Patient Handling: Regulations, Equipment & Best Practices

Patient handling is one of the highest-risk manual handling activities in any workplace. Unlike handling objects, moving and handling people involves unpredictable movements, dignity considerations, and unique physical challenges. In the UK, back injuries from patient handling remain the leading cause of work-related absence in health and social care.

Patient handling vs. general manual handling

Patient handling differs fundamentally from handling objects or loads:

Unique challenges of handling people

Unpredictable movement:

• Patients may move suddenly or unexpectedly
• Cognitive impairment affecting cooperation
• Involuntary muscle spasms or tremors
• Fear or anxiety causing resistance
• Loss of balance during transfers

Variable capability:

• Ability changes day-to-day or hour-to-hour
• Fluctuating pain levels
• Fatigue affecting cooperation
• Medication effects on alertness and muscle tone
• Progressive deterioration in conditions

Dignity and comfort:

• Emotional distress from loss of independence
• Privacy and modesty concerns
• Fear of falling or being dropped
• Communication needs
• Personal preferences for handling methods

Size and weight distribution:

• No handles or grip points
• Weight unevenly distributed
• Body parts move independently
• Height and build variations
• Obesity presenting additional challenges

Why patient handling causes more injuries

Healthcare and social care workers experience musculoskeletal injury rates significantly higher than most other sectors:

Risk factors:

• Frequency — multiple handling tasks throughout every shift
• Urgency — pressure to respond quickly, especially in emergencies
• Asymmetric loading — supporting one side of a person
• Sustained postures — holding or supporting for extended periods
• Confined spaces — bathrooms, bedrooms, tight spaces around beds
• Emotional pressure — reluctance to use equipment when someone is distressed

Moving and handling people regulations

Patient handling is governed by the Manual Handling Operations Regulations 1992, with additional considerations under other health and safety legislation.

Legal framework

Manual Handling Operations Regulations 1992:

• Duty to avoid hazardous manual handling where reasonably practicable
• Requirement to assess risks of handling that cannot be avoided
• Obligation to reduce risks to the lowest level reasonably practicable
• Duty to provide information and training to handlers

Health and Safety at Work Act 1974:

• General duty to ensure health, safety, and welfare of employees
• Duty to ensure safety of non-employees (patients, visitors)
• Requirement for safe systems of work
• Duty to provide adequate supervision

Lifting Operations and Lifting Equipment Regulations 1998 (LOLER):

• Applies to hoists and other lifting equipment used for patient handling
• Requires six-monthly thorough examination by a competent person
• Equipment must be suitable for the purpose
• Lifting operations must be planned and supervised

Management of Health and Safety at Work Regulations 1999:

• Requirement for suitable and sufficient risk assessments
• Need to consider capabilities of workers when allocating tasks
• Duty to provide health surveillance where appropriate

The hierarchy of control for patient handling

The regulations require you to follow this hierarchy:

1. Avoid hazardous handling

• Promote patient independence and mobility
• Enable patients to move themselves
• Use beds, chairs, and toilets at appropriate heights
• Redesign care environments to reduce handling needs

2. Assess remaining risks

• Individual patient risk assessments
• Consider patient capability and cooperation
• Evaluate environmental factors
• Assess staff competence and training needs

3. Reduce risks to the lowest level reasonably practicable

• Provide appropriate handling equipment
• Ensure adequate staffing levels
• Train staff in safe handling techniques
• Implement safe systems of work

Patient handling risk assessment

Every patient who requires handling assistance needs an individual risk assessment. Generic assessments are inadequate because each person's needs, capabilities, and circumstances differ.

Individual patient assessment

A comprehensive patient handling risk assessment should cover:

Patient capability:

• Can they weight-bear? For how long?
• Range of movement and flexibility
• Grip strength and ability to hold on
• Balance and stability when moving
• Cognitive ability to understand and follow instructions
• Communication ability (can they express discomfort?)
• Vision and hearing that might affect cooperation

Medical considerations:

• Conditions affecting bones (osteoporosis, fractures)
• Skin integrity (pressure sores, fragile skin)
• Pain levels and location
• Recent surgery or injuries
• Cardiovascular or respiratory limitations
• Medications affecting alertness or muscle tone
• Catheter, drains, or medical equipment in place

Behavioural factors:

• Cooperation level and willingness
• Fear or anxiety about handling
• Cognitive impairment affecting understanding
• History of aggression or resistance
• Cultural or religious considerations
• Personal preferences for handling methods

Physical characteristics:

• Height and weight
• Body shape and distribution
• Presence of contractures or fixed deformities
• Amputation or paralysis
• Obesity or bariatric considerations

Environmental context:

• Where handling takes place (bed, chair, toilet, bath)
• Equipment available in each location
• Space constraints
• Floor surfaces
• Emergency access routes

TILE framework for patient handling

Apply the standard TILE framework with specific consideration for handling people:

Task factors:

• What type of transfer? (bed to chair, chair to toilet, repositioning in bed)
• How frequently throughout the day?
• Is it a planned or emergency transfer?
• Does it involve lifting any body weight?
• Are there twisting or reaching movements?
• Does it require sustained holding or supporting?

Individual factors (the handler):

• How many staff are needed?
• Are staff trained in patient handling?
• Do staff understand this specific patient's needs?
• Any staff with injuries or restrictions?
• Is appropriate staffing available at all required times?

Load factors (the patient):

• Weight and size of patient
• Level of cooperation and assistance patient can provide
• Stability and balance
• Presence of pain or medical equipment
• Predictability of movement

Environment factors:

• Space around bed, chair, toilet
• Ability to position equipment
• Floor surface and slip risks
• Lighting for safe handling
• Privacy for dignity
• Access for emergency services if needed

Documenting patient handling needs

Each patient should have a documented handling plan including:

Assessment date and reviewer:

• When assessment was completed
• Who conducted it (with appropriate competence)
• Patient or family involvement

Patient capability summary:

• What the patient can do independently
• What assistance they need and why
• Changes in capability throughout the day

Handling requirements for each activity:

• Bed transfers (in and out)
• Chair transfers (sitting, standing, moving)
• Toileting and bathing
• Repositioning in bed or chair
• Walking or mobility assistance
• Emergency evacuation

Equipment required:

• Type of hoist and sling (if applicable)
• Slide sheets, transfer boards, or other aids
• Number and positioning of staff
• Any specific techniques or precautions

Review arrangements:

• When reassessment is due
• Triggers for earlier review (change in condition, incident, patient request)

Patient handling equipment

Appropriate equipment is essential for safe patient handling. The days of manual lifting are over — equipment should be standard for all but the most minor assistance.

Hoists

Hoists are the primary equipment for transferring patients who cannot stand or weight-bear:

Types of hoists:

Mobile floor hoists:

• Most common type for care homes and hospitals
• Wheeled base fits under beds and chairs
• Boom lifts patient using a sling
• Suitable for bed to chair transfers, toileting, bathing
• Requires reasonable floor space to manoeuvre

Ceiling track hoists:

• Fixed or portable track mounted on ceiling
• Excellent for confined spaces like bathrooms
• Smoother, more controlled movement
• Requires installation and structural assessment
• More expensive but highly effective in high-use areas

Stand-aid hoists:

• For patients who can weight-bear but can't stand independently
• Patient places feet on platform and holds handles
• Hoist assists them to standing position
• Useful for standing transfers and repositioning
• Promotes patient participation and independence

Bath hoists:

• Specifically designed for moving patients in and out of baths
• Various designs (over-bath, in-bath, reclining)
• Important for maintaining dignity during personal care

Bariatric hoists:

• Higher weight capacity (typically 300kg+)
• Wider slings and stronger components
• Essential for safe handling of obese patients
• Cannot substitute standard hoist for bariatric patients

Slings

Slings attach the patient to the hoist and must be chosen carefully:

Sling types:

Full-body slings (general purpose):

• Support from shoulders to thighs
• For patients with no weight-bearing ability
• Most versatile type
• Various back heights (low, medium, high)

Toileting slings:

• Open design allowing access for toileting
• Less support than general purpose slings
• Suitable for weight-bearing patients only
• Cannot be left under patient for extended periods

Bathing slings:

• Mesh or quick-dry material
• Can be used in water
• Some designed to stay under patient during bathing

Hammock slings:

• More supportive, head-to-thigh coverage
• Better for patients with poor trunk control
• Can be more comfortable for extended use

Divided leg slings:

• Legs positioned separately
• Better positioning for some patients
• Useful for intimate care activities

Sling selection considerations:

• Patient weight (slings have maximum capacities)
• Patient comfort and medical conditions
• Level of support needed
• Whether sling stays under patient or is removed
• Fabric type (standard, mesh, disposable)
• Size (small, medium, large, extra-large)

Sling safety:

• Each sling must be checked before every use (tears, damage, worn stitching)
• Slings should be individual to each patient (infection control)
• Never exceed the sling's weight limit
• Must be compatible with the hoist being used
• Follow manufacturer's instructions for positioning and attachment
• Launder according to manufacturer's guidance

Slide sheets

Slide sheets reduce friction when repositioning patients in bed or moving them across surfaces:

Uses:

• Moving patient up or down in bed
• Turning patient side to side
• Lateral transfers (bed to trolley)
• Repositioning in chair

Types:

• Single tubular (rolled)
• Flat sheet
• Various sizes and lengths
• Standard or low-friction material

Proper technique:

• Never drag patient across surface without slide sheet
• Use two staff members for safety
• Remove slide sheet after repositioning (unless designed to stay in place)
• Ensure patient is not left on slippery surface
• Coordinate movements with verbal cues

Transfer aids

Various aids facilitate transfers and reduce handling demands:

Transfer boards (banana boards):

• Bridge between bed and chair or wheelchair
• Patient slides across rather than being lifted
• Requires some upper body strength from patient
• Useful for promoting independence

Handling slings and belts:

• Provide secure grip points for staff
• Assist patient during standing or walking
• Must not be used to take patient's full weight
• Help with guidance and balance support

Rotunda (turning disc):

• Circular disc patient stands on
• Rotates to change direction during standing transfer
• Reduces twisting for staff and patient
• Patient must be able to weight-bear

Transfer platforms:

• Patient positions feet on platform
• Staff use platform to guide patient's movement
• Reduces force required for standing transfers

Leg lifters:

• Assist patients to lift legs into and out of bed
• Particularly useful for patients with weakness or injury
• Promotes independence

Bed rails and grab handles:

• Assist patient to reposition themselves
• Must be risk-assessed (entrapment risk)
• Help maintain independence

Equipment maintenance and inspection

Patient handling equipment is subject to legal requirements:

LOLER requirements:

• Hoists must be thoroughly examined by competent person every six months
• Records must be kept of examinations
• Defects must be addressed before further use
• Equipment must be suitable for the purpose

Routine checks:

• Visual inspection before every use
• Check for damage, wear, missing parts
• Test operation (brakes, controls, smooth movement)
• Report any defects immediately
• Remove faulty equipment from service

Service and maintenance:

• Follow manufacturer's service schedule
• Keep records of service and repairs
• Only use competent service engineers
• Maintain spare equipment to cover items being serviced

Patient handling training requirements

Staff who handle patients require specific, practical training. Generic manual handling training is inadequate for patient handling.

What patient handling training must cover

Theoretical knowledge:

• Why patient handling causes injuries
• Legal requirements and employer duties
• Principles of patient-centred handling
• Risk assessment for individual patients
• When and why to use equipment
• Consequences of unsafe handling

Practical skills:

• Using hoists safely (all types in your workplace)
• Selecting and fitting slings correctly
• Operating slide sheets effectively
• Assisting standing transfers with equipment
• Repositioning patients in bed and chair
• Reading and implementing individual handling plans
• Recognising when handling is unsafe and needs reassessment

Communication skills:

• Explaining procedures to patients to gain cooperation
• Coordinating with colleagues during handling
• Obtaining consent and respecting dignity
• Responding to patient anxiety or resistance
• Documenting and reporting concerns

Patient-specific training:

• Understanding individual patient needs
• Following documented handling plans
• Adapting approach to patient capability and mood
• Recognising changes that require reassessment

Training frequency

Initial training:

• Before staff perform any patient handling
• Comprehensive theory and practical skills
• Typically one full day for care environments
• Assessment of competence before unsupervised practice

Refresher training:

• Every 6-12 months as good practice
• Annual refreshers common in care homes and hospitals
• More frequently if poor technique observed or injuries occur
• After introduction of new equipment

Ongoing competency:

• Supervision and coaching by experienced staff
• Observation of technique and immediate correction
• Regular toolbox talks on specific aspects
• Review of individual patient handling plans

Additional training triggers:

• New equipment introduced
• Changes in patient populations (e.g., more bariatric patients)
• After handling incidents or injuries
• When staff request additional support
• Changes in legislation or best practice guidance

Safe patient handling techniques

Bed to chair transfers using a hoist

The most common patient handling activity in care environments:

Preparation:

1. Check individual handling plan
2. Inspect hoist and sling for damage
3. Position chair at angle to bed
4. Explain procedure to patient
5. Ensure brakes on bed and chair are applied
6. Two staff members present (minimum)

Applying the sling:

1. Roll patient to side (using slide sheet if needed)
2. Position sling behind patient (fan-folded)
3. Roll patient onto other side and straighten sling
4. Return patient to back, adjust sling positioning
5. Ensure sling is smooth and correctly positioned
6. Patient's arms outside sling (unless specified otherwise)

Hoisting:

1. Position hoist over patient with legs either side
2. Attach sling loops to hoist (follow colour coding or loop numbering)
3. Ensure attachments are secure and even
4. Remove bed brakes, apply hoist brakes
5. Operate hoist control smoothly to raise patient
6. Check patient is comfortable, not twisted
7. Release hoist brakes, guide patient over chair
8. Lower gently into chair
9. Apply chair brakes, remove sling attachments
10. Adjust patient positioning for comfort

Removing the sling:

• Decision based on sling type and patient needs
• Some slings remain under patient
• Others removed by rolling patient side to side
• Follow individual handling plan

Key safety points:

• Always use brakes appropriately
• Never rush the procedure
• Keep patient informed throughout
• Watch for signs of discomfort or distress
• Ensure hoist legs fully under bed/chair before lifting
• Never leave patient suspended in hoist

Repositioning patients in bed

Frequent activity that must be done safely:

Using slide sheets:

1. Two staff members, one on each side
2. Explain to patient what you're doing
3. Position slide sheet under patient
4. Both staff members hold edges of outer sheet
5. On coordinated count, pull sheet upward toward head of bed
6. Remove slide sheet (or leave if designed to stay)
7. Ensure patient is comfortable and well-positioned

Without patient assistance:

• Must use slide sheet or similar equipment
• Never drag patient across surface
• Consider using bed that adjusts height to optimal working position
• May need profiling bed to aid positioning

With patient assistance:

• Encourage patient to help by pushing with feet
• Patient may be able to pull using bed rails or grab handles
• Still use slide sheet to reduce friction
• Praise and encourage independence

Assisting standing transfers

For patients who can weight-bear:

Assessment first:

• Confirm patient can take weight on legs
• Check they understand what to do
• Ensure they're wearing appropriate footwear
• Assess if stand-aid hoist needed

Technique (with patient assistance):

1. Patient sitting on edge of bed/chair
2. Feet flat on floor, shoulder-width apart
3. Staff positioned to side (not pulling from front)
4. Patient leans forward, nose over toes
5. Patient pushes with legs to stand (staff guides, doesn't lift)
6. Pivot to reposition
7. Reverse procedure to sit

Using a stand-aid hoist:

1. Position hoist in front of patient
2. Patient places feet on platform
3. Apply knee/shin supports
4. Patient holds handles
5. Operate hoist to bring patient to standing
6. Patient remains on hoist for repositioning
7. Lower patient into seated position

Special patient handling situations

Bariatric patient handling

Patients with obesity require specific considerations:

Equipment needs:

• Bariatric hoist with appropriate weight capacity
• Larger slings designed for bariatric patients
• Wider beds and chairs
• Reinforced commodes and toilets
• Additional slide sheets

Handling considerations:

• More staff may be required (even with equipment)
• Longer time needed for procedures
• Dignity and sensitivity particularly important
• Skin folds require careful positioning
• Higher risk of pressure injuries

Risk assessment:

• Must not assume standard equipment is adequate
• Check actual weight capacity of all equipment
• Environmental access (doorways, room size)
• Emergency evacuation planning

Patients with cognitive impairment

Dementia and confusion present unique challenges:

Assessment considerations:

• Capacity to consent and cooperate
• Level of understanding of instructions
• Triggers for distress or resistance
• Best times of day for handling
• Communication approaches that work

Handling approach:

• Simple, clear explanations
• Consistent routine and familiar staff
• Calm, reassuring manner
• Allow more time, don't rush
• Distraction techniques for anxiety
• May need different approach on different days

When patients resist:

• Don't force handling if patient is distressed
• Step back, wait, try different approach
• Consider if handling is necessary right now
• Balance safety with dignity and autonomy
• Seek advice from senior staff or healthcare professionals

Emergency patient handling

Despite best planning, emergencies occur:

Acceptable emergency handling:

• Moving patient from immediate danger (fire, flood)
• Supporting patient who is falling (don't try to catch, but guide down safely)
• Performing CPR or other medical interventions

Not acceptable as "emergency":

• Routine transfers without equipment because equipment is inconvenient
• Manual lifting because patient is "urgent"
• Improper technique because you're short-staffed

Emergency preparedness:

• Emergency evacuation plans that consider patient handling needs
• Equipment positioned for emergency access
• Staff trained in emergency procedures
• Evacuation aids (ski sheets, evacuation chairs) available

Common patient handling mistakes

Mistake 1: Manual lifting "because it's quicker"

The problem:

• Equipment seems inconvenient or time-consuming
• Pressure to work quickly
• Patient requests manual assistance

Why it's wrong:

• Back injuries can end careers
• May injure the patient (dropping, fractures)
• Creates culture of unsafe practice
• Violates risk assessment and handling plans

The solution:

• Plan ahead so equipment is positioned and ready
• Build equipment use into workflow
• Make it clear that manual lifting is never acceptable
• Address staffing if time pressure is genuine

Mistake 2: One staff member handling alone

The problem:

• Other staff member not available
• Task seems simple or quick
• Patient seems light or easy to move

Why it's wrong:

• No one to help if something goes wrong
• Asymmetric handling postures unavoidable
• Patient more likely to fall if handler loses grip
• Even with equipment, most patients need two staff

The solution:

• Wait for second staff member
• Arrange staffing to ensure two people available
• Make single-handed handling unacceptable except for specifically assessed situations

Mistake 3: Ignoring the patient's own capability

The problem:

• Automatically using hoist for all transfers
• Doing everything for patient rather than encouraging participation
• Not reassessing when patient capability improves

Why it's wrong:

• Reduces patient independence and confidence
• Accelerates loss of ability
• Doesn't meet person-centred care principles
• May be more restrictive than necessary

The solution:

• Encourage maximum patient participation
• Reassess regularly to identify improving capability
• Balance safety with independence
• Use less restrictive equipment when appropriate

Mistake 4: Not following individual handling plans

The problem:

• Handling plans exist but staff don't read them
• Staff improvise rather than following documented approach
• New staff not shown where plans are located

Why it's wrong:

• Patient may be handled unsafely
• Inconsistent approach causes confusion and anxiety
• Handling plans become meaningless paperwork

The solution:

• Display handling plans clearly at bedside
• Include in handover and new staff induction
• Make following plans non-negotiable
• Update plans when they don't reflect actual practice

Mistake 5: Delaying equipment maintenance

The problem:

• Faulty equipment not taken out of service
• LOLER examinations overdue
• Repairs put off to save money

Why it's wrong:

• Equipment failure can cause serious injury
• Using faulty equipment is illegal
• Creates risk to staff and patients

The solution:

• Immediate removal of faulty equipment
• Clear reporting system for defects
• Ensure LOLER examinations scheduled and completed
• Budget adequately for maintenance

Frequently asked questions

Next steps

If you're responsible for patient handling in your organisation:

1. Audit current practice — Observe actual handling activities and compare to documented assessments and plans.

2. Review individual assessments — Ensure every patient who requires handling assistance has a current, detailed individual assessment and handling plan.

3. Check equipment — Verify you have adequate, appropriate equipment for all assessed needs, and that LOLER examinations are current.

4. Assess staff competence — Review training records and observe technique to ensure staff are competent in patient handling with equipment.

5. Address gaps urgently — Unsafe patient handling causes serious injuries. Don't delay addressing identified risks.

Related articles:

• What is manual handling?
• TILE assessment guide
• Manual handling training requirements

Useful tools:

• Manual Handling Risk Calculator
• Training Tracker