professional guidelines (Nursing and Midwifery Council,
2008). This enables the application of a safe system of work, which maximizes patients’ capabilities, where possible, as well as preventing falls and other injuries. Evidence from student
Jocelyn Cornish and Anne Jones are Lecturers in Nursing, Florence
Nightingale School of Nursing and Midwifery
King’s College London
Accepted for publication: November 2011
166
nurses concerning their experience of moving and handling
(M&H) in practice has suggested that some patients are harmed as a result of poor care (Cornish and Jones, 2007; 2009).
There is limited evidence from qualified staff to validate the findings from these studies; however, incident reports of patient and staff accident and injury could potentially illustrate issues of M&H and their association with patient harm. This study describes an analysis of clinical incident data from an M&H perspective, with a view to providing information to enhance nursing practice for patient benefit. Permission from the
National Patient Safety Agency (NPSA) was granted to analyse a sample of reported incidents for this purpose.
Background
In an evaluation of an M&H training programme for preregistration students, examples of good and poor practice in patient handling were identified (Cornish and Jones, 2007).
Students reported M&H events that resulted in bruising to a patient’s head, a patient with a pressure ulcer being dragged up the bed, pulling a patient under the arms resulting in pain, and the dislocation of a total hip replacement. The follow-up study (Cornish and Jones, 2009) highlighted factors affecting students’ compliance with good and poor practice, and provided other examples of patient incidents,
including
