Problem Solving

26th March 2017

A joint assessment was requested by the Occupational Therapist and Case Manager to ensure that all equipment provided for the care of the service user was fit for purpose and safe practises were in place for the handling needs and the safety of care givers. In addition, the Physio requested we look at physiological benefits in moving and handling /equipment. 

The service user was a C4 Tetraplegic, with good head control and has some movement in his hands. He suffered with flexor and extensor spasm of the trunk and lower limbs.  

 At the time of assessment, the issues immediately identified were:

  • The service user was on an in bed turning system which always keeps the person supine with no rotation of trunk / pelvis and so decreases the ability to reduce positional triggers of spasm. 
  • As service user lied supine most of the time his chest was not positioned in optimal positions to maximise ventilation and perfusion of lungs. 
  • Range of movements – again supine lying reduces opportunity of positional changes to aid with maintaining range in the trunk and lower limbs, require facilitating greater variation in positioning to help with maintaining range. 


Initial observations and findings: 

The bed system that was in place was not suitable for the service user.  

  • There were two inserted bolsters to fill the gap at the head and foot section created as the bed is fully extended allowing for the service users height (6ft 5”) and as the mattress supplied cannot fill the full length of the bed surface. 
  • At the time of assessment, the mattress and bed combination was impacting on the care being facilitated on the bed and posed a significant risk to any carers, as they were not be able to adopt the correct postures for facilitating safe moving and handling due to the size and shape of the service user.  

It was recommended that an alternative system that would allow rolling without stress on staff and would enable a good stable position for the service user when turning should be implemented. A bed with a longer mattress platform and a turning mattress was recommended. 

In addition, this provided the physiological benefits of turning rather than supine rolling of the initial system (range of spine, lower limbs, spasm, chest.) and facilitated greater variation in positioning to help with maintaining range. 


Assessment of sling suitability

At the time of assessment, the service user had overhead ceiling hoist, dual motor, free span, and double spreader bar system in place. This is an excellent combination, which with the correct size sling would allow care staff to position the service user comfortably and safely, in his chair. However, the sling in use at the time of assessment was not the correct size. 

  • Staff had good knowledge of how to insert the sling correctly but were being hindered when positioning the service user as the sling being used was low back sling because it is too small.
  • Knots have been tied in the lower loops of the sling further reducing its size. This was affecting the positioning of the service user onto his chair during transfer from bed to chair. 

During the assessment it was identified that an urgent sling assessment was required to ensure the service user had the correct size sling. A suitable sling was identified, and a sling assessment booked during the assessment to resolve the situation as quickly as possible.

Sliding transfers onto shower trolley and tilt table. 

It was identified that use of a disposable Hovermat system in conjunction with extension handles would enable safe lateral transfer from bed to tilt table. 

A disposable version of this system was recommended as it can be left under the service user while his physiotherapy support is taking place thereby reducing the risk of acquiring pressure damage.    

This system reduces the weight of the service user it is being used with, from 100% to 17% greatly reducing the risk of injury to any care givers. 

Emergency Lifting from the floor. 

At the time of assessment there was no safe system to carry out any emergency lifting from the floor should the service user slip to the floor. 

During the assessment it was discovered that there had already been several episodes of the service user coming out of his chair so it was therefore a foreseeable event and appropriate risk assessment needed be put in place and a safe method of raising the service user from the floor was required. 

The Hover Jack has been identified by the N.P.S.A (National Patient Safety Agency) Rapid Response Report September 2010) as an option that should be used if it is foreseeable that patients may on occasion fall to the floor and should be considered as an alternative to hoisting. 

It was recommended that the use of the Hover Jack would greatly reduce the risk of further injury to the service user and would be a safer system for any care givers or emergency teams called to assist in the event of him falling from his chair. 

In addition to flat lifting this system can be used for evacuation in the event of a fire. 


In conclusion:  

The service user was shown the recommended systems, and it was agreed that a trial be carried out for a period of 1 month by renting the bed system and mattress. This would allow for the service user to fully evaluate prior to any future purchase. 

A sling assessment has been completed and a new sling was trialled by the service user. Initial observations were that the repositioning of the service user and use of the system have greatly improved. 

It was recommended that periodic training should continue to be provided until all staff were competent in the correct use of equipment.  



John Humphray 

Manual Handling Advisor 

Plus, size person (Bariatric) Handling Specialist  


Supporting Testimonial

Dear John 

John has worked tirelessly to assess and recommend the most appropriate bed, mattress and hoist and moving equipment for a tetraplegic client of mine who is a large, tall chap. 

He is dynamic and knowledgeable and takes the case on with a high level of professional commitment – so that you can be confident that he is exploring options thoroughly, working with the client and their carer’s and keeping you well informed. He produced a written report which was very helpful in setting out his reasoning and recommendations which is helpful when you need to convince those who may fund this equipment. 

He is willing to review decisions and problem solve as the case and needs unfold and maybe events change what is needed. He is convincing and a good communicator with all involved. A second report would have been helpful to outline the final decisions and recommendations, but John has kept me well informed of his thinking throughout. 

He has trained care staff and therapy staff and family and the client very thoroughly and I have no hesitation in recommending him as a Moving and Handling specialist. 


Kind regards


Sandra Rogers

Independent Occupational Therapist/Case Manager

Contact our team

We would be delighted to hear from you

Reason for the enquiry: