| Task |
Solutions |
Risk Control W/sheet |
Type of Control |
| getting in or out of bed |
If person can’t assist: Lifting machine/electrical ceiling hoist: 2 staff required. Adjust bed height. Do not lift clients legs or shoulders to fit sling - roll them. Position equipment to minimise movement of hoist whilst client suspended. Correct sling fit and positioning should eliminate the need to lift client to reposition them once lowered in chair or bed from hoist. |
1 |
Elimination |
| getting in or out of bed |
If person can assist: Physical and Verbal prompts: to maximise clients body mechanics. i.e., ensure client laying on their side & use their strongest upper limb closest to the mattress to push on mattress, to sitting. clients strongest leg should slide towards the edge of the bed. |
1 |
|
| getting in or out of bed |
If person can assist: Prompting by staff: Ensure client sufficiently alert in morning. Use noise, music, verbal interaction, light, incentives, and adequate time to prompt client to transfer from bed independently. Include physical prompts once client sufficiently alert, and motivated to transfer out of bed. Physical prompts include; tapping clients legs & shoulder, towards sitting, and legs to slide feet off bed. |
1 |
|
| getting in or out of bed |
If person can assist: Bed stick: fitted to the edge of the bed. Client pulls self to the side of the bed, into sitting then standing position. Requires good upper limb strength, and able to weight bear through legs. |
1 |
|
| getting in or out of bed |
If person can assist: Standing hoist; clients must be co operative and able to weight bear. Clients who are prone to uncooperative behaviour, become agitated, or do not have the cognitive skills to hold hoist reliably, are not suited to a standing hoist. |
1 |
Elimination |
| getting in or out of bed |
If person can assist: Electric adjustable bed and backrest on bed: to elevate client to sitting. Ensure bed adjusted to correct height client slides legs off bed with feet touching floor. Client is able to raise to standing. Grab rail, bed stick, staff prompting may assist. |
1 |
|
| getting in or out of bed |
Delay the transfer if client agitated or resistive. Bed bath/sponge, or continence aides as alternative to normal routine. |
2 |
Substitution |
| getting in or out of bed |
If client can assist: Monkey bars / bed ropes. Client needs good upper body strength and cognition to assist. |
2 |
Engineering |
| getting in or out of bed |
If client can assist. Elevate bed heights: to maximise client's mobility and physical function, to transfer from sitting on the side of the bed to standing. High / Low Electric bed recommended. |
2 |
Engineering |
| getting in or out of bed |
If client can assist. Lower bed height: to maximise clients ability to transfer into bed, i.e. thinner mattress, reduce height of bed legs. High / Low Electric bed recommended |
2 |
Substitution |
| getting in or out of bed |
No Generic Solution available |
3 |
|
| sitting person up in bed |
If person can assist: Verbal and Physical prompts: to maximise clients body mechanics, & independence i.e., prompt client to push through their strongest side, bend one or both knees, and push down on feet into the mattress. At the same time client should push with their strongest upper limb. |
1 |
Elimination |
| sitting person up in bed |
If person can assist: Electrically operated back rest – Ensure the client is positioned correctly in bed to enable them adopt suitable sitting position, i.e.; Prompt the client to position themselves up the bed, before adjusting the back rest, or use slide sheet. See solution for moving in bed. |
1 |
|
| sitting person up in bed |
If person can assist: Client positions themselves using a bed stick, bed rope or bed ladder. Client requires high levels of upper limb and strength and co ordination, in both arms for rope and ladder, and at least one arm for bed stick. Position equipment for use by clients strongest upper limb. |
2 |
Substitution |
| sitting person up in bed |
If person can assist: Client positions themselves using a slide sheet ( folded) with prompting from staff. Slide sheet placed under clients hips. Client bends knees, and pushes down on mattress with feet ( staff may help to stabilise clients feet). Client slides backwards up on bed on slide sheet as they push through feet. May be used in conjunction with bed stick, or bed rope. See solution for moving client in bed. |
2 |
Engineering |
| sitting person up in bed |
If person can’t assist: Avoid client sitting up in bed. Transfer client via hoist into sitting posture in chair out of bed. |
2 |
|
| sitting person up in bed |
If person can’t assist: Review why the client needs to sit up in bed. Maybe existing practices can be changed i.e. medication given before client put to bed etc. |
3 |
Administration |
| sitting person over the edge of the bed |
If client can assist: electric operated backrest on bed to raise client to sitting position. Lower bed height to allow foot support for client. |
1 |
Elimination |
| sitting person over the edge of the bed |
If client can assist: use bed stick; Client moves feet to edge of the bed. Client rolls onto side, and reaches for bed stick. client uses bed stick to stabilise self in sitting. Prompt person to assist client to slide feet off the edge of the bed. |
2 |
Substitution |
| sitting person over the edge of the bed |
If client can’t assist: Move client to chair using hoist. Client stands from chair. |
2 |
|
| sitting person over the edge of the bed |
If client can assist. electric adjustable bed and backrest on bed: Bend clients knees. Adjust backrest to sitting position. Staff to slide clients feet off the edge of the bed, then raise backrest fully. client can use upright backrest and foot support for stability in sitting. |
2 |
Engineering |
| sitting person over the edge of the bed |
No Generic Solution available |
3 |
|
| moving person to or from their bed to wheelchair/commode/shower trolley |
If person can’t assist: Lifting machine/electrical ceiling hoist: 2 staff required. Adjust bed height. Do not lift clients legs or shoulders to fit sling - roll them. Position equipment to minimise movement of hoist whilst client suspended. Correct sling fit and positioning should eliminate the need to lift client to reposition them once lowered into chair from hoist. |
1 |
Elimination |
| moving person to or from their bed to wheelchair/commode/shower trolley |
If person can assist: Client uses body mechanics: Position wheelchair or commode at right angles to bed on clients strongest side. Suitable bed height, firm foot support, feet spaced evenly. Client to lean forward into standing, reaching to arm rest of chair. |
1 |
|
| moving person to or from their bed to wheelchair/commode/shower trolley |
If person can assist: Standing hoist; clients must be co operative, and able to weight bear. Clients who are prone to uncooperative behaviour, become agitated, or do not have the cognitive skills to hold hoist reliably, are not suited to a standing hoist. |
1 |
Elimination |
| moving person to or from their bed to wheelchair/commode/shower trolley |
If person can assist: Client uses body mechanics & walk belt: Position wheelchair or commode at right angles to bed on clients strongest side. Suitable bed height, firm foot support, feet spaced evenly. Client to lean forward into standing, reaching to arm rest of chair. Staff can prompt clients hips forward and to pivot to chair, using walking/ transfer belt. |
1 |
|
| moving person to or from their bed to wheelchair/commode/shower trolley |
If person can assist: Transfer board / slide sheet: client sitting on edge of the bed. Edge of transfer board slid under client buttock, forming a bridge to the chair. Client shuffles across transfer board to chair. Use of slide sheet may assist. Adjust equipment such that client transfers with down hill incline, i.e.; transfer to lower height. Reverse process to transfer into bed from chair. |
1 |
|
| moving person to or from their bed to wheelchair/commode/shower trolley |
If person can’t assist: 2 staff. place slide sheet under person and use “pat slide” board to side person to trolley. Both staff roll person off sheet. |
2 |
Engineering |
| moving person to or from their bed to wheelchair/commode/shower trolley |
No Generic Solution available |
3 |
|
| rolling person in bed |
If person can assist: Bed stick; client pulls self to roll onto side using bed stick, and prompts from staff, i.e. reaching, place far leg across bed in direction of roll. This assists clients hip movement. |
1 |
Elimination |
| rolling person in bed |
If client can’t assist: Using client's body mechanics, and 1 staff physical assistance: Adjust bed staff's knuckle height. Staff place client's arm across body, and far leg across near leg in direction of roll. Staff support client at hip and shoulder and roll client towards them. |
2 |
Substitution |
| rolling person in bed |
If client can’t assist: 2 staff assisting. Adjust bed to correct height for staff . Staff place clients arm and far leg in direction of roll. Staff support client at hip and shoulder and roll client towards, 1st staff . 2nd Staff pushes client towards 1st staff . Where there is a height difference between staff, adjust bed height to suit taller staff. Taller staff pull client in rolling action, shorter staff, push client. Both staff support clients hip and shoulders during roll. |
2 |
Engineering |
| rolling person in bed |
Please scroll up |
2 |
|
| rolling person in bed |
If client can’t assist: Slide sheets: 1 sheet folded, or 2 separate slide sheets. 2 staff recommended to assist. Staff stand on opposite sides of bed. Place slide sheet under client, ensuring it is under their hips and shoulders. 1st staff pulls top layer of slide sheet towards themselves whilst stepping backwards, to roll client away from them. 2nd staff, on opposite side of bed, supports client to finish the roll. Specific slide sheet training is required. |
2 |
Substitution |
| rolling person in bed |
Pressure care mattress used to reduce need for rolling. |
3 |
Training |
| rolling person in bed |
If rolling person to change sheets due to continence issues, review continence products presently used. |
3 |
Training |
| moving person in bed |
If person can assist: client uses body mechanics: Verbal prompting by staff. Clients should attempt to push through their strongest side if appropriate |
1 |
Elimination |
| moving person in bed |
If person can assist: To move client across the bed, client positions themselves, using body mechanics: Staff prompt client to bends knees, and shuffles hips across mattress. Staff may help to stabilise clients feet, or hand on mattress. May be used in conjunction with bed stick, bed rope, or monkey bar. |
1 |
|
| moving person in bed |
If person can assist: To move across the bed, client positions themselves using a slide sheet, with prompting from staff. Slide sheet folded & placed under clients hips. Client bends knees, and shuffles hips across mattress. ( staff may help to stabilise clients feet). May be used in conjunction with bed stick, bed rope, or monkey bar. |
1 |
|
| moving person in bed |
If person can’t assist: To move across the bed, Slide sheets: slide sheet folded, or 2 separate slide sheets. Staff pulls top layer of slide sheet, to move client towards them. If client heavy, use 2 staff. 2nd staff can push at clients hip and shoulders, whilst 1st staff pulls slide sheet. This transfer may be possible with single slide sheet if client smaller. |
2 |
Substitution |
| moving person in bed |
If person can’t assist: use lifting machine / ceiling hoist. |
2 |
Substitution |
| moving person in bed |
Review why there is a need to move person in bed as a change in procedures, process, products may make the need for this task redundant. |
3 |
Training |
| moving person up the bed |
If person can assist: Client uses body mechanics: Verbal prompting by staff. Client should push through their strongest side if appropriate. Client should bend knees, and encourage them to push though feet, and hands. |
1 |
Elimination |
| moving person up the bed |
If person can assist: Client positions themselves using a bed stick, bed rope or bed ladder. Client requires high levels of upper limb and strength and co ordination, in both arms for rope and ladder, and at least one arm for bed stick. Position equipment for use by clients strongest upper limb. |
1 |
Elimination |
| moving person up the bed |
If person can assist: Client positions themselves using a slide sheet ( folded) with prompting from staff. Slide sheet placed under clients hips. Client bends knees, and pushes down on mattress with feet. Staff may help to stabilise clients feet. Client slides backwards on slide sheet as they push through feet. May be used in conjunction with bed stick, or bed rope. See solution for moving client in bed. |
2 |
Substitution |
| moving person up the bed |
If person can’t assist: Slide sheet,1 staff assisting. Place 2 slide sheets under client. Staff stand at head end of bed ( bed head to be removed). Staff to grasp top slide sheet at clients shoulders, pull client up the bed. Use of single layer of slide sheet if client small or lightweight |
2 |
Substitution |
| moving person up the bed |
If client can’t assist: Slide sheet, Suitable if access to head rest of bed not possible. 2 staff required. Place 2 slide sheets under client. Staff stand at either side of bed. Grasp top slide sheet, at clients hips and shoulders. Staff stand in line with client hip and shoulder, and slide client towards at head end of bed. Staff to step and transfer their body weight onto their leg closest to the head end of the bed . Staff must not lift slide sheet during sliding action |
2 |
Engineering |
| moving person up the bed |
Review why client slides down the bed. A change in procedures, process, products may make the need for this task redundant. |
3 |
Training |
| moving in bed |
No Generic Solution available |
1 |
|
| moving in bed |
No Generic Solution available |
2 |
|
| moving in bed |
No Generic Solution available |
3 |
|
| moving from bath to shower trolley or change table |
Avoid transfer. Client can be showered on trolley |
1 |
Elimination |
| moving from bath to shower trolley or change table |
Ceiling or mobile Hoist: Sling can be kept under client whilst in bath. Staff must minimise bending into bath. Adjust bath to suitable height, or staff adopt semi squat or bracing posture to keep spine aligned, to reach into lower height bath. Adjust change table/ shower trolley to correct height for staff use. |
2 |
Substitution |
| moving from bath to shower trolley or change table |
Mobile hoist: minimise movement of hoist, position change table as close as possible to bath. Adjust change table/ shower trolley to correct height for staff use. |
2 |
Engineering |
| moving from bath to shower trolley or change table |
No Generic Solution available |
3 |
|
| assisting person in/out of bath |
If person can assist: Grab rails: Specific positioning of grab rails must meet client needs, and particular functional capacity, i.e.; vertical, horizontal, angled, wall mounted, head / foot of bath mounted. Client needs to be able access grab rails with strongest upper limb. |
1 |
Elimination |
| assisting person in/out of bath |
If person can assist: Bath board and grab rails: Client can sit on bath board, and use grab rails to slide across bath. Suitable for clients who are unsteady stepping in/out of bath. Client may be able to lower themselves in / out of the bath off the bath board if they are physically able. Use of handheld shower if client needs to remain on bath board. |
1 |
Elimination |
| assisting person in/out of bath |
If person can assist: Height adjustable bath: Adjusted for easier transfers in/out by clients, and reduced bending and reaching for staff. |
1 |
|
| assisting person in/out of bath |
If person can assist: Adjustable baths - with accessible sides, ( doors), to enable clients to transfer more easily. |
1 |
Elimination |
| assisting person in/out of bath |
If person can’t assist: Use Shower trolley if client risk of falls too high during the transfer, the use of grab rails is not possible, or no hoist is available. |
2 |
|
| assisting person in/out of bath |
If person can’t assist: Use of ceiling or mobile hoist: Bathing sling required, and should remain under client during bathing. |
2 |
|
| assisting person in/out of bath |
If person can’t assist: Bath hoist: client lowered into bath whilst sitting on bath hoist seat. They can remain seated on bath hoist during bath. Slings not required. |
2 |
|
| assisting person in/out of bath |
No Generic Solution available |
3 |
|
| assisting person to bath or shower |
If person can assist: equipment to maximise client independence: grab rails, shower stool, hand held shower to enable them to clean themselves with more physical stability, and less physical support / supervision required by staff. |
1 |
Elimination |
| assisting person to bath or shower |
Grab rails: to assist client to raise to standing, to allow staff to access client for thorough washing. |
1 |
Elimination |
| assisting person to bath or shower |
If person can’t assist: shower chair: client can sit during shower for increased stability. Staff use stool for washing lower body areas. Must have non slip feet on legs of chair. |
2 |
Substitution |
| assisting person to bath or shower |
If person can’t assist: mobile shower/commode chair / Shower Trolley: to avoid transferring clients manually to shower, where they are unstable walking. Transfer between toilet and shower can be avoided. Staff can move mobile chair to gain better access to clients, to minimise bending and reaching during showering. |
2 |
Substitution |
| assisting person to bath or shower |
If person can assist: Hand held shower hose: client may be able to assist more with their showering. Staff likely to be able to maintain more aligned postures, closer to client, as water is directed more specifically |
2 |
Engineering |
| assisting person to bath or shower |
Staff should wear a water proof apron and shoe covers (in non slip areas only), to encourage them to work closer to client without getting wet. And to minimise bending and reaching into the shower. |
2 |
Substitution |
| assisting person to bath or shower |
If person can’t assist: shower trolley: if client unable to maintain sitting posture in shower chair, or staff are unable to access all body parts with client in shower chair. |
2 |
Engineering |
| assisting person to bath or shower |
No Generic Solution available |
3 |
|
| shaving person |
Avoid or delay shaving where client agitated. |
1 |
Elimination |
| shaving person |
Client positioning: for increased stability, and easier staff access; eg in chair, in bed. Head support for client may be necessary, i.e. wheelchair/ lounge chair with head rest, or when in bed, elevate back rest of bed. |
2 |
Substitution |
| shaving person |
Shaver: trial variety of types, i.e.: battery, electric, may be more tolerable for some clients. Clients may be able to assist themselves safely with mechanical shaver. |
2 |
Engineering |
| shaving person |
Mobile stool for staff: Staff can position themselves on height adjustable mobile stool, to adjust their posture. Staff should maintain upright posture, and work close to client to avoid reaching and bending. Mobile stool enables staff to readjust their positioning as required. |
2 |
Substitution |
| shaving person |
Consistent technique: to maximise clients ability to assist, anticipate, and cooperate with staff. Consistent techniques by staff maximises client's function, and reduces risk of client uncertainty, or behavioural triggers. |
3 |
Training |
| shaving person |
Regular discussion between house staff, at house meetings to ensure consistency in techniques used, and household routine for shaving. This is particularly important where client tendency to become agitated with shaving. |
3 |
Administration |
| shaving person |
Household routine should ensure shaving is performed daily. Less frequent shaving increases force and discomfort for client. |
3 |
Training |
| shaving person |
Where client behaviour impacts on staff, develop consistent strategies, eg; regular/ routine time each day, or when client most relaxed, use of incentives. |
3 |
Administration |
| assisting person from sitting to standing |
If person can’t assist: Avoid manual transfer: where client unable to weight bear independently or with use of mobility aid. |
1 |
Elimination |
| assisting person from sitting to standing |
If person can’t assist: Lift chair: manual or electric. |
1 |
Elimination |
| assisting person from sitting to standing |
If person can assist: lift cushion or foam inserts: Placed on top of chair, manually adjusted, to assist client to standing. Can be moved between chairs. |
1 |
Elimination |
| assisting person from sitting to standing |
If person can assist: verbal prompting to assist clients to use their own body mechanics to transfer independently. Clients should not grasp mobility aid until they are in standing position. Walking aids are not usually stable enough for clients to pull on to standing. |
1 |
Elimination |
| assisting person from sitting to standing |
If person can assist: Modify chair: to maximise clients ability to use their own body mechanics, i.e.: chair as high as possible, whilst client still has foot support. Chair should not too deep, and should have firm cushioning and arm rests for client to push on. Client's knees should be slightly lower than hips, and feet spaced evenly on the floor, in line with front of chair. |
1 |
Elimination |
| assisting person from sitting to standing |
If client can weight bare with assistance; Client uses body mechanics, 1 staff assists. Staff to stand side on to client, and prompt client to lean forwards. Staff to guide clients hips forward off the chair by pushing client’s hips forward gently, as client pushes on arm rests of chair. Staff to support clients at shoulder and hip to help stabilise initially once standing. Staff to transfer their weight to front leg, i.e. in direction of client transfer. . |
2 |
Substitution |
| assisting person from sitting to standing |
If client can weight bare with assist: Client uses body mechanics, 2 staff assist. Staff to stand on each side of client, and prompt client forwards. Staff to guide clients hips forward off the chair, by pushing client’s hips forward gently, whilst client pushes on armrest of chair, or reaches forward. Staff to support clients at shoulder and hip to help stabilise initially once standing. Staff to transfer their weight to their front leg, i.e. in direction of client transfer. . |
2 |
Engineering |
| assisting person from sitting to standing |
No Generic Solution available |
3 |
|
| assisting person with personal hygiene |
If person can assist: client manages independently. Has suitable grab rails to assist transferring on/off toilet. |
1 |
Elimination |
| assisting person with personal hygiene |
If person can’t assist: mobile commode: If client unable to stand during transfer on/off toilet, staff to be aware of minimising bending and reaching, maintain spinal alignment. |
2 |
Substitution |
| assisting person with personal hygiene |
If person can’t assist: Mechanical hoist: If thorough personal hygiene not possible with client in sitting, and client is unable to transfer between chair and toilet. |
2 |
Engineering |
| assisting person with personal hygiene |
If person can’t assist: height adjustable Shower trolley: If client unable to maintain sitting posture in shower chair, or staff are unable to access all body parts with client in shower chair. Use low steps of lifting machine. |
2 |
Substitution |
| assisting person with personal hygiene |
If person can’t assist: Continence Aides: investigate use of , or availability of alternative types, to suite staff accessibility, where client mobility limited. |
3 |
Training |
| moving from shower trolley or change table to wheelchair |
If person can assist: transfer to standing: verbal prompts for client to transfer from change table. Client may be able to use grab rail to pull up to sitting on the trolley. Lower height of change table to allow client's feet to reach the floor. ( see transfers out of bed) |
1 |
Elimination |
| moving from shower trolley or change table to wheelchair |
If person can’t assist: Ceiling or mobile Hoist: Sling can be fitted by rolling client, whilst lying on the change table or shower trolley. Ceiling or mobile hoists are the most commonly used method of transferring clients off change table and shower trolley. |
2 |
Elimination |
| moving from shower trolley or change table to wheelchair |
Assessment of client function and ability to use manual transfers, I individual manual transfer methods may need to be tailored to each client, depending on functional ability, i.e. left/ right sided weakness, cognitive ability. |
3 |
Training |
| moving on or off shower trolley/change table |
If person can assist: transfer to standing: verbal prompts for client to transfer from change table. Client may be able to use grab rail to pull up to sitting on the trolley. Lower height of change table to allow client's feet to reach the floor. Small steps could be used. ( see transfers out of bed) |
1 |
Elimination |
| moving on or off shower trolley/change table |
If person can’t assist: Ceiling or mobile Hoist: Sling can be fitted by rolling client, whilst lying on the change table or shower trolley. Ceiling or mobile hoists are the most commonly used method of transferring clients off change table and shower trolley. |
2 |
Substitution |
| moving on or off shower trolley/change table |
No Generic Solution available |
3 |
|
| supporting persons head whilst brushing teeth |
Avoid or delay where possible: if client agitated, & needs head support, due to mood. |
1 |
Elimination |
| supporting persons head whilst brushing teeth |
toothbrush style: trial variety of types, i.e.: battery, electric, may be more tolerable for some clients. Clients may be able to assist themselves safely with mechanical toothbrush. |
2 |
Substitution |
| supporting persons head whilst brushing teeth |
Mobile stool for staff: Staff can position themselves on height adjustable mobile stool, to adjust their posture. Staff should maintain upright posture, and work close to client to avoid reaching and bending. Mobile stool enables staff to readjust their positioning and working height as required. |
2 |
Engineering |
| supporting persons head whilst brushing teeth |
Firm backed cushion: provision of a cushion with a rigid side. This could be placed behind clients back in their chair, and extend for head support. This could provide a portable form of head support for client. |
2 |
Substitution |
| supporting persons head whilst brushing teeth |
Client positioning: if head support required, use wheelchair with head support, or lounge chair with head rest, or when in bed, with back rest elevated. Avoid supporting clients head manually, with hand. |
2 |
Engineering |
| supporting persons head whilst brushing teeth |
Use additional cleaning methods, i.e. mouth washes, ( if tolerable for client), to minimise amount of time cleaning is required |
2 |
Substitution |
| supporting persons head whilst brushing teeth |
Consistent technique: to maximise clients ability to assist, anticipate, and cooperate with staff. Consistent techniques by staff maximises client's function, and reduces risk of client uncertainty, or behavioural triggers. |
3 |
Training |
| physically supporting/holding person while bathing |
If person can’t assist: avoid bathing, if sustained holding required. Shower client or use shower trolley as alternative. |
1 |
Elimination |
| physically supporting/holding person while bathing |
If person can assist: Provision of a bath insert to support client |
1 |
Elimination |
| physically supporting/holding person while bathing |
If person can assist: Grab rails so client can support themselves |
1 |
Elimination |
| physically supporting/holding person while bathing |
Use low water level to eliminate the need to hold client. |
1 |
Elimination |
| physically supporting/holding person while bathing |
Shower client: use a shower chair or use a reclining or moulded shower chairs where client is unable to sit unaided. |
2 |
Substitution |
| physically supporting/holding person while bathing |
No Generic Solution available |
3 |
|
| moving from wheelchair to toilet |
If person can assist: Grab rails: client able to assist and weight bear. Wheelchair positioned in front of toilet & at right angle to the toilet, with grab rails in front. Client stands from wheelchair, holds grab rails, and pivots to toilet. Grab rails must be accessible to clients strongest side. |
1 |
Elimination |
| moving from wheelchair to toilet |
If person can’t assist: mechanical hoist - mobile or ceiling hoist. Sling fitted to client in wheelchair. Sling can often be left under client in wheelchair, to reduce number of times sling fitting required. Ensure sling suitable for toileting. If using mobile hoist, minimise movement of hoist with client suspended |
2 |
Substitution |
| moving from wheelchair to toilet |
If person can assist: Grab rails: client weight bares, with staff assistance. Staff prompt verbally, and assist to stabilise and pivot client hips. Wheelchair positioned in front of & at right angles to toilet, with grab rails in front. Client holds grab rails, stands, pivots to toilet. Grab rails must be accessible to clients strongest side. |
2 |
Engineering |
| moving from wheelchair to toilet |
If person can’t assist: Grab rails & slide board: client has upper body strength, cognition but is unable to weight bare sufficiently through legs. Client positions wheelchair, ( parallel to toilet). Slide board is placed under clients buttock, and across to toilet. Client reaches across to grab rails and slides self across to toilet. Staff may assist to position slide board, and guide hips. |
2 |
Engineering |
| moving from wheelchair to toilet |
If person can’t assist: Mobile commode chair: Where manual transferring onto toilet not possible, eg, or space too confined, no ceiling hoist, client not physically able to assist with transfer, client to be showered directly after toileting. |
2 |
Engineering |
| moving from wheelchair to toilet |
Consider change in work practices: Do toileting, then showering, commode to shower trolley via hoist |
3 |
Training |
| assisting person to eat |
If person can assist: food presentation & cutlery modification: To enable client manage food independently, eg: finger food, cut into portions, modified grips on cutlery, weighted non spill plates and cups, easy grip cups. Ensure client sitting height maximises upper limb function, and stability. |
1 |
Elimination |
| assisting person to eat |
If person can’t assist: Position client at table: for staff easiest access, and to avoid reaching, twisting and bending. Staff seated across the corner of the table from client, i.e. 45 degree angle is best. Staff can rest elbow on table top whilst client chewing, swallowing, to reduce static muscle tension in the shoulders. Staff should be seated to avoid bending. |
2 |
Substitution |
| assisting person to eat |
If PEG feeding make sure equipment is organised and readily accessible. |
2 |
Engineering |
| assisting person to eat |
Staff seating: manoeuvrable, height adjustable ( gas lift), stool to allow staff to position themselves suitably, i.e. correct height, reach, pivot, and to push themselves away quickly if necessary. |
2 |
Engineering |
| assisting person to eat |
No Generic Solution available |
3 |
|
| dressing/undressing and or putting on shoes |
If person can assist: suitable clothing: organise clothing to promote independence, i.e.; easy to fit, large enough, simple fastening, wide necks, stretchable or loose fitting. Clothes often shrink with time, or are purchased without ease of dressing considered. Shoes and socks , should have wide opening, Velcro fastening, long handled shoe horn, sock aids. |
1 |
Elimination |
| dressing/undressing and or putting on shoes |
If person can assist: Client techniques: prompt consistent method, to reduce confusion and frustration, eg; dress less functional side first, and undress most functional side first. Appropriate seating, and footstool to help client stability and reaching to feet. Allow adequate time |
1 |
Elimination |
| dressing/undressing and or putting on shoes |
Client assists and can weight bear: dress less functional side first, and undress most functional side first. Dress upper body whilst client seated - staff to access both sides of chair to avoid reaching. place pants over lower limbs, pull to knees. client stands, and staff raises, fastens pants. Fit shoes & socks before client stands to assist with stability. |
1 |
Elimination |
| dressing/undressing and or putting on shoes |
If person can’t assist: client techniques: dress with staff assistance. prompt consistent method, to reduce confusion and frustration for client, eg dress less functional side first, and undress most functional side first. Appropriate seating, and footstool to help client stability and reaching to feet. Allow adequate time. Staff may assist client to position and fit clothes. |
2 |
Substitution |
| dressing/undressing and or putting on shoes |
Staff dressing stool: Mobile height adjustable stool to allow staff to position themselves suitably for reaching to clients lower limbs and feet. , i.e. prevents staff bending and reaching, and to push themselves away quickly if necessary, eg client kicks. Elevate clients feet on box or step, to reduce bending |
2 |
Substitution |
| dressing/undressing and or putting on shoes |
No Generic Solution available |
3 |
|
| assisting person to be positioned in a chair at a table or chairs in general |
If person can’t assist: Avoid transfer. Client can be positioned at dining table in wheelchair. |
1 |
|
| assisting person to be positioned in a chair at a table or chairs in general |
Verbal Prompting: Staff encourage clients to remain standing until dining chair is positioned appropriately. Use incentives and prompts if necessary, i.e.; behavioural rewards, eg, withholding meal until she is correctly positioned in a the table. Staff must not slide chair with client in it. |
1 |
|
| assisting person to be positioned in a chair at a table or chairs in general |
Suitable seating: client chair correct height, with arm rests to push on, and not too deep, with firm foot support. This maximises clients ability to transfer on/off and to remain upright in sitting. Chairs can be modified, i.e.; raising blocks, cushion at back to reduce depth, foot support to prevent slipping /slumping in chair. |
1 |
|
| assisting person to be positioned in a chair at a table or chairs in general |
Mobile dining chair: dining chair with lockable castors. These chairs are also usually height adjustable. Ensure chair is adjusted to correct height, and castors locked for mealtimes. Staff must avoid pushing chair into table, with client seated in it. |
1 |
|
| assisting person to be positioned in a chair at a table or chairs in general |
If person can’t assist: Avoid transfer. Client can be positioned at dining table in wheelchair. |
2 |
|
| assisting person to be positioned in a chair at a table or chairs in general |
Verbal Prompting: Staff encourage clients to remain standing until dining chair is positioned appropriately. Use incentives and prompts if necessary, i.e.; behavioural rewards, eg, withholding meal until she is correctly positioned in a the table. Staff must not slide chair with client in it. |
2 |
|
| assisting person to be positioned in a chair at a table or chairs in general |
Suitable seating: client chair correct height, with arm rests to push on, and not too deep, with firm foot support. This maximises clients ability to transfer on/off and to remain upright in sitting. Chairs can be modified, i.e.; raising blocks, cushion at back to reduce depth, foot support to prevent slipping /slumping in chair. |
2 |
|
| assisting person to be positioned in a chair at a table or chairs in general |
Mobile dining chair: dining chair with lockable castors. These chairs are also usually height adjustable. Ensure chair is adjusted to correct height, and castors locked for mealtimes. Staff must avoid pushing chair into table, with client seated in it. |
2 |
|
| assisting person to be positioned in a chair at a table or chairs in general |
No Generic Solution available |
3 |
|
| dressing person in bed |
Client able to assist: Adjust bed height to suit staff. Client helps roll body to side, prompt clients to roll or use bed stick, grab rail or bed rail. Dress less functional side first, & undress most functional side first. Minimise the amount of rolling, pull clothes over same side hip and shoulder, then roll to opposite side. staff should have access to both sides of bed. |
1 |
Elimination |
| dressing person in bed |
If person can’t assist: Avoid dressing clients upper body in bed, where client is able to sit upright. Dressing upper body is best performed with client sitting upright. |
2 |
Substitution |
| dressing person in bed |
client unable to assist: 2 staff assist, stand on each side of bed. Adjust bed height to suit taller staff. Dress less functional side first & undress most functional side first. Minimise amount of rolling, pull clothes over same side hip and shoulder, then roll to opposite side. Use of slide sheet may assist to move client across the bed for easier rolling. |
2 |
Engineering |
| dressing person in bed |
If person can’t assist: Dress upper body in chair: Access to upper body is easier if client seated. Upper body is bed dressed when client sitting upright, to minimise amount of rolling required. Dress, less functional side first & undress most functional side first. |
2 |
Substitution |
| dressing person in bed |
If person can’t assist: Suitable clothing: ensure clothes easy to fit, i.e. large enough, simple fastening, wide necks, stretchable or loose fitting. Clothes often shrink with time, or are purchased without ease of dressing considered. Especially shoes and socks |
2 |
Engineering |
| dressing person in bed |
If person can’t assist: Shoes and socks: should be fitted whilst clients on bed, where legs are elevated. |
2 |
Substitution |
| dressing person in bed |
No Generic Solution available |
3 |
|
| persons who fall, drop, have an awkward gait or have difficulty understanding and/or following instructions |
Patterns of clients gait and epilepsy is well documented and communicated to staff. This helps to avoid unfamiliar staff offering assistance, where it is not required. |
1 |
Elimination |
| persons who fall, drop, have an awkward gait or have difficulty understanding and/or following instructions |
Avoid walking: Limit walking where client risk of falling / injury is high. Limit walking where staff are more likely to try to assist client in the event of a fall, eg community, uneven surfaces, other people around. |
1 |
Elimination |
| persons who fall, drop, have an awkward gait or have difficulty understanding and/or following instructions |
Walking for mobility/exercise and can be restricted to specific times, eg, safe environments, or certain times when client more relaxed, well, responsive, less fatigued. Use wheelchair or mobile commode for personal care tasks & transfers |
1 |
Elimination |
| persons who fall, drop, have an awkward gait or have difficulty understanding and/or following instructions |
Identification of warning/ indicators of client risks: where clients are more likely to fall, or have seizures, i.e.: notable triggers. Staff to limit client walking during these times. |
1 |
Elimination |
| persons who fall, drop, have an awkward gait or have difficulty understanding and/or following instructions |
Prompting: identify most appropriate prompts to simplify instructions, maximise client comprehension, and guide physical movements. Ensure unnecessary assistance is not provided by staff. |
2 |
Substitution |
| persons who fall, drop, have an awkward gait or have difficulty understanding and/or following instructions |
Mobility Aid: provision of suitable aide, to maximise mobility and reduce incidence of fall. Most appropriate aide for physical and cognitive ability needs to be considered. |
2 |
Engineering |
| persons who fall, drop, have an awkward gait or have difficulty understanding and/or following instructions |
Staff require training in the most suitable techniques for each individual client. Training in postural methods for staff assisting with assisted walking, and support during falling. Staff should not attempt to catch or stop client from falling. Techniques are possible for staff to assist a client to lower to the floor safely in some situations. |
3 |
Training |
| persons who fall, drop, have an awkward gait or have difficulty understanding and/or following instructions |
If dropping is a behavioural issue engage appropriate professional to assist with developing strategies, identifying causes etc |
3 |
Training |
| moving from floor to wheelchair |
Avoid or limit client being on the floor, if they are unable to transfer off the floor independently. |
1 |
Elimination |
| moving from floor to wheelchair |
Avoid lifting/ pulling client off the floor: allow time, provide verbal prompting, and chair, to assist client to transfer without providing physical assistance. Use of mechanical hoist is necessary if client unable to assist themselves off floor, or follow instructions. |
1 |
Elimination |
| moving from floor to wheelchair |
Avoid transfer: if client injured - call ambulance. Following seizure, wait until client recovered sufficiently, and able to transfer independently, or with prompting by staff. |
1 |
Elimination |
| moving from floor to wheelchair |
Client able to assist: client rolls onto hands and knees. Staff place chair in front of client. Client reaches with one hand, and kneels on one knee. On staff prompt, client pushes on hand and foot and pivots to sitting. |
2 |
Substitution |
| moving from floor to wheelchair |
Client transfers to standing: Client transfers to sitting first, using chair to assist. They can proceed to standing/ walking from chair if they are physically able. |
2 |
Engineering |
| moving from floor to wheelchair |
mechanical hoist - mobile or ceiling hoist. If client laying down, position the hoist close enough to the client to avoid having to lift clients head and shoulders to fit sling to hoist. |
2 |
Substitution |
| moving from floor to wheelchair |
Review practices as to why client is on the floor. This may eliminate the need for this task. |
3 |
Training |
| moving from floor to wheelchair |
Identify tasks where client drops and use other types of transfers |
3 |
Training |
| assisting person from sitting to standing |
No Generic Solution available |
1 |
|
| assisting person from sitting to standing |
No Generic Solution available |
2 |
|
| assisting person from sitting to standing |
No Generic Solution available |
3 |
|
| moving from wheelchair to lounge/couch |
Avoid transfer: client can remain in wheelchair in some situations. Where high levels of physical assistance is required, staff should avoid manual transfers. |
1 |
Elimination |
| moving from wheelchair to lounge/couch |
client independent, providing chairs are positioned suitably, i.e. wheelchair close to lounge - at right angles. Lounge chair has arm rests, that client can reach for to assist them to stand, and pivot to lounge. |
1 |
Elimination |
| moving from wheelchair to lounge/couch |
Avoid clients using couches, where client cannot transfer themselves, or do not have a mechanical hoist. Clients positioned in the middle of the couch, have no armrests, and staff cannot stand to the side of client to assist with transfer. There is increased risk of clients laying down which increases the physical demands & difficulty required to transfer off. |
1 |
Elimination |
| moving from wheelchair to lounge/couch |
If person can assist: Client uses body mechanics: Position wheelchair at 90 o or opposite lounge. Clients should transfer towards their strongest side. |
1 |
Elimination |
| moving from wheelchair to lounge/couch |
Suitable lounge chair: with firm cushioning, suitable height, depth, armrest height & firm foot support. this helps client body mechanics, to transfer independently. Provision of chair raising blocks, back cushion to reduce seat depth, or lift cushion, to assist client transferring off lounge. (see sitting to standing) |
1 |
Elimination |
| moving from wheelchair to lounge/couch |
If person can assist: Client uses body mechanics, with assistance: Position wheelchair at 90 degrees or opposite lounge. Clients to transfer to strongest side. Check client firm foot support, feet spaced evenly. Client leans forward into standing, reaching to armrest of lounge. Staff prompt clients hips forward & to pivot to chair, use of walk/transfer belt may be suitable. |
1 |
Elimination |
| moving from wheelchair to lounge/couch |
If person can’t assist: Slide board: client has upper body strength, cognition but is unable to weight bear. Client positions wheelchair at 90 degrees beside lounge. Slide board is placed under clients buttock, and across to lounge. Client reaches across to grab rails and slides self across to lounge. Staff may assist to position slide board, and guide clients hips. |
2 |
Engineering |
| moving from wheelchair to lounge/couch |
If person can’t assist: Lift cushion: to assist client to stand out of lounge. |
2 |
Substitution |
| moving from wheelchair to lounge/couch |
If person can’t assist: Use mechanical hoist - sling can be kept under client in lounge chair to eliminate need to refit the sling. |
2 |
Substitution |
| moving from wheelchair to lounge/couch |
No Generic Solution available |
3 |
|
| guiding and supporting persons to walk (including when out in the community) |
Avoid walking with client: where they lean heavily on staff, or are prone to falls or dropping. Avoid walking with client in community where they require sustained physical assistance and support from staff. |
1 |
Elimination |
| guiding and supporting persons to walk (including when out in the community) |
Assisting clients walking in community: may need to be avoided due to additional risks, i.e.; longer distances, unfamiliar or uneven surfaces & ground, distractions. Consider using wheelchair or walking aid if assistance required. |
1 |
Elimination |
| guiding and supporting persons to walk (including when out in the community) |
Prompting: identify most appropriate prompts to simplify instructions, maximise comprehension, and guide physical movements. Ensure assistance is not provided by staff where client does not require it. This may lead to confusion, and increased dependence. |
1 |
Elimination |
| guiding and supporting persons to walk (including when out in the community) |
Mobility Aid: provision of suitable aide, to maximise mobility and reduce incidence of fall. Most appropriate aide for physical and cognitive ability needs to be considered. |
2 |
Substitution |
| guiding and supporting persons to walk (including when out in the community) |
Identification of warning/ indicators of client risks: where clients are more likely to fall, or seizure, i.e.: notable triggers. Staff to limit client walking during these times. |
3 |
Training |
| guiding and supporting persons to walk (including when out in the community) |
Staff require training in methods to assist individual clients to walk. Depending on client's physical function, the method used may need to be modified. Training in postural methods for staff , to avoid sustained bending, reaching, lifting and twisting. |
3 |
Training |
| guiding and supporting persons to walk (including when out in the community) |
Method of assistance when walking in community: May need to be modified from methods used at home. There are Increased risks in community due to unfamiliar environment, more distractions, unpredictable floor surfaces, and longer distances travelled. |
3 |
Administration |
| assisting person to walk on gradients |
Avoid: where assistance required by clients causes them to lean heavily on staff, or risk of falling is increased. |
1 |
Elimination |
| assisting person to walk on gradients |
If person can assist: Client should use handrails, walking aid, or wheelchair and client should have suitable footwear. |
1 |
Elimination |
| assisting person to walk on gradients |
Avoid walking on gradients where possible, i.e. take alternative route. |
1 |
Elimination |
| assisting person to walk on gradients |
Use of wheelchair, or other mobility aid, to eliminate client need to walk on gradients. |
1 |
Elimination |
| assisting person to walk on gradients |
Mobility Aid: provision of suitable aide, to maximise mobility. Most appropriate aide for physical and cognitive ability needs to be assessed |
1 |
Elimination |
| assisting person to walk on gradients |
Assistance from staff: Client requires some physical prompting, i.e.; see " Physical assistance from staff", supporting clients from behind or beside. |
2 |
Substitution |
| assisting person to walk on gradients |
Physical assistance from staff: Assistance should be in the form of prompting, guidance and stabilizing, encouraging. Staff must not support clients body weight. Staff should prompt client at shoulder and hips, to help maintain clients upright stance. Walk/transfer belt helps provide handholds on client hips for staff. |
2 |
Engineering |
| assisting person to walk on gradients |
Physical assistance beside client: Staff stand side on to client, support client under their forearm, ( to prompt their shoulders to upright), and at the back of their hips, ( to prompt clients hips forward, into upright stance). 2 staff can assist with this method, standing on each side of client. This method is suitable for short distances only, i.e. between rooms. |
2 |
Substitution |
| assisting person to walk on gradients |
Physical assistance from staff: Should not include linking arms, holding clients hands, walking backwards whilst supporting clients, allowing clients to hold staff shoulders for support. |
2 |
Engineering |
| assisting person to walk on gradients |
No Generic Solution available |
3 |
|
| pushing person up gradient in wheelchair |
Avoid where possible, i.e. take alternative path, even if longer route or avoid venue |
1 |
Elimination |
| pushing person up gradient in wheelchair |
Drive client: To avoid use of wheelchair in street with steep gradient. |
1 |
Elimination |
| pushing person up gradient in wheelchair |
Use elevators: where possible, rather than ramps in shopping centres |
1 |
Elimination |
| pushing person up gradient in wheelchair |
Use electric wheelchair or get a specialized add on electric motor. |
1 |
Elimination |
| pushing person up gradient in wheelchair |
No Generic Solution available |
2 |
|
| pushing person up gradient in wheelchair |
Ensure wheelchair tyres are properly inflated. Staff must attempt to maintain upright stance, and keep elbows braced close to waist. Staff to use legs and body weight to push wheelchair. Avoid leaning and reaching forwards up the hill. |
3 |
|
| pushing wheelchairs over rough ground/gutters (including when out in the community) |
Avoid where possible, i.e. take alternative path, even if longer route or avoid venue |
1 |
Elimination |
| pushing wheelchairs over rough ground/gutters (including when out in the community) |
Drive client: if it is not possible to avoid travelling over steep gradient, uneven ground, or gutters. |
1 |
Elimination |
| pushing wheelchairs over rough ground/gutters (including when out in the community) |
Use electric wheelchair or get a specialized add on electric motor. |
1 |
Elimination |
| pushing wheelchairs over rough ground/gutters (including when out in the community) |
Provision of ramp to be placed over gutter. Ramps can be portable. |
1 |
Elimination |
| pushing wheelchairs over rough ground/gutters (including when out in the community) |
Place block or small ramp in corner of the gutter if staff need to use this regularly. |
2 |
Engineering |
| pushing wheelchairs over rough ground/gutters (including when out in the community) |
Wheelchair down gutters: If cannot be avoided, back client/ wheelchair down gutter, to avoid risk of client falling. Ease rear wheels down the gutter. Attempt to let them roll, do not lift wheelchair. Tilt wheelchair back slightly to allow the front wheels to roll down. Ensure wheelchair is square to the gutter. 2 staff assisting. |
3 |
Training |
| pushing wheelchairs over rough ground/gutters (including when out in the community) |
wheelchair up gutters: If cannot be avoided, face client/wheelchair up the gutter, to prevent them falling. Tilt wheelchair onto rear wheels, to allow front wheels onto gutter, then roll rear wheels onto gutter. 2 staff to assist where possible. Do not lift wheelchair. |
3 |
Training |
| pushing wheelchairs over rough ground/gutters (including when out in the community) |
Ensure wheelchair tyres are properly inflated. Staff must attempt to maintain upright stance, stand close to wheelchair, and keep elbows braced close to waist. Staff must use their legs and body weight to push wheelchair, stay square to the wheelchair, to avoid twisting. Avoid leaning and reaching forwards up the hill. |
3 |
Training |
| pushing wheelchairs over rough ground/gutters (including when out in the community) |
Report to local council broken or rough footpaths |
3 |
Administration |
| persons whose mobility needs change when they are outside the house/accessing the community |
Avoid walking with client: where they lean heavily on staff, or are prone to falls or dropping. Avoid walking with client in community where they require sustained physical assistance and support from staff. |
1 |
Elimination |
| persons whose mobility needs change when they are outside the house/accessing the community |
Assisting clients walking in community: may need to be avoided due to additional risks, i.e.; longer distances, unfamiliar or uneven surfaces & ground, distractions. Consider using wheelchair or walking aid if assistance required. |
1 |
Elimination |
| persons whose mobility needs change when they are outside the house/accessing the community |
Prompting: identify most appropriate prompts to simplify instructions, maximise comprehension, and guide physical movements. Ensure assistance is not provided by staff where client does not require it. This may lead to confusion, and increased dependence. |
1 |
Elimination |
| persons whose mobility needs change when they are outside the house/accessing the community |
Mobility Aid: provision of suitable aide, to maximise mobility and reduce incidence of fall. Most appropriate aide for physical and cognitive ability needs to be considered. |
1 |
Elimination |
| persons whose mobility needs change when they are outside the house/accessing the community |
Identification of warning/ indicators of client risks: where clients are more likely to fall, or seizure, i.e.: notable triggers. Staff to limit client walking during these times. |
1 |
Elimination |
| persons whose mobility needs change when they are outside the house/accessing the community |
No Generic Solution available |
2 |
Training |
| persons whose mobility needs change when they are outside the house/accessing the community |
Staff require training in methods to assist individual clients to walk. Depending on client's physical function, the method used may need to be modified. Training in postural methods for staff , to avoid sustained bending, reaching, lifting and twisting. |
3 |
Training |
| persons whose mobility needs change when they are outside the house/accessing the community |
Method of assistance when walking in community: May need to be modified from methods used at home. There are Increased risks in community due to unfamiliar environment, more distractions, unpredictable floor surfaces, and longer distances travelled. |
3 |
Administration |
| securing seatbelts/A frames in vehicles |
No Generic Solution available |
1 |
|
| securing seatbelts/A frames in vehicles |
Replace straps, or A frames: with more advanced system where possible. |
2 |
Substitution |
| securing seatbelts/A frames in vehicles |
Ensure wheelchair and A frame are in good condition, i.e.; not bent or damaged. Wheelchair straps should be stored appropriately, i.e., not left laying on floor when not in use. This may cause them to get caught under wheelchairs, or difficult to reach once wheelchairs loaded. |
2 |
Substitution |
| securing seatbelts/A frames in vehicles |
Preparation: Prior to loading bus, ensure seatbelts, wheelchair straps and A frames are positioned for easiest access. |
2 |
Engineering |
| securing seatbelts/A frames in vehicles |
. Wheelchair straps/ A frame lever should be pulled or pushed directly forwards or backwards from body, whist in squat position do not pull across the body. Pulling across the body is not as powerful and increases injury risk through twisting. |
2 |
Substitution |
| securing seatbelts/A frames in vehicles |
Use kneeling pad, to assist with comfort when kneeling on bus floor. |
2 |
Engineering |
| securing seatbelts/A frames in vehicles |
Bus loading sequence: Should maximise access to A frame, & wheelchair straps. Avoid loading other wheelchairs or clients until A frame/ wheelchair straps secured. Where multiple wheelchairs and A frame are used, ensure loading pattern maximises accessibility for each chair. |
2 |
Substitution |
| securing seatbelts/A frames in vehicles |
Bus loading and securing wheelchairs: 2 staff assist, & rotate tasks, i.e., alternate between loading and securing wheelchairs, to minimise physical demands on individual staff bending and reaching to locking mechanism. |
2 |
Engineering |
| securing seatbelts/A frames in vehicles |
No Generic Solution available |
3 |
|
| assisting persons during seizures or during other medical situations |
Allow client to stay on floor. Do not attempt to move them or transfer them, until they are recovered, or ambulance is in attendance. |
1 |
Elimination |
| assisting persons during seizures or during other medical situations |
Avoid lifting/ pulling client off the floor: allow time, provide verbal prompting, and chair, to assist client to transfer without providing physical assistance. Use of mechanical hoist is necessary if client unable to assist themselves off floor, or follow instructions. |
1 |
Elimination |
| assisting persons during seizures or during other medical situations |
Avoid transfer: if client injured - call ambulance. Following seizure, wait until client recovered sufficiently, and able to transfer independently, or with prompting by staff. |
1 |
Elimination |
| assisting persons during seizures or during other medical situations |
Assistance from staff: remain with client, but do not physically support, i.e. lifting, carrying moving them. Reassure client, talking, maintain their dignity, provide comfortable, blanket, pillow, until medical assistance available, or client recovers . |
1 |
Elimination |
| assisting persons during seizures or during other medical situations |
Client able to assist to transfer off the floor: client rolls onto hands and knees. Staff place chair in front of client. Client reaches with one hand, and kneels on one knee. On staff prompt, client pushes on hand and foot and pivots to sitting. They can proceed to standing/ walking from chair if they are physically able |
1 |
Elimination |
| assisting persons during seizures or during other medical situations |
Client transfers off the floor: Client transfers to sitting first, using chair to assist. . |
1 |
Elimination |
| assisting persons during seizures or during other medical situations |
Assisted Falling: If client falls whilst staff assisting, staff can help ease them to the floor. ( see supported walking methods). Staff may be able to help client fall, by using their hip or knee as a brace for client, as they lower to the floor. Staff may kneel or squat to the floor, with client. Do not try to catch, lift, or stop client falling. |
2 |
Substitution |
| assisting persons during seizures or during other medical situations |
Assist client from floor using methods outlined ( Assisting person from floor to chair using hoist). |
2 |
Substitution |
| assisting persons during seizures or during other medical situations |
mechanical hoist - mobile or ceiling hoist. If client laying down, position the hoist close enough to the client to avoid having to lift clients head and shoulders to fit sling to hoist. |
2 |
Substitution |
| assisting persons during seizures or during other medical situations |
No Generic Solution available |
3 |
|
| assisting person from floor to standing |
Avoid or limit client being on the floor, if they are unable to transfer off the floor independently. |
1 |
Elimination |
| assisting person from floor to standing |
Avoid lifting/ pulling client off the floor: allow time, provide verbal prompting, and chair, to assist client to transfer without providing physical assistance. Use of mechanical hoist is necessary if client unable to assist themselves off floor, or follow instructions. |
1 |
Elimination |
| assisting person from floor to standing |
Avoid transfer: if client injured - call ambulance. Following seizure, wait until client recovered sufficiently, and able to transfer independently, or with prompting by staff. |
1 |
Elimination |
| assisting person from floor to standing |
client manages independently. Staff use verbal prompts, to guide client off the floor, into sitting and then standing. |
1 |
Elimination |
| assisting person from floor to standing |
Client able to assist: client rolls onto hands and knees. Staff place chair in front of client. Client reaches with one hand, and kneels on one knee. On staff prompt, client pushes on hand and foot and pivots to sitting. Client can then proceed to standing after sitting. |
1 |
Elimination |
| assisting person from floor to standing |
If person can assist: Client transfers to standing: Client transfers to sitting first, using chair to assist. They can proceed to standing/ walking from chair if they are physically able. |
1 |
Elimination |
| assisting person from floor to standing |
If person can’t assist: mechanical hoist - mobile or ceiling hoist. If client laying down, position the hoist close enough to the client to avoid having to lift clients head and shoulders to fit sling to hoist. |
2 |
Substitution |
| assisting person from floor to standing |
No Generic Solution available |
3 |
|
| assisting person to sit in kitchen/lounge chairs or couch |
Client independent, providing chairs are positioned suitably, i.e. wheelchair close to lounge - at right angles. Chairs have arm rests, that client can reach for to assist them to stand, and pivot to lounge. |
1 |
Elimination |
| assisting person to sit in kitchen/lounge chairs or couch |
Avoid clients using couches, where client cannot transfer themselves, or do not have a mechanical hoist. Clients positioned in the middle of the couch, have no armrests, and staff cannot stand to the side of client to assist with transfer. There is increased risk of clients laying down which increases the physical demands & difficulty required to transfer off. |
1 |
Elimination |
| assisting person to sit in kitchen/lounge chairs or couch |
Electric lift lounge chair: |
1 |
Elimination |
| assisting person to sit in kitchen/lounge chairs or couch |
verbal prompting to assist clients to use their own body mechanics to transfer independently. Clients should not grasp mobility aid until they are in standing position. Walking aids are not usually stable enough for clients to pull on to standing. |
1 |
Elimination |
| assisting person to sit in kitchen/lounge chairs or couch |
Suitable chairs: with firm cushioning, suitable height, depth, armrest height & firm foot support. this helps client body mechanics, to transfer independently. Provision of chair raising blocks, back cushion to reduce seat depth, or lift cushion, to assist client transferring off lounge. (see sitting to standing) |
1 |
Elimination |
| assisting person to sit in kitchen/lounge chairs or couch |
Client uses body mechanics: Position wheelchair at 90 degrees or opposite lounge. Clients should transfer towards their strongest side. |
1 |
Elimination |
| assisting person to sit in kitchen/lounge chairs or couch |
Lift cushion / foam cut outs: to assist client to stand out of lounge, to transfer into alternative chair. Can be moved between chairs. |
1 |
Elimination |
| assisting person to sit in kitchen/lounge chairs or couch |
If person can’t assist: Client uses body mechanics, with assistance: Position wheelchair at 90 o or opposite lounge. Clients to transfer to strongest side. Check client firm foot support, feet spaced evenly. Client leans forward into standing, reaching to armrest of lounge. Staff prompt clients hips forward & to pivot to chair, use of walk/transfer belt may be suitable. |
2 |
Substitution |
| assisting person to sit in kitchen/lounge chairs or couch |
If person can’t assist: Slide board: client has upper body strength, cognition but is unable to weight bear. Client positions wheelchair at 90 o beside lounge. Slide board is placed under clients buttock, and across to lounge. Client reaches across to grab rails and slides self across to lounge. Staff may assist to position slide board, and guide clients hips. |
2 |
Engineering |
| assisting person to sit in kitchen/lounge chairs or couch |
Unable to assist: Use mechanical hoist - sling can be kept under client in lounge chair to eliminate need to refit the sling. |
2 |
Substitution |
| assisting person to sit in kitchen/lounge chairs or couch |
If person can’t assist: Client uses body mechanics, 1 staff assist. Staff to stand side on to client, and prompt leaning forwards. Guide clients hips forward off the chair, whilst client pushes on arm rests of chair. Staff to support clients at shoulder and hip to help stabilise initially once standing. Staff lunge towards front of chair as client stands. |
2 |
Engineering |
| assisting person to sit in kitchen/lounge chairs or couch |
If person can’t assist: Client uses body mechanics, 2 staff assist. Staff to stand on each side of client, and prompt client forwards. Staff guide clients hips forward off the chair, whilst client pushes on armrest of chair. Staff to support clients at shoulder and hip to help stabilise initially once standing. Staff lunge sideways towards front of chair as they guide client to standing. |
2 |
Substitution |
| assisting person to sit in kitchen/lounge chairs or couch |
No Generic Solution available |
3 |
|
| assisting visually impaired persons |
Maximise alternative sensory information, i.e. tactile & auditory, to avoid physical assistance required from staff. Consult vision clinic to identify range of options that can be implemented, to allow client to mobilise independently. |
1 |
Elimination |
| assisting visually impaired persons |
Arrange furniture to avoid obstacles, and ensure consistency. Where client can learn the layout of rooms and furniture, and can be confident that the layout will be consistent, they are more likely to be confident to ambulate independently. |
1 |
Elimination |
| assisting visually impaired persons |
Guided walking: Adopt methods consistent with vision clinic advice, however, consider overall physical ability. Physical assistance from staff should be in the form of prompting, guidance and stabilizing, encouraging. Staff must not support clients body weight. |
2 |
Engineering |
| assisting visually impaired persons |
Guided & assisted walking: in conjunction with provision of suitable aide, to maximise mobility. Most appropriate aide for physical and cognitive ability needs to be assessed. |
2 |
Substitution |
| assisting visually impaired persons |
Physical assistance should not include linking arms, holding clients hands, walking backwards whilst supporting clients, or allowing clients to hold staff's shoulders for support. |
2 |
Engineering |
| assisting visually impaired persons |
Identification of warning/indicators of client risks: where clients are fatigued, uncooperative, or more likely to fall, or lean heavily on staff. Staff should limit client walking during these times. |
2 |
Substitution |
| assisting visually impaired persons |
Physical assistance from staff: Assistance should be in the form of prompting, guidance and stabilizing, encouraging. Staff must not support clients body weight. Staff should prompt client at shoulder and hips, to help maintain clients upright stance. Walk/transfer belt helps provide handholds on client hips for staff. |
2 |
Engineering |
| assisting visually impaired persons |
Physical assistance beside client: Staff stand side on to client, support client under their forearm, ( to prompt their shoulders to upright), and at the back of their hips, ( to prompt upright stance). 2 staff can assist with this method, standing on each side of client. This method is suitable for short distances only, i.e. between rooms. |
2 |
Substitution |
| assisting visually impaired persons |
No Generic Solution available |
3 |
|
| assisting person to walk where person leans on staff for support or grabs staff unexpectedly when unsure/uncomfortable |
Avoid walking with client: where they lean heavily or grab staff. Avoid walking with these client in community where they require sustained physical assistance from staff, with more distractions and unpredictably. |
1 |
Elimination |
| assisting person to walk where person leans on staff for support or grabs staff unexpectedly when unsure/uncomfortable |
Mobility Aid: provision of suitable aide, to maximise mobility and reduce incidence of fall. Most appropriate aide for physical and cognitive ability needs to be considered. |
1 |
Elimination |
| assisting person to walk where person leans on staff for support or grabs staff unexpectedly when unsure/uncomfortable |
Identification of warning indicators, where clients likely to lean more heavily. Avoid walking clients on these occasions, or clients in situations where client unsure / uncomfortable, eg; outdoors, bathroom, shopping centres. |
2 |
Substitution |
| assisting person to walk where person leans on staff for support or grabs staff unexpectedly when unsure/uncomfortable |
Prompting: identify most appropriate prompts to advise clients that walking will cease until appropriate gait pattern / independence is maintained. Ensure client is not provided by with assistance where they do not require it. This may lead to confusion, reinforce attention seeking behaviour or increased dependence.. |
2 |
Substitution |
| assisting person to walk where person leans on staff for support or grabs staff unexpectedly when unsure/uncomfortable |
Physical assistance from staff: All methods described, allow for staff " self protective postures", i.e. they can remove support from client where client attempts to grab or lean heavily. Staff are less likely to be able to grab staff, and if additional stability/support required, staff can offer it with less risk of injury, i.e. no lifting, reaching or bending. |
2 |
Engineering |
| assisting person to walk where person leans on staff for support or grabs staff unexpectedly when unsure/uncomfortable |
Physical assistance from staff: Assistance should be in the form of prompting, guidance and stabilizing, encouraging. Staff must not support clients body weight. Staff should prompt client at shoulder and hips, to help maintain clients upright stance. Walk/transfer belt helps provide handholds on client hips for staff. |
2 |
Substitution |
| assisting person to walk where person leans on staff for support or grabs staff unexpectedly when unsure/uncomfortable |
Physical assistance from behind client: Staff walking behind client should prompt client at shoulder and hips, to help maintain clients upright stance. Walk/transfer belt helps provide handholds on client hips for staff. |
2 |
Engineering |
| assisting person to walk where person leans on staff for support or grabs staff unexpectedly when unsure/uncomfortable |
Physical assistance beside client: Staff stand side on to client, support client under their forearm, ( to prompt their shoulders to upright), and at the back of their hips, ( to prompt upright stance). 2 staff can assist with this method, standing on each side of client. This method is suitable for short distances only, i.e. between rooms. |
2 |
Substitution |
| assisting person to walk where person leans on staff for support or grabs staff unexpectedly when unsure/uncomfortable |
Physical assistance from staff: Should not include linking arms, holding clients hands, walking backwards whilst supporting clients, allowing clients to hold staff shoulders for support. |
2 |
Engineering |
| assisting person to walk where person leans on staff for support or grabs staff unexpectedly when unsure/uncomfortable |
Method of assistance when walking in community: May need to be modified from methods used at home. Increased risks in community due to unfamiliar environment, more distractions, unpredictable floor surfaces, and longer distances travelled. |
2 |
Substitution |
| assisting person to walk where person leans on staff for support or grabs staff unexpectedly when unsure/uncomfortable |
Staff require training in methods to assist individual clients to walk. Depending on client's physical function, the method used may need to be modified. Training in postural methods for staff , to avoid sustained bending, reaching, lifting and twisting. |
3 |
Training |
| assisting person to walk where person leans on staff for support or grabs staff unexpectedly when unsure/uncomfortable |
Assessment of individual client function and most suitable assistance method, if possible |
3 |
Administration |
| assisting person up or down stairs |
Avoid stairs where client unstable, or unsure. Use lifts, ramps, or avoid venue where possible. |
1 |
Elimination |
| assisting person up or down stairs |
eliminate steps from home environment, where client requires mobility assistance. |
1 |
Elimination |
| assisting person up or down stairs |
client to use grab rail beside stairs. Ensure grab rails are accessible to their stronger side ( if clients have an obvious stronger leg or arm. ) |
1 |
Elimination |
| assisting person up or down stairs |
Physical assistance from staff: Assistance should be in the form of prompting, guidance and stabilizing, encouraging. Staff must not support clients body weight. Staff should prompt client at shoulder and hips, to help maintain clients upright stance. Walk/transfer belt helps provide handholds on client hips for staff. |
2 |
Engineering |
| assisting person up or down stairs |
Clients should step up stairs leading with their strongest leg. Stepping down stairs, lead with their weaker leg. If they have an obvious stronger side. Staff support client's weaker side. |
2 |
Engineering |
| assisting person up or down stairs |
Physical assistance from behind client: Staff walking behind client should prompt client at shoulder and hips, to help maintain clients upright stance. Staff can prompt client at hips, to step, with appropriate timing . Walk/transfer belt helps provide handholds on client hips for staff. |
2 |
Substitution |
| assisting person up or down stairs |
Physical assistance beside client: Staff stand side on to client, support client under their forearm, ( to prompt their shoulders to upright), and at the back of their hips, ( to prompt upright stance, and stepping action). 2 staff can assist with this method, standing on each side of client. This method is suitable for short distances only. |
2 |
Engineering |
| assisting person up or down stairs |
Physical assistance from staff: Should not include linking arms, holding clients hands, walking backwards whilst supporting clients, allowing clients to hold staff shoulders for support. |
2 |
Substitution |
| assisting person up or down stairs |
Method of assistance using steps in community: May need to be modified from methods used at home. Increased risks in community due to unfamiliar environment, more distractions, unpredictable floor surfaces, and longer distances travelled. |
2 |
Engineering |
| assisting person up or down stairs |
Staff require training in methods to assist individual clients to walk. Depending on client's physical function, the method used may need to be modified. Training in postural methods for staff , to avoid sustained bending, reaching, lifting and twisting. |
3 |
Training |
| assisting person up or down stairs |
Assessment of individual client function and most suitable assistance method, if possible |
3 |
Administration |
| moving person up or adjusting persons in wheelchair |
Avoid client losing their upright position in chair: suitable chair, firm foot support, suitable height, depth, seat recline, one way slip cushion. Correct positioning in chair with initial transfer. |
1 |
Elimination |
| moving person up or adjusting persons in wheelchair |
Avoid assisting: client often repositions themselves when they are ready or prompted. |
1 |
Elimination |
| moving person up or adjusting persons in wheelchair |
hoist transfer into chair: ensure sling suitable, and hoist transfer lowers and positions client suitably, so as not to require repositioning. Repeat hoist positioning in chair if necessary. |
2 |
Substitution |
| moving person up or adjusting persons in wheelchair |
Client assists: prompt client to push through their feet and hands on arm rests, to push back in chair. Staff may need to physically prompt client to position their feet for firm support, and push through arm rests of chair. |
2 |
Substitution |
| moving person up or adjusting persons in wheelchair |
client unable to assist: leave sling under client in chair, and reposition using the hoist. |
2 |
Engineering |
| moving person up or adjusting persons in wheelchair |
client unable to assist: recline seat - if possible, and allow client to slide back into seat - gentle pushing at front of clients knee may help. |
2 |
Substitution |
| moving person up or adjusting persons in wheelchair |
Client unable to assist: slide sheets. Specific design help slide client back in chair. |
2 |
Engineering |
| moving person up or adjusting persons in wheelchair |
Assessment of individual client function and most suitable assistance method, and equipment to be used, i.e. suitability of chair & sling. Possible modifications to these. |
3 |
Training |
| moving person up or adjusting persons in wheelchair |
Staff require training in methods to assist individual clients to be positioned correctly in chair. Depending on client's physical function, the method used may need to be modified. |
3 |
Administration |
| manoeuvring wheelchairs in tight spaces |
Avoid taking wheelchair: into confined spaces where possible. |
1 |
Elimination |
| manoeuvring wheelchairs in tight spaces |
Modify confined environment - where possible, i.e. remove unnecessary furniture, or renovate room. |
1 |
Elimination |
| manoeuvring wheelchairs in tight spaces |
Use alternative chair, eg, wheeled commode, or shower chair that may be smaller, and easier to turn |
2 |
Engineering |
| manoeuvring wheelchairs in tight spaces |
Where insufficient space around wheelchair to push from behind, staff stand beside wheelchair and push it across their bodies, i.e. sideways pushing action for staff - this prevents them bending reaching and twisting. |
2 |
Substitution |
| manoeuvring wheelchairs in tight spaces |
Ensure wheelchair tyres fully inflated for easier manoeuvrability |
3 |
Training |
| persons who need assistance getting in/out of vehicles |
Avoid transferring clients, who require excessive physical support from staff, i.e.; clients have limited weight bearing, unable to transfer from chair to standing. Theses clients should use a wheelchair taxi, or bus with wheelchair hoist. |
1 |
Elimination |
| persons who need assistance getting in/out of vehicles |
client assists into standing :pivots legs around to sit square to the car door opening. Open car door window, to provide additional handhold for client. Client pushes up with hand on door and car seat into standing. Client should transfer towards their stronger side. |
1 |
Elimination |
| persons who need assistance getting in/out of vehicles |
client assists into sitting: pivots legs around to sit square to the car door opening. Open car door window, to provide additional handhold for client. Position wheelchair as close as possible to door. Client pushes up with hand on door and car seat, and pivots onto the wheelchair. |
1 |
Elimination |
| persons who need assistance getting in/out of vehicles |
Pivot disc: A pivoting cushion that assists clients to pivot on the car seat, when turning to place their legs in/out of car. |
1 |
Elimination |
| persons who need assistance getting in/out of vehicles |
Transferring on/off buses. Clients should step up stairs leading with their strongest leg. Stepping down stairs, lead with their weaker leg. If they have an obvious stronger side. Prompt clients to use grab rails |
1 |
Elimination |
| persons who need assistance getting in/out of vehicles |
Physical assistance from staff: Assistance should be in the form of prompting, guidance and stabilizing, encouraging preparing equipment. Staff must not support clients body weight. Staff should prompt client at shoulder and hips, to help maintain clients upright stance. Prompt clients to use available handholds. Walk/transfer belt provides handhold for staff to pivot client hips. |
2 |
Substitution |
| persons who need assistance getting in/out of vehicles |
wheelchair & slide board: client has upper body strength, cognition but is unable to weight bear. Positions wheelchair as close as possible to car. Slide board is placed under clients buttock, and across to car seat. Client reaches across and slides self across slide board. Staff may assist to position slide board, and guide hips. Slide sheet may also be used on transfer board to assist. |
2 |
Substitution |
| persons who need assistance getting in/out of vehicles |
Physical assistance from behind client: Staff walking behind client should prompt client at shoulder and hips, to help maintain clients upright stance, handholds on bus. Staff can prompt client at hips, to step, with appropriate timing . Walk/transfer belt helps provide handholds on client hips for staff. |
2 |
Substitution |
| persons who need assistance getting in/out of vehicles |
Physical assistance from staff: Should not include linking arms, holding clients hands, walking backwards whilst supporting clients, allowing clients to hold staff shoulders for support. |
2 |
Engineering |
| persons who need assistance getting in/out of vehicles |
Method of assistance using step in community: May need to be modified from methods used at home. Increased risks in community due to unfamiliar environment, more distractions, unpredictable floor surfaces, and longer distances travelled. |
2 |
Substitution |
| persons who need assistance getting in/out of vehicles |
No Generic Solution available |
3 |
|