Elizabeth Hallows: Physiotherapist

05/11/2024

I've stopped posting here. Please find me on Linked in instead

04/05/2024

With thanks to Juliet Everson and her colleagues at DAC Beachcroft
who each year publish a review of the main themes from the "Prevention of Future Deaths Reports" issued by coroners in inquests involving health and social care providers.
One PFD in particular is very relevant for all of us who assess for, prescribe and use slings to hoist people and I think that there are some useful lessons here for all of us, in what are often quite difficult circumstances. In this case, a gentleman very sadly died after "slipping through a sling while being hoisted..". The sling being used ( a toileting sling) had been judged as being unsuitable for the client but was not removed from the property and the care agency were not informed of the concerns. Do let me know if you'd like a full copy of the pdf of the Regulation 28 report and the response from the NHS Trust which identifies actions they've taken.
I've also attach a link to the main report from DAC Beachcroft. https://lnkd.in/e_me43-v

04/05/2024

Manual handling of people isn't always about transfers (bed to chair, for example) but can also be integral to the delivery of care tasks. Carrying out case tasks on the bed can be postural challenging, involving static postures and over-reaching as carers reach to wash, dress and maybe carry out passive movements with the client on the bed.
I often recommend using slide sheets to move the patient into a diagonal position on the bed, so that, for example, if you are helping them with their trousers and socks then you slide their legs towards you and their upper body away. If you are providing mouth or airway care, then reverse the position to bring the person's head and upper body nearer to the working side of the bed. This reduces the need to lean over the bed. I also recommend the carer stands in an offset, oblique position (as shown below) so that they avoid twisting.
Lastly, there are slide sheet-fabric dressing packs, which can reduce friction between the clothing and the person's legs (or arms) and the bed sheet. Hospital Direct offer these products (sometimes called "Fishermans Legs" and the link is below. The video is clear and helpful. https://lnkd.in/gjFXzAvz Hospital Direct Marketing Ltd

28/03/2024

A simple question: Should we apply the brakes of a mobile passive hoist when using it with a client?
Like many of these questions, the answer appears very straightforward at first glance. I think most of my colleagues would say "No". But we need to be clear and careful in our answers. It's not enough to say that we should read the manufacturers' instructions for use.....a brief look at instructions for well-known brands such as Invacare Corporation, Joerns Healthcare UK, Prism Medical UK and others shows that the advice varies...with some stating that the castors SHOULD BE LOCKED during lifting, some stating that they should NOT be locked, others stating that they should be locked when lifting from the floor and one advising that they should be locked when the sling is being fitted or removed (when I wouldn't expect the hoist to be near the client).
It's not surprising, then, that some manual handling advisors are recommending that castors should be locked during the lift.
It's always advisable to see what the says. They published HSIS3 some years ago after investigating a number of hoisting accidents. Their helpful flow chart states: "Hoist brakes OFF (unless otherwise stated in manufacturer's instructions". So, that's fine, unless you've bought a hoist from the manufacturer whose instructions say "During lifting, the rear castors should remain locked to ensure that the hoist will not move"....
In my own clinical work, and in my training, I follow this approach:
"Hoist brakes should usually be OFF when hoisting. The common exception to this is when hoisting from the floor, when they usually need to be LOCKED at the start of the lift and released once the person is just off the floor"
It'd be good to hear if anyone has an alternative approaches that they use?

21/03/2024

I feel very fortunate to be entrusted to provide manual handling training by a wide number of organisations. Today was a specialist children-handling training day for a North Wales group of OTs. I was helped by Kathryn Emasealu and Leon White from Care & Independence and by Gary Baker from The Osprey Group and am very grateful for their time and product expertise. The delegates evaluated the training very positively and one of the key learning outcomes for them was the need to fully assess a child’s movement skills. This can include bottom-shuffling, commando and 4-point crawling, standing with support, bridging, high-kneeling and climbing. We mustn’t miss an opportunity to identify and then use these movement skills in our manual handling assessments and recommendations. It benefits both the child and the helper.

28/02/2024

It has recently been my pleasure, along with every other physiotherapist in the UK, to renew my registration with the HCPC, who are our regulatory body. If we're not registered with them, we can't call ourselves physiotherapists or work as one. The HCPC's role is to ensure that we meet their standards and are safe to practice our profession.
Renewing this time felt extra special for me. Last year, a fitness to practice concern was raised about me, which the HCPC investigated.
It was brought as a result of concerns that I had raised about what appeared to be a very close working relationship between a therapist in NHSE and the commercial provider of single handed care training, that breached the NHS "Conflict of Interest" guidance and RCOT guidance too. NHSE responded very positively and quickly to my concerns, carried out an investigation and terminated the connection.
I am delighted to say that the HCPC found that I had raised legitimate concerns in a professional manner and that there was no question at all of my being unfit to practice as a physiotherapist.
It's not easy to be a whistleblower, but sometimes we have to do the right thing. I am very grateful to the HCPC for their finding and delighted to have renewed my registration.

20/02/2024

Please consider signing this important campaign, which aims at ensuring that everyone who needs rehab after stroke, brain injury, surgery, falls, fractures, amputation etc, gets it.

544 signatures are needed, let’s get there by the end of the day?

18/02/2024

It’s been a busy week with complex manual handling risk assessments of clients in their homes, bespoke training for a group of personal assistants, an NHS day and then training key workers at the Together Trust . The training was an annual update for the team who’ve all attended a 4 day train-the-trainer and risk assessor course. Their role is to assess the manual handling needs of students and clients who are supported by Together Trust in various settings, as well as delivering competency-based training to their colleagues. We reviewed the relevant legislation, new guidance from HOP7, the evidence around low bone mineral density and fragility fractures (with information from Angela Wing at BCUHB) and the process of carrying out a manual handling risk assessment using relevant scenarios. Delegates were able to discuss real scenarios that they’re facing (whilst maintaining confidentiality). Practical moves were directed by the delegates, who’d identified what they wanted to review. I was very impressed by their level of engagement, their enthusiasm for the subject and motivation to get manual handling right for their students, clients and colleagues. Thank you to Mandy Conduit Assoc CIPD for booking the session with me.

28/09/2023

Repositioning up the bed:
Thanks to a post from Etac, I've read an interesting and useful article
(Fragala G. Facilitating Repositioning in Bed. AAOHN Journal. 2011;59(2):63-68. doi:10.1177/216507991105900203) which found that, when using a slide sheet to slide a 90kg dummy up towards the head of the bed, tilting the head of the bed down by just 4 degrees reduced the work demands on the carers by 46%, and tilting the bed by 6 degrees reduced work demand by 64%, compared to doing the same move with a slide sheet on a flat bed. That's a significant reduction in effort from a very small tilt. It makes me think that perhaps we should tilt the bed for this task whenever the client can tolerate it and whenever there's space to accommodate it. Also, when prescribing hi-low beds for heavier patients, we should ensure that the bed can be tilted head down (sometimes called the Trendelenburg position).

10/09/2023

Looking forward to assessing the manual handling needs of students with disabilities at a local college this week. I've (again!) updated the form that I use, aiming to prompt the assessor to gather all the relevant information and also to include clear clinical reasoning for the recommendations and handling plan. I very much agree with Jacqui Smith and Julia Love, who write in HOP7 that "the route (to potential solutions)...is frequently unclear and unrecorded in many standard pre-formatted person handling risk assessment documents." I'm happy to share my document with anyone who'd like a copy and it can be used, adapted or amended as you like.

06/09/2023

Oh..it's been a long time since I posted here...I'm thinking that people have moved to Linked in and maybe to Twitter? Anyway, just in case..here's a post: .Planning a bespoke manual handling training course for physiotherapists and occupational therapists who work with children and young people has made me reflect on all the dynamic manual handling risk assessments that we carry out in our clinical, hands-on rehab work. The decision to ask a colleague to come with us to see the patient, whether or not to use equipment..how to balance everyone's safety with the "utility" of rehab. Tomorrow we'll consider the variety of methods we can use to position a person over a wedge, help a person off the floor and to stand and walk. Efficient methods, +/- equipment.