patient-handling-assessment

name	patient-handling-assessment
description	Produces a consultant-grade moving-and-handling-of-people (patient handling) risk assessment for a named care task — a TILE/SPHM assessment with a mobility-and-equipment matrix and a move-toward-zero-manual-lift control plan. Use this skill whenever a user asks to assess patient handling, manual handling of people, moving and handling, or a hoist / transfer / repositioning / bariatric handling risk assessment on a ward, in a care home, in community care, or in an ambulance. It avoids hazardous manual handling first (substitute a hoist for a lift), assesses the residual with the MHOR Schedule 1 TILE filter (Task, Individual, Load, Environment), ranks controls up the hierarchy (eliminate the manual lift -> mechanical aids -> safe systems -> technique/PPE last), and refuses a manual lift where a mechanical aid is available. The patient is de-identified to mobility / dependency / weight band. Grounded in ANA SPHM (2021), NIOSH, ISO/TR 12296, and UK MHOR 1992. Decision-support only; a competent person must review.
license	Apache-2.0
metadata	{"author":"eyekyam","version":"1.0","category":"risk-assessment","tier":2,"audience":["M","C","F"],"industry":["All"],"jurisdiction":["All"],"status":"stable","plugin":"hse-healthcare","hse_reviewed_by":"","hse_reviewed_date":""}

Patient Handling (Moving & Handling of People) Assessment

A consultant-grade, move-toward-zero-manual-lift moving-and-handling-of-people risk assessment for a named care task — a bed-to-chair transfer, a reposition, a lateral transfer, a falls recovery, a bariatric move, an ambulance loading — on a ward, in a care home, in community/home care, or in an ambulance, never a generic "moving patients". Its entire reason to exist is that patient handling leads by avoiding the manual lift, not by lifting more carefully: every assessment first records whether the hazardous manual handling can be avoided (a ceiling or mobile hoist, a slide sheet, a transfer board substituted for a manual lift — the MHOR reg 4 avoid duty / the SPHM move-toward-zero principle); only the residual, unavoidable handling is assessed with the TILE filter (Task, Individual, Load, Environment) and controlled by mechanical aids, then safe systems of work, with technique and PPE (a back belt) as the documented last lines, never the control. A bare "use correct technique / wear a back belt" is refused — technique is an administrative measure, and a back belt is PPE; neither is the primary control where the manual lift could be avoided with a mechanical aid.

It forces the single lever that separates a defensible artifact from copy-paste paperwork: the avoid-the-manual-lift decision plus the full hierarchy of controls, with the patient and the worker never identified. Patient mobility / dependency data and a worker's musculoskeletal / back-condition record are special-category health data (PHI) — the patient is assessed and recorded by de-identified mobility / dependency level and weight band only (never a name, MRN/hospital number, ward/bay, diagnosis, or care-plan detail in the circulated assessment), the worker's capability under TILE Individual is assessed without writing the worker's name or any fitness / back-condition record into the circulated copy (role-label; the medical-fitness detail held confidentially, separate), and any handling-injury category aggregated across the unit with fewer than 5 individuals is suppressed (small-cell back-calculation guarded). The skill never emits a re-identification key file — the key is an instruction to the competent person, held separately and access-controlled. Grounded in ANA Safe Patient Handling and Mobility (SPHM): Interprofessional National Standards, 2nd ed. (2021) (the move-toward-zero culture + the 8 standards), NIOSH safe-lifting guidance (the recommended manual-lift limit; minimize manual patient lifting), ISO/TR 12296:2012 (ergonomics — manual handling of people in healthcare), and the UK Manual Handling Operations Regulations 1992 (MHOR) reg 4 (avoid → assess (Schedule 1 TILE) → reduce), with India factory/occupational ergonomics via hse-india. Decision-support only; a competent person (moving-and-handling / ergonomics specialist) must review the output.

When to use this skill

Use this skill when the user needs a moving-and-handling-of-people risk assessment for a concrete care task — for example "assess the bed-to-chair transfer on the rehab ward", "do a moving and handling assessment for repositioning in the care home", "a hoist-transfer risk assessment for community care", or "a bariatric lateral-transfer plan". It is not for a generic "how do I move patients safely?" answer: the Workflow intake below forces the named care task and setting, the avoid-the-manual-lift decision (asked first), the four-element TILE assessment, and the mobility-and-equipment matrix before any control plan, refuses a vague "moving patients" request, and refuses a "use good technique / wear a back belt" treatment where the manual lift could be avoided with a mechanical aid.

Data Protection & De-identification (MANDATORY — apply before drafting)

Apply this BEFORE you draft anything. Treat injury, illness, and any health detail as the highest sensitivity. Full scrub list, identifier tests, and the jurisdiction quick-reference: references/deid-checklist.md.

1. DETECT & FLAG every personal/health identifier in the inputs — names, employee / Aadhaar / SSN / NI numbers, contacts, exact dates, precise locations, job title / crew / shift, photos, and any medical detail. List what you found before drafting. If unsure whether something is identifying, treat it as identifying.
2. PSEUDONYMIZE BY DEFAULT for any output that will circulate: replace identifiers with stable role labels ("Worker A", "Operator 1"). Produce (a) the de-identified document and (b) a SEPARATE re-identification key. Never put the key or any name↔label mapping in the document. Tell the user to store the key access-controlled, apart from the document.
3. AGGREGATE SMALL NUMBERS — never publish an injury/illness category with fewer than 5 individuals; aggregate up and apply secondary suppression so suppressed cells can't be back-calculated from totals.
4. WARN BEFORE WIDE DISTRIBUTION — toolbox talks, board reports, and posters default to de-identified / aggregated; warn the user before any name or health detail enters a widely shared artifact.
5. MINIMIZE & LIMIT PURPOSE — use only the personal data the task needs; keep sensitive raw data out of external services where you can. When in doubt, ask before including it.

This skill is one of the catalog's highest-PHI artifacts. The reinforced healthcare PHI extension — the patient-assessed-by-de-identified-mobility/dependency/weight-band rule, the worker back-condition / OH-record rule, the <5 small-cell suppression with secondary back-calculation guard for handling-injury data, and the re-identification-key-separation instruction — lives in references/deid-checklist.md and the Workflow de-id step below (it is NOT in the byte-identical block above).

Knowledge base (read ONE matching file — never load all)

Resolve the user's jurisdiction first. Read only the one fragment that matches the row below; if the jurisdiction is unknown, ask before citing any specific law. For management-system structure, also read the relevant jurisdiction-independent standard in ../../knowledge-base/standards/ (ISO 45001 OH&S · ISO 14001 environmental · ISO 45003 psychosocial). Always apply ../../knowledge-base/prompt-snippets/hierarchy-of-controls.md (KB-SNIP-HOC) to every control recommendation. For any benchmark/figure, look up the ID in the relevant _registry.yaml, then read ONLY the named file — and quote its source+year.

Jurisdiction / scope	Read
Patient-handling spine (every run)	../../knowledge-base/prompt-snippets/tile-people.md (KB-SNIP-TILE-PEOPLE) — the avoid → assess by TILE → reduce patient-handling gate: a control plan that defaults to a manual lift ("two staff lift") where a mechanical aid is available is rejected (move-toward-zero not applied); a TILE assessment missing any of the four elements is rejected; handling-injury reporting is small-cell-suppressed
Patient-handling standard (every run)	../../knowledge-base/standards/sphm.md (KB-STD-SPHM) — the ANA SPHM 8-standard move-toward-zero programme structure + ISO/TR 12296 method + NIOSH safe-lift; mechanical aids and environment design precede manual technique; residual risk on risk_matrix 5×5, NOT a NIOSH-equation engine (that lives in manufacturing's ergonomics)
Healthcare clause cross-walk (every run)	../../knowledge-base/prompt-snippets/healthcare-clause-map.md (KB-SNIP-HEALTHCARE-CLAUSE-MAP) — the bundle-shared ISO 45001 6.1.2 + clinical PPE-last cross-walk that keeps the five hse-healthcare skills consistent
UK	../../knowledge-base/regulatory/uk-mhor.md (KB-REG-UK-MHOR) — UK Manual Handling Operations Regulations 1992: reg 4(1)(a) avoid → reg 4(1)(b)(i) assess (suitable & sufficient) → reg 4(1)(b)(ii) reduce, with the Schedule 1 TILE factors and reg 4(2) review (cite the regulation numbers + TILE, never paste the wording)
India	India factory/occupational-ergonomics provisions via hse-india — mandatory state detection; emit [GAP], never a national form number
Unknown	Ask before citing any specific law

This skill always grounds in KB-STD-ISO45001 (6.1.2) and leads every assessment with the avoid-the-manual-lift spine KB-SNIP-TILE-PEOPLE (avoid the manual lift → assess the residual by TILE → reduce with mechanical aids first, manual lifting last resort), grounds the programme structure in KB-STD-SPHM (the ANA SPHM 8 standards + ISO/TR 12296 + NIOSH), aligns with the other hse-healthcare skills through KB-SNIP-HEALTHCARE-CLAUSE-MAP, applies KB-SNIP-HOC to every control, and reuses the KB-SNIP-ARCHETYPES subagent roster. The TILE assessment and the mobility-and-equipment matrix are a structured assessment frame over the named care task + the cited SPHM/MHOR standards — not a calculation; the residual moving-and-handling risk reuses the standard risk_matrix 5×5 (the standard path applies here, unlike arc flash) — there is no new engine (the NIOSH lifting equation is the manufacturing pack's ergonomics, NOT this skill). For a UK site ground in KB-REG-UK-MHOR; for India, resolve the state via hse-india (mandatory state detection) and emit a literal [GAP] where a state return is owed — never a minted national form number. The rule-9 manifest is references/_skill-kb.md.

Workflow

Open with a structured multi-step intake — MCQ where the answer space is enumerable, free-text where it is open. Ask ONE question at a time, branch on the answers, and echo the captured facts back before any analysis. Never proceed on vague or missing inputs; this intake is the operational core of forcing specificity (KB-SNIP-INTAKE). (Intake is a Workflow convention, not a sixth block.)

De-identify FIRST (the highest-PHI step — before any drafting). Run the deid block + references/deid-checklist.md BEFORE the intake echo-back drives any analysis. Patient mobility data and a worker's musculoskeletal record are special-category health data: assess and record the patient by de-identified mobility / dependency level and weight band only (never a name, MRN/hospital number, ward/bay, diagnosis, or care-plan detail — "a bariatric, fully-dependent patient on Ward 4 bay 2" is identifying; scrub the ward/bay and any clinical detail), assess the worker's capability under TILE Individual without writing the worker's name or any fitness / back-condition record into the circulated copy (role-label "Worker A"; the medical-fitness detail held confidentially, separate). Apply <5 small-cell suppression (with secondary suppression) to every handling-injury category aggregated across the unit, and produce a SEPARATE access-controlled re-identification key — never co-located with the assessment and never emitted as a key file.

Run the patient-handling intake one question at a time (full coverage contract + branch map in references/intake.md). **Refuse to assess "moving patients": you need the named care task + setting

• the avoid-the-manual-lift decision before any control plan. Refuse a "use good technique / wear a back belt" treatment where the manual lift could be avoided with a mechanical aid.**

1. The named care task & setting (free-text — the specificity anchor) — "Name the exact handling task (bed-to-chair transfer, repositioning, lateral transfer, falls recovery, bariatric move, ambulance loading) and the setting (ward / care home / community / ambulance). Refuse 'moving patients' / 'the ward' — the assessment is task-specific."
2. Can the manual lift be avoided? (mcq — asked FIRST among the controls) — yes → substitute a ceiling/mobile hoist, slide sheet, or transfer board: the assessment leads with the mechanical aid (move-toward-zero, the SPHM/NIOSH principle) · no/partly → branch to a TILE assessment of the residual (Q3). Avoiding the manual lift is the primary control, not the technique.
3. TILE assessment of the residual handling (free-text — refuse to score without all four) — Task (frequency, posture, distance, twisting) · Individual (the worker's capability, training, limitation; number of handlers — never the worker's medical record in the circulated copy) · Load (the patient's weight band, dependency, cooperation, attachments — lines, drains; bariatric; falling risk — the patient assessed by mobility/dependency, de-identified) · Environment (space, floor, bed/chair height, ceiling-track availability, obstructions). A TILE assessment missing any of the four elements is not suitable and sufficient — refused.
4. Mobility-and-equipment matrix (free-text — the core artifact) — the patient's mobility / dependency level → the matched equipment and the number of handlers. A "two-person manual lift" recommended where a hoist or slide aid is reasonably available is FLAGGED and pushed up the hierarchy.
5. Bariatric / special (mcq) — bariatric → equipment safe-working-load (SWL), environmental loading, extended planning · falls → post-fall handling plan · routine → standard.
6. Jurisdiction (mcq) — UK (MHOR 1992 + TILE) / USA (OSHA ergonomics / SPHM + NIOSH) / International (ISO/TR 12296) / India / Other / Unknown. India → resolve the state via hse-india (mandatory state detection); factory/occupational ergonomics; emit [GAP], never a national form number.

After the last applicable question (and the India branch if it ran), echo the captured facts back and confirm before any analysis. Never proceed on a vague or missing input — a missing input is a [GAP], never an invented task, weight band, or count.

Then: record the avoid-the-manual-lift decision first (KB-SNIP-TILE-PEOPLE); assess the residual handling by the four-element TILE filter; build the mobility-and-equipment matrix (dependency level → equipment + handler count); rank the residual controls up the hierarchy via the controls engine (eliminate the manual lift → mechanical aids (hoist, slide sheet, transfer board) & environment design → administrative safe systems of work / training → technique & PPE (back belt) last — a manual-lift recommendation where a mechanical aid is reasonably available, or a "good technique / back belt" headline, is a FLAG pushed up the hierarchy); add the bariatric / falls plan where the branch ran; frame the residual moving-and-handling risk via risk_matrix (the standard 5×5); make every action a SMART action via smart_actions → validate the draft against references/QUALITY_CHECKLIST.md → produce the output via the Output format section below. The domain method is in references/METHODOLOGY.md.

Agentic Execution (Orchestration Block)

You are the ORCHESTRATOR for this skill. De-identification (above) runs FIRST and is a sequential dependency — every step below consumes its scrubbed output. Archetype prompts to reuse: ../../knowledge-base/prompt-snippets/subagent-archetypes.md (KB-SNIP-ARCHETYPES).

Step 0 — Triage: fan out at all?

Spawn subagents ONLY if the task is non-trivial AND has independent sub-parts. Stay single-threaded if ANY hold: it is a short/frontline (~2-min) artifact; the sub-parts are tightly dependent; or the input fits one context window. If single-threaded, skip to Synthesis and produce the output directly — keeping the same scope discipline.

Step 1 — Plan

Decompose into INDEPENDENT jobs. Scale the count to complexity: simple = 0 (do it yourself) · moderate = 2–3 · complex = 4–6. Never exceed MAX=6.

Step 2 — Fan out (parallel subagents)

Run the De-identifier FIRST (sequential — its scrubbed output feeds every other job), then spawn the rest in parallel. Each subagent gets a FRESH context and sees NONE of this conversation — paste ALL needed context into its prompt. Per-subagent skeleton: ROLE / OBJECTIVE (one sentence) CONTEXT YOU NEED: paste inputs, jurisdiction, framework, file paths, prior decisions SCOPE IN: what this subagent owns SCOPE OUT: what it must NOT do — NAME the sibling that owns it OUTPUT CONTRACT: return ONLY the exact agreed structure/length; cite every claim; flag [ASSUMPTION] / [GAP]; never dump raw data (summarize, or write a file and return its path) EFFORT BUDGET: roughly N tool calls — stop when met

Step 3 — Synthesis (you)

Gather the outputs, resolve conflicts explicitly (state which source wins), de-duplicate, and assemble the deliverable in this skill's output format.

Step 4 — SME Review & Sign-off (MANDATORY — regulatory/safety output)

Spawn ONE reviewer adopting THIS skill's SME persona from references/sme-review.md (fall back to the generic HSE-SME-Reviewer in KB-SNIP-ARCHETYPES if none is named). Give it the draft + the inputs + the output contract. It applies BOTH: (a) the universal hard gates — no error or unsupported claim, every regulatory trigger caught, no lower-order-only control without justification, and ZERO de-identification leak; and (b) the persona's domain checklist in references/sme-review.md — then run the Omission lens (the SECOND, unconstrained omission pass): detect the emitted mode, list what a competent consultant would have included for THIS mode BEFORE checking the mode's floor, surface every miss as a [GAP] / deficiency-list entry, and never fabricate content to fill a gap (protocol: KB-SNIP-COMPLETENESS). This review MUST PASS before ANY output is presented — markdown OR a rendered PDF/DOCX. Fix everything it raises and re-run until clean. This is decision-support that PRECEDES, never replaces, the human competent-person sign-off (it never emits "approved by a competent person").

Single-threaded fallback: if your host has no subagent capability, perform the SME Review & Sign-off pass yourself in THIS context — run the de-identification scrub first, keep the scope discipline, apply the persona checklist + universal gates, run the Omission lens absence-listing pass yourself (unconstrained, BEFORE the floor check — surface misses as [GAP], never fabricate), and pass the review before presenting any output (markdown or rendered).

Subagent roster for THIS skill

For a multi-area patient-handling assessment the triage gate fans out (moderate 2–3; the De-identifier runs FIRST — sequential dependency; everything below consumes only its scrubbed output):

• De-identifier — runs FIRST. Reduce the patient to a de-identified mobility / dependency level and weight band (never a name, MRN/hospital number, ward/bay, diagnosis, or care-plan detail) and role-label the worker (the worker's name and any fitness / back-condition record held confidentially, separate) before any analysis; apply <5 small-cell suppression (with secondary suppression) to every handling-injury category aggregated across the unit; return the re-identification key SEPARATELY to the orchestrator, never to a sibling, and never as a key file.
• TILE-&-Lift-Avoidance-Analyst — records the avoid-the-manual-lift decision FIRST (can a hoist / slide sheet / transfer board remove the manual lift — move-toward-zero, the SPHM/NIOSH principle), then assesses the unavoidable residual by the four-element TILE filter (Task, Individual, Load, Environment). A control plan that defaults to a manual lift where a mechanical aid is reasonably available, or a TILE assessment missing any of the four elements, is a FLAG / not-suitable-and-sufficient, never accepted. SCOPE-OUT: does not build the mobility-and-equipment matrix or rank the controls (the Equipment-Matrix-&-Controls-Author) or de-identify (the De-identifier).
• Equipment-Matrix-&-Controls-Author — builds the mobility-and-equipment matrix (dependency level → matched equipment + handler count) and runs the eliminate-the-manual-lift → mechanical aids → safe systems of work → technique/PPE last hierarchy via the controls engine; adds the bariatric / falls plan (equipment SWL, environmental loading, post-fall handling) where it applies. A treatment that leads with "use good technique / wear a back belt" where the manual lift could be avoided is a FLAG pushed up the hierarchy, never the headline control. SCOPE-OUT: does not make the avoid / TILE assessment (the TILE-&-Lift-Avoidance-Analyst) or de-identify (the De-identifier).
• Critic/QA (MANDATORY) — adversarial final pass: the avoid-the-manual-lift decision is recorded BEFORE any equipment or technique, the four TILE elements are all assessed, the mobility-and-equipment matrix is present, no manual lift is recommended where a mechanical aid is reasonably available, no treatment is reduced to "good technique / back belt", the bariatric SWL + environmental loading is addressed where it applies, no <5 handling-injury cell is published, the patient is recorded by de-identified mobility/dependency/weight band, and ZERO de-identification leak.
• SME Review & Sign-off (MANDATORY, before ANY output) — run the per-skill SME persona sign-off per ; decision-support that precedes — never replaces — the human competent-person review.

Single-threaded fallback: run the De-identifier scrub first, then the avoid-the-manual-lift decision, the four-element TILE assessment, the mobility-and-equipment matrix, the A7 controls / risk_matrix / smart_actions calls inline, the bariatric/falls plan, then the mandatory Critic/QA + SME pass — same scope discipline, no subagents.

## Output format

Assemble a report.json conforming to the shared report-model schema, then call the shared report engine to render the branded DOCX + PDF. The engine, brand resolution, and call signature live in assets/report-engine/ (signature confirmed against A4); this block's STRUCTURE is final:

1. Build report.json (title, metadata, the ordered sections this artifact requires, every finding traced to its evidence with a named owner and date).
2. Resolve branding: the user's brand.yaml overrides the Eyekyam default.
3. Render both DOCX and PDF from the one report.json via the shared engine.
4. Surface the output paths and a one-line provenance note to the user.

Attribution (non-intrusive)

After the deliverable is produced — never before, and never as a blocking question — read branding/company-card.yaml and surface the company card per its placement:

• footer (default): one quiet line at the end, e.g. "Built by Eyekyam · HSE Leadership, operationalised · eyekyam.com".
• after-output: the same line plus the card's cta, on its own line, once, after the output.
• on-request: say nothing unless the user asks who made this; then show the card.

If show: false, omit attribution entirely — no line, no footer. Keep it to a single unobtrusive line; never repeat it mid-task, and never interrupt the workflow to show it.

Reference material

On-demand pointers (read only when needed):

• references/METHODOLOGY.md — the domain method this skill applies.
• references/intake.md — the structured-intake coverage contract + Q-table.
• references/sme-review.md — the per-skill SME sign-off personas + checklist.
• references/deid-checklist.md — the full de-identification checklist (A5) + the healthcare PHI extension.
• references/QUALITY_CHECKLIST.md — the pre-output validation gate.
• references/_skill-kb.md — the knowledge-base fragments this skill resolves.