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Musculoskeletal​ ​Injury​ ​Prevention

Christian​ ​Horizons
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Table​ ​of​ ​Contents

1. Introduction……………………………………………………………………………..3
2. Definitions​ ​of​ ​Techniques………………………………………………………​ ​….....3
3. Common​ ​Musculoskeletal​ ​Disorders………………………….​ ​…………………....3
4. Risks​ ​for​ ​Injury………………………………………………………………………....3
5. Body​ ​Mechanics…………………………………………………………………….....4
6. Rules​ ​for​ ​Safe​ ​Lifting……………………………………………………………….….5
7. Minimal​ ​Lift​ ​Program…………………………………………………………………..5
8. Assessment………………………………………………………………………….....5
9. Proper​ ​Lifting/Transfer​ ​Techniques…………………………………………..…..…..7
10. Prevention…………………………………………………………………………..…..1
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Introduction
Work​ ​Related​ ​Musculoskeletal​ ​Disorders​ ​(WMSDs)​ ​is​ ​a​ ​term​ ​that​ ​defines​ ​injuries​ ​to
muscles,​ ​tendons​ ​or​ ​nerves​ ​that​ ​are​ ​caused​ ​or​ ​aggravated​ ​by​ ​work.

Definitions​ ​of​ ​Techniques

Transfers​​ ​include​ ​assisting​ ​the​ ​client​ ​from​ ​one​ ​surface​ ​to​ ​another.​ ​The​ ​client​ ​is​ ​able​ ​to
bear​ ​some​ ​weight​ ​in​ ​the​ ​arms​ ​and​ ​legs​ ​and​ ​part​ ​of​ ​the​ ​weight​ ​is​ ​borne​ ​by​ ​an​ ​assistive
device​ ​such​ ​as​ ​a​ ​transfer​ ​belt,​ ​transfer​ ​board,​ ​walker​ ​or​ ​a​ ​cane.
Lifts​ ​are​ ​any​ ​procedure​ ​where​ ​the​ ​clients​ ​entire​ ​body​ ​weight​ ​is​ ​borne​ ​by​ ​someone​ ​or
something​ ​other​ ​than​ ​the​ ​client,​ ​such​ ​as​ ​a​ ​mechanical​ ​lifting​ ​device,​ ​for​ ​purposes​ ​of
repositioning​ ​or​ ​moving​ ​to​ ​another​ ​surface.
Repositioning​ ​is​ ​shifting,​ ​adjusting​ ​or​ ​changing​ ​the​ ​client’s​ ​position​ ​in​ ​bed,​ ​wheelchair,
chair​ ​or​ ​other​ ​supportive​ ​surface.

Common​ ​Musculoskeletal​ ​Disorders

- Strained​ ​Ligaments:​​ ​ ​Fast​ ​forces​ ​(such​ ​as​ ​slipping​ ​and​ ​falling)​ ​can​ ​tear​ ​or​ ​strain
ligaments.​ ​Slower​ ​forces​ ​can​ ​tear​ ​ligaments​ ​from​ ​the​ ​bone.​ ​Prolonged​ ​stretch​ ​of
ligaments​ ​(such​ ​as​ ​from​ ​prolonged​ ​slouching)​ ​can​ ​cause​ ​muscle​ ​spasms.
- Strained​ ​Muscles:​ ​Muscle​ ​strains​ ​usually​ ​occur​ ​during​ ​activities​ ​that​ ​require​ ​the
muscle​ ​to​ ​tighten​ ​forcefully.​ ​The​ ​muscle​ ​is​ ​strained​ ​either​ ​because​ ​it​ ​is​ ​not
properly​ ​stretched,​ ​or​ ​warmed​ ​up,​ ​before​ ​the​ ​activity;​ ​it​ ​is​ ​too​ ​weak;​ ​or​ ​because
the​ ​muscle​ ​is​ ​already​ ​injured​ ​and​ ​not​ ​allowed​ ​time​ ​to​ ​recover.​ ​Muscle​ ​strains​ ​can
occur​ ​when​ ​lifting​ ​and​ ​transferring​ ​clients​ ​and​ ​heavy​ ​objects.
- Back​ ​Injuries:​ ​Lifting​ ​heavy​ ​loads​ ​in​ ​awkward​ ​positions​ ​can​ ​cause​ ​stress​ ​on​ ​the
discs​ ​in​ ​the​ ​back.​ ​This​ ​stress​ ​can​ ​then​ ​result​ ​in​ ​inflammation​ ​and​ ​soreness.
Lifting​ ​while​ ​the​ ​back​ ​is​ ​bent,​ ​holding​ ​the​ ​load​ ​away​ ​from​ ​your​ ​body​ ​and​ ​twisting
and​ ​jerking​ ​movements​ ​can​ ​increase​ ​this​ ​stress.

Risks​ ​for​ ​Injury

- Single​ ​high​ ​load​ ​incidents
- Awkward​ ​postures​ ​for​ ​sustained​ ​periods​ ​of​ ​time
- Lifting​ ​continuously​ ​all​ ​day​ ​without​ ​significant​ ​rest​ ​or​ ​breaks
- Chronic​ ​strain​ ​to​ ​muscles​ ​and​ ​joints
- Repetitive​ ​lifting​ ​or​ ​loading​ ​in​ ​one​ ​direction
- Stressful​ ​living:​ ​poor​ ​nutrition​ ​or​ ​hydration,​ ​sedentary​ ​lifestyle
- Psychosocial​ ​factors:​ ​time​ ​pressures,​ ​stressful​ ​work​ ​environments,​ ​heavy
responsibilities,​ ​not​ ​enough​ ​breaks​ ​and​ ​too​ ​many​ ​tasks
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Body​ ​Mechanics
Definition:​ ​Body​ ​mechanics​ ​is​ ​a​ ​term​ ​used​ ​to​ ​describe​ ​an​ ​effort​ ​coordinated​ ​by​ ​the
muscles,​ ​bones​ ​and​ ​nervous​ ​system.​ ​Body​ ​mechanics​ ​are​ ​used​ ​in​ ​every​ ​activity​ ​you
perform​ ​at​ ​work​ ​and​ ​in​ ​your​ ​everyday​ ​life.​ ​Use​ ​of​ ​proper​ ​body​ ​mechanics​ ​can​ ​help​ ​avoid
musculoskeletal​ ​strain,​ ​injury​ ​to​ ​staff​ ​and​ ​the​ ​client​ ​and​ ​fatigue.
Rules:
- Keep​ ​lower​ ​portion​ ​of​ ​your​ ​back​ ​in​ ​its​ ​normal​ ​position​ ​at​ ​all​ ​times
- Move​ ​as​ ​close​ ​to​ ​patient’s​ ​bed​ ​as​ ​possible
- Do​ ​not​ ​twist​ ​your​ ​body.​ ​Always​ ​move​ ​your​ ​feet​ ​to​ ​step​ ​up​ ​or​ ​pivot.
- Set​ ​your​ ​feet​ ​in​ ​a​ ​comfortable​ ​and​ ​solid​ ​wide​ ​base​ ​of​ ​support
- Keep​ ​your​ ​abdominal​ ​muscles​ ​contracted​ ​when​ ​lifting​ ​and​ ​bow​ ​slightly​ ​using​ ​the
hips​ ​and​ ​squat
- Keep​ ​your​ ​head​ ​upright​ ​and​ ​hold​ ​your​ ​shoulders​ ​up
- Push​ ​up​ ​from​ ​the​ ​knees​ ​and​ ​use​ ​your​ ​own​ ​momentum​ ​to​ ​lift
Stable​ ​Center​ ​of​ ​Gravity
To​ ​maintain​ ​a​ ​stable​ ​center​ ​of​ ​gravity,​ ​you​ ​should​ ​evenly​ ​distribute​ ​your​ ​body​ ​weight.
1. Keep​ ​your​ ​center​ ​of​ ​gravity​ ​low​ ​for​ ​greater​ ​balance.
2. Flex​ ​your​ ​knees​ ​and​ ​keep​ ​your​ ​body​ ​straight​ ​rather​ ​than​ ​bending.
Wide​ ​Base​ ​of​ ​Support
1. Having​ ​a​ ​wide​ ​base​ ​of​ ​support​ ​gives​ ​your​ ​body​ ​more​ ​stability.
2. Spread​ ​your​ ​feet​ ​apart​ ​to​ ​a​ ​reasonable​ ​distance.
3. Flex​ ​your​ ​knees​ ​to​ ​move​ ​the​ ​center​ ​of​ ​gravity​ ​closer​ ​to​ ​the​ ​base​ ​of​ ​support.
Proper​ ​Body​ ​Alignment
1. Body​ ​alignment​ ​refers​ ​to​ ​the​ ​way​ ​the​ ​joints,​ ​tendons,​ ​ligaments​ ​and​ ​muscles
are​ ​arranged​ ​when​ ​initiating​ ​a​ ​position.
2. A​ ​line​ ​of​ ​gravity​ ​passing​ ​through​ ​your​ ​base​ ​of​ ​support​ ​maintains​ ​your​ ​balance.
3. Equal​ ​activity​ ​balance​ ​in​ ​upper​ ​and​ ​lower​ ​parts​ ​of​ ​the​ ​body​ ​would​ ​reduce​ ​your
risks​ ​of​ ​having​ ​back​ ​injury.
4. When​ ​you’re​ ​stronger​ ​muscle​ ​group​ ​are​ ​involved,​ ​greater​ ​amount​ ​of​ ​work​ ​can
be​ ​safely​ ​done.
5. Keep​ ​the​ ​back​ ​upright​ ​when​ ​performing​ ​interventions.
Moving​ ​Clients​ ​or​ ​Objects
Here​ ​are​ ​some​ ​guidelines​ ​into​ ​how​ ​to​ ​properly​ ​move​ ​clients​ ​and​ ​other​ ​objects​ ​on​ ​the
work​ ​area​ ​using​ ​proper​ ​body​ ​mechanics:
Pushing
1. Stay​ ​close​ ​to​ ​the​ ​subject​ ​being​ ​pushed.
2. Place​ ​one​ ​foot​ ​in​ ​front​ ​of​ ​the​ ​other
3. Place​ ​the​ ​hands​ ​on​ ​the​ ​subject,​ ​flex​ ​your​ ​elbows​ ​and​ ​lean​ ​to​ ​the​ ​subject.
4. Place​ ​the​ ​weight​ ​from​ ​your​ ​flexor​ ​to​ ​the​ ​extensor​ ​portions​ ​of​ ​your​ ​leg.
5. Apply​ ​pressure​ ​with​ ​the​ ​use​ ​of​ ​your​ ​leg​ ​muscles.
6. To​ ​prevent​ ​fatigue,​ ​provide​ ​alternate​ ​rest​ ​periods.
Pulling
1. Stay​ ​close​ ​to​ ​the​ ​subject​ ​being​ ​pulled.
2. Place​ ​one​ ​foot​ ​in​ ​front​ ​of​ ​the​ ​other
3. Hold​ ​the​ ​subject,​ ​flex​ ​your​ ​elbows​ ​and​ ​lean​ ​your​ ​body​ ​away​ ​from​ ​the​ ​subject.
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4. Shift​ ​your​ ​weight​ ​away​ ​from​ ​the​ ​subject.

5. Avoid​ a ​ ny​ ​unnecessary​ ​movements.
6. To​ ​prevent​ ​fatigue,​ ​provide​ ​alternate​ ​rest​ ​periods.

Rules​ ​for​ ​Safe​ ​Lifting

When​ ​lifting​ ​objects,​ ​use​ ​the​ ​acronym​ ​“BACK”​ ​as​ ​a​ ​guide​ ​to​ ​prevent​ ​injury:
B​ack​ ​Straight
A​void​ ​Twisting
C​lose​ ​to​ ​Body
K​eep​ ​Smooth
Back​ ​Straight:​ ​the​ ​discs​ ​in​ ​your​ ​back​ ​can​ ​tolerate​ ​larger​ ​loads​ ​when​ ​the​ ​back​ ​is
straight.​ ​Discs​ ​are​ ​weaker​ ​when​ ​lifting​ ​in​ ​a​ ​flexed​ ​or​ ​bent​ ​position.​ ​Maintain​ ​the​ ​spine’s
neutral​ ​curves​ ​when​ ​lifting.​ ​This​ ​minimizes​ ​the​ ​stress​ ​exerted​ ​on​ ​the​ ​spine.
Avoid​ ​Twisting:​ ​Discs​ ​are​ ​weaker​ ​when​ ​lifting​ ​is​ ​combined​ ​with​ ​a​ ​twisting​ ​motion.
Twisting​ ​the​ ​back​ ​while​ ​lifting​ ​can​ ​cause​ ​the​ ​joints​ ​to​ ​become​ ​injured​ ​and/or​ ​sore.​ ​If​ ​you
need​ ​to​ ​change​ ​direction​ ​while​ ​lifting,​ ​move​ ​your​ ​feet​ ​to​ ​turn​ ​instead​ ​of​ ​twisting​ ​the​ ​back.
Close​ ​to​ ​Your​ ​Body:​​ ​Your​ ​back​ ​muscles​ ​and​ ​joints​ ​have​ ​to​ ​work​ ​harder​ ​to​ ​lift​ ​when​ ​an
object​ ​is​ ​held​ ​at​ ​a​ ​greater​ ​distance​ ​from​ ​your​ ​body.​ ​By​ ​holding​ ​the​ ​load​ ​closer​ ​to​ ​your
body,​ ​less​ ​stress​ ​is​ ​exerted​ ​on​ ​the​ ​back.
Keep​ ​Smooth:​ ​avoid​ ​quick,​ ​jerking​ ​motions​ ​when​ ​lifting.​ ​These​ ​movements​ ​increase
the​ ​load​ ​that​ ​are​ ​on​ ​the​ ​discs.

Minimal​ ​Lift​ ​Program

This​ ​program​ ​helps​ ​reduce​ ​unnecessary​ ​risks​ ​for​ ​injury​ ​for​ ​both​ ​clients​ ​and​ ​staff​ ​by
reducing​ ​the​ ​amount​ ​manual​ ​lifting​ ​of​ ​clients.​ ​This​ ​program​ ​promotes​ ​the​ ​usage​ ​of
assistive​ ​equipment​ ​like​ ​the​ ​hoyer​ ​lift,​ ​the​ ​sit-to-stand​ ​lift​ ​and​ ​the​ ​ceiling​ ​lift.​ ​Regular
training​ ​about​ ​the​ ​use​ ​of​ ​these​ ​lifts​ ​is​ ​recommended.

Assessment
Completing​ ​an​ ​assessment​ ​before​ ​a​ ​transfer​ ​or​ ​lift​ ​is​ ​important​ ​because​ ​it:
- Helps​ ​to​ ​determine​ ​risk​ ​for​ ​injury
- Promotes​ ​continuity​ ​of​ ​care
- Helps​ ​you​ ​to​ ​be​ ​prepared​ ​for​ ​possible​ ​risks
- Helps​ ​to​ ​minimize​ ​the​ ​risk​ ​of​ ​injury​ ​for​ ​the​ ​health​ ​care​ ​worker​ ​and​ ​the​ ​client
Assessment​ ​of​ ​the​ ​Work​ ​Area:
- A​ ​room​ ​should​ ​not​ ​be​ ​cluttered​ ​with​ ​furniture​ ​or​ ​equipment.​ ​A​ ​cluttered​ ​room
increases​ ​the​ ​potential​ ​for​ ​trips​ ​and​ ​falls.
- A​ ​small​ ​room,​ ​such​ ​as​ ​a​ ​bathroom,​ ​may​ ​not​ ​allow​ ​natural​ ​body​ ​movements.
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- A​ ​highly​ ​polished​ ​or​ ​wet​ ​floor​ ​does​ ​not​ ​provide​ ​good​ ​traction​ ​or​ ​a​ ​safe​ ​base​ ​for
lifting​ ​(i.e.​ ​shower).​ ​Slips​ ​are​ ​more​ ​likely​ ​to​ ​occur​ ​on​ ​a​ ​highly​ ​polished​ ​or​ ​wet
floor.
Equipment:
Purchase​ ​furniture​ ​with​ ​patient​ ​handling​ ​in​ ​mind.
- Removable​ ​arm​ ​and​ ​foot​ ​rests​ ​on​ ​wheelchairs​ ​and​ ​shower​ ​chairs​ ​make​ ​transfers
easier
- Beds​ ​that​ ​can​ ​be​ ​raised​ ​or​ ​lowered​ ​also​ ​make​ ​transfers​ ​easier.
- Adaptive​ ​clothes​ ​are​ ​needed​ ​for​ ​patients​ ​who​ ​are​ ​toileted​ ​using​ ​the​ ​hoist.
- The​ ​shower​ ​and​ ​toilets​ ​should​ ​be​ ​designed​ ​so​ ​pushing​ ​and​ ​pulling​ ​shower​ ​chairs
into​ ​position​ ​is​ ​as​ ​easy​ ​as​ ​possible
Staffing:
Ensure​ ​there​ ​are​ ​enough​ ​nurses​ ​and​ ​nursing​ ​assistants​ ​available​ ​to​ ​perform​ ​patient
handling​ ​tasks​ ​safely​ ​especially​ ​during​ ​high​ ​activity​ ​periods.
Client​ ​Assessment:
Before​ ​performing​ ​a​ ​lift​ ​or​ ​transfer,​ ​you​ ​should​ ​assess​ ​your​ ​client​ ​to​ ​determine​ ​what
technique​ ​to​ ​use.
Patient​ ​assessment​ ​criteria​ ​may​ ​include:
● How​ ​much​ ​assistance​ ​does​ ​the​ ​patient​ ​require?
● What​ ​is​ ​the​ ​weight​ ​bearing​ ​capacity​ ​of​ ​the​ ​patient?
● Does​ ​the​ ​patient​ ​have​ ​enough​ ​upper​ ​body​ ​strength​ ​to​ ​support​ ​their​ ​weight​ ​during
the​ ​transfer?
● Is​ ​the​ ​patient​ ​co-operative,​ ​and​ ​can​ ​they​ ​understand​ ​instructions?
● Is​ ​the​ ​patient​ ​able​ ​to​ ​cooperate​ ​with​ ​each​ ​lift,​ ​or​ ​does​ ​this​ ​change​ ​each​ ​time​ ​(e.g.,
time​ ​of​ ​day)?
● Are​ ​there​ ​physical​ ​characteristics​ ​that​ ​should​ ​be​ ​noted​ ​(height,​ ​weight,​ ​age)?
● Are​ ​there​ ​special​ ​circumstances​ ​such​ ​as​ ​injuries,​ ​presence​ ​of​ ​tubes,​ ​history​ ​of
falls,​ ​osteoporosis,​ ​fractures,​ ​pressure​ ​ulcers,​ ​splints,​ ​history​ ​of​ ​spasms,​ ​etc.?
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Proper​ ​Lifting​ ​Techniques

-Independent​ ​transfers​-Should​ ​be​ ​used​ ​when​ ​a​ ​client​ ​is​ ​able​ ​to​ ​mobilize​ ​without​ ​risk​ ​of
injury​ ​and​ ​the​ ​client​ ​is​ ​comfortable​ ​with​ ​the​ ​use​ ​of​ ​mobility​ ​aids.

-Supervised​ ​transfers​-Should​ ​be​ ​used​ ​when​ ​the​ ​client​ ​is​ ​able​ ​to​ ​mobilize,​ ​but​ ​may
require​ ​verbal​ ​of​ ​minimal​ ​physical​ ​cueing.​ ​Transfer​ ​belts​ ​should​ ​be​ ​used​ ​in​ ​all​ ​of​ ​these
cases.

-One-person​ ​transfer​ ​belt/Pivot​ ​transfer​-Should​ ​be​ ​used​ ​when​ ​a​ ​client​ ​can​ ​stand
unsupported​ ​or​ ​can​ ​weight​ ​bear​ ​with​ ​assistance​ ​from​ ​one​ ​staff​ ​member​ ​who​ ​will​ ​provide
less​ ​than​ ​40​ ​pounds​ ​of​ ​assistance.​ ​A​ ​transfer​ ​belt​ ​must​ ​be​ ​used​ ​for​ ​safe​ ​handling​ ​in​ ​this
situation.
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-Two​ ​person​ ​standing​ ​pivot​ ​transfer​-Should​ ​be​ ​used​ ​when​ ​a​ ​client​ ​can​ ​weight​ ​bear
through​ ​their​ ​legs​ ​but​ ​are​ ​heavy.​ ​This​ ​requires​ ​two​ ​staff​ ​members​ ​and​ ​the​ ​taller​ ​staff
member​ ​must​ ​be​ ​standing​ ​behind​ ​the​ ​client.​ ​A​ ​transfer​ ​belt​ ​must​ ​be​ ​used

-Walker​ ​transfer​-Should​ ​be​ ​used​ ​when​ ​a​ ​client's​ ​upper​ ​extremity​ ​strength​ ​and​ ​mobility
are​ ​adequate​ ​and​ ​they​ ​can​ ​weight​ ​bear​ ​through​ ​at​ ​least​ ​one​ ​leg.

-​Sit-stand​ ​mechanical​ ​lift​ ​(SARA​ ​lift)-​Should​ ​be​ ​used​ ​when​ ​a​ ​client​ ​can​ ​sit​ ​with
minimal​ ​support​ ​on​ ​the​ ​edge​ ​of​ ​the​ ​bed​ ​and​ ​can​ ​weight​ ​bear.​ ​The​ ​client​ ​must​ ​be​ ​able​ ​to
tolerate​ ​a​ ​harness​ ​underneath​ ​the​ ​arms.
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-Total​ ​mechanical​ ​lift​-Should​ ​be​ ​used​ ​when​ ​a​ ​client​ ​can​ ​only​ ​minimally​ ​transfer​ ​and​ ​is
not​ ​able​ ​to​ ​help​ ​with​ ​weight​ ​bearing.​ ​This​ ​should​ ​be​ ​used​ ​when​ ​client​ ​is​ ​cognitively
unreliable​ ​or​ ​uncooperative​ ​and​ ​has​ ​poor​ ​head​ ​control​ ​and​ ​poor​ ​sitting​ ​balance.​ ​This
can​ ​also​ ​be​ ​used​ ​when​ ​the​ ​client​ ​is​ ​extremely​ ​large​ ​or​ ​heavy​ ​and​ ​requires​ ​assistance.

-Transfer​ ​belt​-Should​ ​be​ ​used​ ​when​ ​a​ ​client​ ​needs​ ​assistance​ ​with​ ​any​ ​transfer​ ​or​ ​for
mobilization

-Slide​ ​board/transfer​ ​board-​Should​ ​be​ ​used​ ​when​ ​transferring​ ​between​ ​equal​ ​height
surfaces.​ ​They​ ​should​ ​also​ ​be​ ​used​ ​to​ ​facilitate​ ​transfer​ ​to​ ​wheelchair​ ​and​ ​for​ ​clients
that​ ​have​ ​excessive​ ​weakness​ ​in​ ​their​ ​lower​ ​extremities.
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-Slide​ ​sheets-​Should​ ​be​ ​used​ ​when​ ​repositioning​ ​a​ ​client​ ​in​ ​bed​ ​who​ ​is​ ​unable​ ​to​ ​move
themselves​ ​independently.​ ​Two​ ​staff​ ​members​ ​are​ ​required.

http://www.ohcow.on.ca/edit/files/general_handouts/Healthcare%20Workers%20Patient
%20Handling.pdf

Prevention
- Use​ ​your​ ​leg​ ​and​ ​hip​ ​muscles​ ​and​ ​knee​ ​joints​ ​to​ ​lift
- When​ ​lifting,​ ​tighten​ ​your​ ​abdominal​ ​and​ ​pelvic​ ​muscles
- Avoid​ ​reaching​ ​over​ ​your​ ​head​ ​to​ ​lift
- Lift​ ​in​ ​stages​ ​if​ ​needed
- Employees​ ​should​ ​also​ ​be​ ​informed​ ​about​ ​the​ ​importance​ ​of​ ​appropriate
footwear​ ​and​ ​clothing.​ ​Proper​ ​footwear​ ​that​ ​is​ ​slip​ ​resistant​ ​and​ ​clothing​ ​that
allows​ ​unrestricted​ ​movement​ ​can​ ​significantly​ ​reduce​ ​the​ ​chance​ ​of​ ​injury​ ​in
transfers.​ ​Jewellery​ ​such​ ​as​ ​necklaces​ ​or​ ​bracelets​ ​can​ ​become​ ​a​ ​hazard​ ​if​ ​the
patient​ ​grabs​ ​at​ ​these​ ​objects​ ​during​ ​a​ ​fall.
- Exercise​ ​such​ ​as​ ​strength​ ​and​ ​conditioning​ ​helps​ ​maintain​ ​functional​ ​ability​ ​and
helps​ ​prevent​ ​work​ ​related​ ​injury.
- Stretching​ ​should​ ​be​ ​incorporated​ ​into​ ​an​ ​exercise​ ​program​ ​to​ ​help​ ​improve
flexibility
- Ensure​ ​that​ ​staff​ ​has​ ​access​ ​to​ ​appropriate​ ​patient​ ​handling​ ​devices​ ​and​ ​ensure
that​ ​all​ ​devices​ ​are​ ​in​ ​good​ ​working​ ​order.