The weight of the world: challenging the problem of rising obesity levels, musculoskeletal injuries and liable in NHS mortuaries

By Sharon Rindsland, Senior Manual Handling Co-ordinator, East Kent Hospitals

Since 1975 worldwide obesity has nearly tripled. In 2016, more than 1.9 billion adults were classed as being overweight, of these 650 million were obese. However, this doesn’t just apply to adults, over 340 million children and adolescents aged 5-19 were overweight or obese in 2016 . Unfortunately, complications related to obesity continue post-mortem.

Nursing staff and mortuary technicians often face these complications when processing and transferring overweight patients. Issues such as loss of dignity for the patient, difficulty transferring patients resulting in musculoskeletal injuries (MSI) for staff, increased legal case costs from MSIs and additional costs for loss of equipment are all avoidable, yet happen on a daily basis.

The physical cost
A recent case review (January 2020) from the East Kent Hospitals University Foundation Trust (EKHFT), stated that mortuary staff are often expected to move around 30 bodies per day using a supine lateral transfer which are traditionally performed using a bed sheet/draw sheet or canvas. However, it was found that using these materials often subjects the caregiver to a large amount of external force. This leaves it as no surprise that the main risk factor of back injury to mortuary staff is when lifting or transferring patients.

If a body weighs 45kg (7 stone) and the trays that the bodies are put onto weigh around 31kg (5 stone) then the total weight that the mortuary technician is having to move is an average of 76kg (12 stone).

This puts the load above the weight considered safe for industrial workers when considering the frequency of lifting and transferring expected. 

Along with this, due to injury, holidays or meetings there is sometimes only 1 mortuary technician present at any given time. This means that not only are they understaffed and expected to lift patients frequently, but they can also be expected to move patients in the extremes, with the largest body to date in the EKHFT mortuary being 440kg (69 stone).  This extreme of weight isn’t abnormal, as an observation from the mortuary in 2014 showed that there were 5 bodies weighing in excess of 30 stone. Far too much for a single technician to move safely. 

As a result of these expectations one example taken from the mortuary showed that of 9 mortuary staff one had two hernias, another a slipped disc and two members of staff had back, neck and wrist problems. Only one of these had been officially reported.

The everyday cost
Hospitals are also incurring further costs during the movement of bodies as the sheets used to wrap patients, giving the patient some dignity, are used when transferring the patient to the care of the undertaker. However, these sheets are rarely returned, and with some bodies needing up to 3 sheets to cover the body, the annual cost to EKHFT’s mortuary was estimated at £35,000+.                  

It is very difficult to remove these sheets from bodies when moving them as the PAT slides used when transferring a body laterally, are very narrow increasing the risk of the body falling to the floor. Apart from further risk to staff in terms of MSIs there is also a high risk of dropping the patient or damaging delicate tissues such as the skin. 

Further disfiguration to the patient can occur in the use of micro-pore tape that is used to wrap around the ankles and head of the patient, this in one extreme case caused the distortion of the nose of a patient. Facial distortion is obviously undignified and would not be the intention of nursing staff who would not have realised it was happening, however, when nursing and mortuary staff are ill-equipped and understaffed it can occur. 

The monetary cost
Those working in health, age care, rehabilitation and disability services often injure themselves moving patients, residents or clients. For workers this can mean personal pain and discomfort which sometimes lasts for years, affecting not only their work but everyday lives, families and relationships. For employers, this type of workplace injury may lead to legal liability claims and may affect wider staff morale. 

Potential liability claims for MSIs can cost the NHS millions of pounds per year. For example, an instance where a nurse was forced to ignore policy by using a ‘drag lift’ because of staff shortages and broken hoists resulted in a musculoskeletal injury resulting in the NHS paying damages in excess of £800,000.

A change in practice
It is reported that 6,000 NHS staff miss work every day because of musculoskeletal problems (Paton, 2015) . In order to aid this, the NHS introduced a “national incentive fund,” of £450m for 2016/17 that Trusts could access if they could show they were investing in the health and wellbeing of staff. This includes offering nurses, therapists, doctors, care assistants and other staff access to workplace physiotherapy (Paton, 2016 ).

Although this would improve and help some NHS staff, a change of practice in relation to manual handling is needed. By using appropriate equipment that is suitable for the intended task, and using it in the correct way, the risk of sustaining an injury and liable costs will be dramatically reduced. 

A ceiling hoist transfer system is designed to promote safe working practice, reduce back injuries and ensure dignity for the deceased. Overhead hoist systems can offer complete room coverage in the fridge area or post-mortem room. The use of these ceiling hoists reduces the amount of repetitions when transferring bodies and requires only one member of staff to safely operate.

The Hillrom ceiling track hoist can take up to 400kg (63 stone) over two motors and two types of sheet, disposable and uses washable lift sheets (Reposheets) to help move the patient without nurses or mortuary technicians having to manually move them. This in turn reduces the amount of lifting to its lowest level. 

Disposable Reposheets are recommended for post-mortem rooms as it allows the patient to be manoeuvred and cleaned after the post-mortem.  Current practice in a mortuary is often for technicians to lift the body over into the prone position to clean it, however, Reposheets facilitate repositioning of the deceased with minimal physical effort reducing the risk of MSIs.

The cost of a ceiling hoist system is around £120,000 (includes 250 Reposheets) which for some senior management teams may seem like a lot, however, when it is weighed up against the cost of losing multiple sheets, using micro-pore tape and how much MSI legal cases cost the NHS as an institution the hoist system is more supported as a business case.

James Rhodes, Marketing Manager for Liko (part of the Hillrom Group), Early Mobilisation and Falls Prevention comments; “The Hillrom hoist system was put in place in East Kent Hospitals University Foundation NHS Trust where they are now saving money and seeing a reduction in staff not reporting injuries through manual handling. A wide variety of hoisting systems are available and the most effective approach for each setting will depend on the physical environment and the precise functions that need to be carried out. Whatever the system and configuration, there is no doubt that a strategic manual handing approach is needed to drive a reduction in MSIs amongst our care-giver teams across the NHS – whether in hospital, mortuaries or the care home sector.”