section 14 - ACC...Section 14: bariatric clients Staff‑to‑client communication is also...

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section 14

Contents

• Providingcareforbariatricclients

• Planningforbariatricclients

• Developingorganisationalcapacityforbariatriccare

• Specificissuesrelatedtothecareofbariatricclients

• Referencesandresources

• Appendix:ChartforcalculationofBMI.

Bariatric clients

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14.1 Providing care for bariatric clientsInthepast20yearstherehasbeenanincreaseinthenumberofbariatricadmissionstohealthcarefacilities.Theincreasingnumberofbariatricclients1presentsachallengetohealthcareandotherserviceproviderstogivecarethatiseffectiveandsafeforboththeclientsandstaff.

Thepurposesofthissectionaretoassiststaffandtoreducetheriskswhenmovingandhandlingbariatricclients.Bariatricclientsshouldreceivetreatmentwithoutprejudiceordiscrimination,andbegiventherespectanddignityaccordedtoallclients.Thissectionoutlinestopicstoconsiderwhenplanningforbariatricclientsandhowtodevelopahealthcarepathway.Itconcludeswithadiscussionofspecificissuesrelatedtothecareofbariatricclients.

Bariatricisthescienceofprovidinghealthcareforthosewhoareseverelyobese.ThetermbariatricderivesfromtheGreekword‘baros’(weight).Severalcriteriaareusedtodetermineifsomeoneisclassifiedasabariatricclient.Thefollowingaresomeexamples.PleasenotethatthereisnotacompleteconsensusonthecriteriaforclassifyingapersonasbariatricbasedonweightorBodyMassIndex(BMI).

• Apersonwithabodyweightgreaterthan140kilograms.2

• ApersonwithaBMIgreaterthan40(severelyobese),oraBMIgreaterthan35(obese)withco‑morbidities.3

• Apersonwhohasrestrictedmobility,orisimmobile,owingtotheirsizeintermsofheightandgirth.4

• Apersonwhoseweightexceeds,orappearstoexceed,theidentifiedsafeworkingloads(SWLs)ofstandardhospitalequipmentsuchaselectricbeds,mechanicallifters,operatingtables,showerchairsandwheelchairs.5

Aworkingdefinitionofabariatricclientissomeonewhoweighs150kgormore,hasaBMIof40ormoreorwhohaslargephysicaldimensions,alackofmobilityorotherconditionsthatmakemovingandhandlingdifficult.6

Box 14.1

What is a bariatric client?

Thedefinitionofwhatconstitutesa‘bariatric’patientisapointofcontentionforanumberofserviceswithinthejourneyofbariatricpatientcare.WhileaBMIofatleast30isseenasausefultriggerpointtoimplementbariatriccareprocedures,itsuseislimitedininformingotherproceduressuchaspurchasing.

Source:AustralianSafety&CompensationCouncil,2009,p.10

1. Weusetheterm‘bariatricclient’ratherthan‘bariatricpatient’torecognisethatnotallpeoplebeingcaredforwillbeinorganisationsthatusetheterm‘patient’.

2,3. BMIiscalculatedusingtheformulaBMI=kg/m²,wherekg=person’sweightandm=heightinmetres(seeAppendix14.1attheendofthissection).

4. SeeMuir&Archer‑Heese,209

5. QueenslandHealth,2010,partB,p.48(InformationSheet–Moving and Handling the Bariatric Patient).

6. SeeRobertson,2010.

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Section 14: bariatric clients

InNew Zealandthedefinitionofobesityforadultsaged18yearsandoverishavingaBMIof30ormoreforallethnicgroups.New Zealand’sunadjustedobesityrateof26.5%in2006‑2007wasthethirdhighestmeasuredobesityrateaftertheUnitedStates(33.8%in2008)andMexico(30%in2006).7Ratesofobesityincreasedinsurveysconductedbetween1997and2007.

Manyhealthcarefacilitiesreportacontinuingincreaseinthenumberofbariatricclientsadmitted.8Forthesereasons,allhealthcareprovidersneedtodevelopplansformovingandhandlingbariatricclients.

Health risks for bariatric clients

Peoplewhohavebeenbariatricforaconsiderabletimefacechronicandserioushealthconditions.Theyusuallyhavedifficultywithhygieneandtoiletingbecauseoftheirlargeabdomen,heavierbodypartsandskinfolds,andallthesefactorsaffecttheirmobility.Skinandotherbodyconditionsneedtobeassessedbeforemovingandhandlingbariatricclients.

Healthconditionscommonlyexperiencedbybariatricclientsinclude9:

• Skinexcoriation(wheretheskincanbestriped),rashesorulcersinthedeeptissuefoldsoftheperineum,breast,legsandabdominalareas.Thereisalsothepossibilityoffungalinfection

• Bodilycongestion,includingfluidretentionandpoorcirculation,resultingfromheartandkidneyfailure.Thiscongestioncancausetheleakingoffluidfromporesthroughoutthebody,astatecalleddiaphoresis,whichmakestheskinevenmorevulnerabletoinfectionsandtearing

• Diabetesandrespiratoryproblems

• Addedstresstothejoints,whichmayresultinosteoarthritis.

Why special planning is needed for bariatric clients

Movingandhandlingpeopleisasignificanthazardforhealthworkers.Caringforabariatricpersonisacrucialpartofhealthcare,butworkingwithbariatricclientscanaccentuatetherisksforbothclientsandcarers.Whileliftinganyclientcanleadtomusculoskeletalinjuries,strains,sprainsandexcessivespinalloadingforcarers,therearesubstantialrisksassociatedwithmovingandhandlingbariatricclientswhenperformingdailytasks.

Giventheriskfactors,clientsafetyandthesafetyofstaffneedspecialattentionwhencaringforbariatricclients.Bariatricclientsmayfacegreaterhealthrisksthanthegeneralpopulationandhavecomplexneeds.Thekeytomanagingtherisksaround

7. MinistryofSocialDevelopment,2010.8. Forexample,Hignettetal2007;Robertson,2010.9. Alistofmedicalconditionsaffectingbariatricclientsthatarerelevanttomovingandhandlingtasksisavailableatwww1.va.gov/visn8/

patientsafetycenter/safePtHandling/BariatricMedicalConditions.pdf.

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movingandhandlingbariatricclientsistodevelopandimplementamovingandhandlingplanbeforetheiradmissiontocare.

Box 14.2

Planning for bariatric clients

Eachtimeanewbariatricpatientpresents,someuniqueissuesarise.

Thismeansthatonlyacertainproportionofthebariatriccaretasksareroutineandsomenewproblemsolvingisrequiredtofullyandsafelyaccommodateeachpatient,whetheritbeintheformofequipmentorpatienttransferprocedures.


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14.2 Planning for bariatric clientsThissectioncoversspecifictopicsthatshouldbeincludedintheplanningprocessforbariatricclientsinordertoreducemovingandhandlingrisks.Thefollowingkeytopicsneedconsideration10:

• Admissionplanning

• Clientassessment

• Communication

• Roompreparation

• Mobilisationplan

• Equipmentneeds

• Spaceandfacilitydesignconsiderations

• Planningfordischarge.

Admission planning

Thecareofabariatricclientusuallystartsatadmission;however,evenbeforetheyareadmittedstaffneedtobepreparedforabariatricclient.Beforetheclientisadmitteditisagoodideatocheckthecorridorsandhallwaysthatleadtotheclient’sroomortreatmentareastoensuretheyarewideenough,andthatthemaximumcapacityofanylifts(elevators)thatneedtobeusedissufficient.Ifnecessary,workoutalternativeroutestoavoidpotentialphysicalobstacles.

Somestepsthatmaybeneededare:

• Provisionoftransportfromtheambulanceorothervehicletotheadmission area

• Recordingtheclient’sexistinghealthconditions

• Theclientisweighedduringadmission–knowledgeoftheclient’sweightisessentialforplanningthemovingandhandlingneedsofthatclient

• Theclient’sfamilyisbriefedonthehospital’smovingandhandlingpolicyandthisisrecordedintheclient’snotes

• Anyequipmentandotherresourcesneededformovingandhandlingthebariatricclientareconfirmedasavailable,andcheckedtoensurethattheyare suitable

• Abariatricclientkitismadeavailable,whichmayincludetwoclientgowns,alargebedpan,twolargeslidesheetsandabariatriccuff

• Allrelevantdepartmentsandmanagersthatwillbeprovidingcareorservicestotheclientareinformedoftheclient’sadmission

10. ThepaperbyMuir&Archer‑Heese(2009),whichdescribesmanyofthesetopics,isacknowledged.

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• Amobilisationplanisdevelopedanddocumentedfortheclientfollowingadmission–thisplanisupdatedatanagreedfrequencyorastheclient’sconditionchanges

• Apreliminarydischargeplanisprepared.

Client assessment

Assessingaclientandthetransfertasksneededisthefirststepinthecareandrehabilitationprocess(seeFigure3.1inSection3).Thepurposeistoidentifytherisks,goalsandresourcesneededaspartoftheriskreductionprocess.Staffmaybefacedwithunplannedsituationsthatcanincreasetherisksforclientandcarer.Theassessmentprocessbalancestherisksandneedsoftheclientwiththeavailableresources.Itisimportanttobegintheassessmentaspartoftheadmissionandscheduleregularupdates.

Assessabariatricclient’sabilitytoassistduringrepositioning,transferringandambulation.Identifytasksthatrequirelifting,lowering,carrying,pulling,pushingandsupporting.Wherepossible,usehoistsormovingandhandlingaidstoperformmovingandhandlingtasks.

Inadditiontotherecommendedriskassessment(seeSection3Riskassessment),criticalissuestoassessincludetheclient’s:

• Requiredlevelof assistance

• Weight‑bearingcapability

• Height,weightandbodycircumference

• Conditionslikelytoaffecttransferorrepositioningtechniques–thesemayincludehipandkneereplacements,paralysis,amputations,contractures,osteoporosis,respiratoryandcardiacconditions,andskinconditions.

Consultationwithotherprofessionalsmaybeneededregardingtheclient’sphysicalfunctionandstrength.

Communication

Twoformsofcommunicationareimportant.Oneisthecommunicationthattakesplaceamongmanagersandstaffwithintheorganisation,andtheotheristhestaff‑to‑clientcommunicationthatcanbecomepartoftheclient’stherapeutic processes.

Organisationalcommunicationisimportantinprovidingaccurate,timelyinformationtotherelevantpeopleabouttheclientandtheirneeds.Clientinformationgatheredduringadmissionandassessment,includingtheirmobilitystatus,shouldbedocumented.Sendthisinformationtorelevantpeoplewhohavecontactwiththeclient,respectingtheclient’sconfidentialitywhereappropriate.

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Staff‑to‑clientcommunicationisalsoimportant.Atherapeuticrelationshipbeginswithgoodcommunicationthatmakestheclientfeelsafe,comfortableandcaredfor.Aclient’sdislikeofusingspecificequipmentortransfertechniquesshouldnotleadtotheuseofunsafemovingandhandlingpractices.Aclient’sinitialresistancecanusuallybeovercomebycarerstakingtimetoexplainwhyspecificequipmentandproceduresareusedtomovepeople.Aswell,discusstreatment,movingandhandlingrequirementsandrehabilitationplanswiththeclient’sfamilyorothersupportpeople.CommunicationiscoveredinmoredetailinSection11Workplaceculture.

Room preparation

Thefollowingpointsneedtobecheckedtoensurethattheclient’sroomorwardlocationisappropriatelyfurnishedandequipped.

• Bed–isthebedarealargeenoughtoaccommodateallequipmentneededtomanagetheclient?Isthereenoughspacearoundthebedareatomovetheclientcomfortablyfrombedtochairorcommodechair?Isasingleroompreferableorisittoosmall?Aretwobedspacesrequiredfortheclient?

• Aretheelectricbedandthemattressofsufficientsizeandweightcapacity?

• Equipment–ensurethatanyrequiredequipmentisdeliveredtotheroomaspartofthebariatrickit.

Considerthespaceneededtomovemobileequipmentaswellasspaceforthenumberofworkersrequiredtoassisttheclientormovetheequipment.Ifthebedorotherequipmentdoesnothavesufficientload‑bearingcapacity,arrangeforasuitablereplacementfromanequipmentpool,orhireitfromanexternalprovider.

Equipment needs

Manyorganisationsdonothavebariatricequipment.Forsmallfacilities,hiringequipmentbeforetheadmissionofabariatricclientisanoption.Thepersonorganisingtheequipmenthiringneedstobeawareofthedifferentfeaturesanddimensionsoftheequipment.Organisationsintendingtobuybariatricequipmentshouldconsultcloselystaffwhoarelikelytoworkwithbariatricclientsandsupplierstoensuretheybuytherightequipmentforthetasksforwhich

Box 14.3

Bariatric equipment assessment

Bariatricequipmentisoftendefinedbyitsweightcapacityandanequaldistributionofloadacrosstheequipmentisassumed.However,inpractice,theshapeofthepatientandthedistributionofweightisvariable.Thisplacesstressoncomponentsoftheequipmentsuchaswheelsduringmovement.


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itwillbeused.Forexample,thenewequipmentwillhavetofitthroughdoorwaysandintolifts.Equipmentthatislikelytobeneededincludes:

• Weighingscales,preferablyatfloorlevelwiththehighestavailablecapacity,inspacesallowingprivacy

• Motor‑drivenbariatricwheelchairs,withthehighestavailableSWL,formovingclientsbetweenlocationswithinafacility.Alsoconsiderseatwidthtoaccommodatewiderclients

• Interviewchairs,withtransportationwheelsifthechairsareusedinmultiple locations

• Bariatricchairsforwaitingrooms,withSWLsclearlymarked

• WalkingaidswithSWLsof250‑300kg

• Air‑assistedtransferdevicesforverticalandlateraltransfers

• Amobilehoistorceilinghoist–ceilinghoistshavebeenidentifiedasthepreferredchoiceforbariatrictransfersandbedrepositioning11

• Amobilehoistforliftingclientsoffthefloorintheeventaclientfalls(ifthebariatricceilinghoistdoesnotcoverthewholearea).Notethatcautionisneededwhenusingmobilehoistswithbariatricclientsowingtotheincreasedpushingforcerequiredandthewheeldesignsofsomehoists

• Appropriateslings

• Electricbariatricbedswithpressure‑reductionmattresses

• Bariatricstretchers(note:somestretchersmayhaveappropriateweightratingsbutbetoonarrowforbariatricpeople).

11. Muir&Archer‑Heese,2009.

Bariatric chair

figure 14.1

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Box 14.4

Providing facilities for bariatric clients

Largeacutehospitalsshouldconsidertheneedfor:

• Oneormorespeciallydesignedbariatricrooms/ensuites

• Provisionforthesepatientsinspecificareassuchasintensivecare,emergency,theatre,negative‑pressureenvironments,diagnosticsandimaging,outpatientsandmaternity.

Smallhospitalsandaged‑carefacilitieswithinfrequentbariatricpresentationsmaychoose to:

• Removeonebedfromatwo‑bedroomandusetheroomforonebariatricpatientwithhiredfurnitureandequipment

• Referbariatricpatientstoalternativefacilities.

Considernotonlythespacerequiredtouseequipmentbutalsostoringitclosetothepointofuse.Considertherequiredpathsoftravelandtheaccessandeaseofusingequipmentalongthesepaths(e.g.doorwaywidths,floor surfaces).

Source:QueenslandHealth,2010,partB,p.50

Otherusefulitemsofequipmentforbariatricclientsinclude:

• Walkingframes

• Sit‑standdevices

• Trapezebarsystemsforoverbeds

• Sittostandhoists

• Electricbariatricarmchairs

• Footstools

• Commodes

• Largebedpans

• Washbasins

• Extra‑largeslidesheets

• Extra‑largegowns

• Bloodpressurecuffs.

Space and facility design considerations

Alargeroomisrequiredforthecareofabariatricclienttoaccommodatetheperson,theequipmentandlargefurniture.Staffneedsufficientspacetoavoidusingawkwardposturesthatcanputthematriskofinjury.Thisincludeshavingawideturningarcforbariatricequipmentthatallowssafebiomechanicalbodypositioningforcarers.Areas

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forspecialattentionarebathroomsandtoilets.Showersshouldbebigandfittedwithheavy‑dutygrabrails,multiplehandrails,largeseatsandhand‑heldshowerheads,whilelargetoiletseatsarerecommended.Foraddedsafety,toiletfixturesandsinksshouldbemountedonthefloor,notthewall,althoughtakecarethatfloor‑mountedsinksdonotinterferewithwheelchairs.Bathroomsshouldbelargeenoughtoallowforstaffassistanceontwosidesoftheclientatthetoiletandshower.12Section9Facilitydesignandupgradinghasmoreinformationondesignfeaturesforbariatric clients.

Planning for discharge

Fordischargeplanning,ensuretheappropriatefacilitiesandarrangementshavebeenmadebeforetheclientisdischargedsothattheywillbeexpectedattheirdestination.

Foraclientreturninghome,beforetheyaredischargedassesswhatequipmentandhomehelptheyarelikelytoneedtofunctionsafelyathome.Ensuretherewillbeappropriateequipmentandhomehelptosupportandmaintainthem.

12. SeeWignall(2008)forfurtherinformationaboutfacilitydesignforbariatricclients.

Discharge planning is important for bariatric clients

figure 14.2

14.3 Developing organisational capacity for bariatric care

Theprevioussectioncoveredspecificfeaturesneededtopreparefortheadmissionofbariatricclients.Thissectioncoverslonger‑termdevelopmentsforbuildingcapacitywithinanorganisationtohandlebariatricclients.Thesedevelopmentsareessentialtoreducepersonalrisksforbothstaffandclients,andthepotentialdisruptionofservices.Thedevelopmentsdescribedinthissectionareparticularlyrelevanttohospitalsandlargefacilities.

Thetopicscoveredinclude:

• Developingabariatricclientpathway

• Stafftrainingandeducation

• Monitoringandevaluation.

Developing a bariatric client pathway

Itisimportanttoplanallthestagesandfacilityrequirementsforbariatricclientsfromadmissionthroughtodischarge.Abariatricclient‘pathway’referstotheroutethataclientwilltakefromfirstcontactwiththeserviceprovidertotreatmentcompletion.13Forfacilitiessuchashospitals,thisistheperiodfromhomeintohospitalanduntiltheclientisdischarged.Theorganisationneedstoensurethattheappropriatefacilities,equipmentandstaffexpertiseareavailableateachstage(seeBox 14.5).

Box 14.5

Stages in the bariatric client pathway

• Notificationofadmissionpriortoarrivalandpreparationforarrival

• Admissionprocedures,includingtransportfromvehicletoadmissionareaforoutpatient arrivals

• Accessfromadmissionareatowardorbed

• Accesstospecialistclinicalfacilities

• Rehabilitationandmobilisationservices

• Dischargeplanning

• Discharge

• Communicationwithotheragenciesworkingwithbariatricclients.

Aspartoftheplanningforabariatricpathway,itisrecommendedthatabariatricworkingpartybesetupwithrepresentativesfromthesectionsorunitsmostlikelyto

13. SeeHignettetal(2007)formoredetails.

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14.3 Developing organisational capacity for bariatric care

Theprevioussectioncoveredspecificfeaturesneededtopreparefortheadmissionofbariatricclients.Thissectioncoverslonger‑termdevelopmentsforbuildingcapacitywithinanorganisationtohandlebariatricclients.Thesedevelopmentsareessentialtoreducepersonalrisksforbothstaffandclients,andthepotentialdisruptionofservices.Thedevelopmentsdescribedinthissectionareparticularlyrelevanttohospitalsandlargefacilities.

Thetopicscoveredinclude:

• Developingabariatricclientpathway

• Stafftrainingandeducation

• Monitoringandevaluation.

Developing a bariatric client pathway

Itisimportanttoplanallthestagesandfacilityrequirementsforbariatricclientsfromadmissionthroughtodischarge.Abariatricclient‘pathway’referstotheroutethataclientwilltakefromfirstcontactwiththeserviceprovidertotreatmentcompletion.13Forfacilitiessuchashospitals,thisistheperiodfromhomeintohospitalanduntiltheclientisdischarged.Theorganisationneedstoensurethattheappropriatefacilities,equipmentandstaffexpertiseareavailableateachstage(seeBox 14.5).

Box 14.5

Stages in the bariatric client pathway

• Notificationofadmissionpriortoarrivalandpreparationforarrival

• Admissionprocedures,includingtransportfromvehicletoadmissionareaforoutpatient arrivals

• Accessfromadmissionareatowardorbed

• Accesstospecialistclinicalfacilities

• Rehabilitationandmobilisationservices

• Dischargeplanning

• Discharge

• Communicationwithotheragenciesworkingwithbariatricclients.

Aspartoftheplanningforabariatricpathway,itisrecommendedthatabariatricworkingpartybesetupwithrepresentativesfromthesectionsorunitsmostlikelyto

13. SeeHignettetal(2007)formoredetails.

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handlebariatricclients.14Theworkingpartyshouldincludehealthandsafetystaff.Thefollowingtasksshouldbeaddressedbythebariatricworkingparty.Someofthesetasksmaybemoreapplicableforlargehealthcareprovidersthathavehighernumbersofbariatricclients.

• Compileinformationonclientadmissionsforthepreviousfiveyearstodocumentthenumberofbariatricclientsbeingadmittedeachyearandthesectionswheretheyhavebeenreceivingclinicalorothercare.UsefuldatatocollectareclientweightandBMI,wardsofadmissionandassistancerequiredforhygienecareandambulation

• Compileabariatricequipmentlistorregister

• Conductanauditofmovingandhandlingequipmenttoconfirmwhichexistingequipmentissuitableforusewithbariatricclients

• Planfortheacquisitionandupgradingofequipmentandspacestohandlebariatricclients

• Makerecommendationsregardingthelocation,accessandpriorityforbariatricequipment(seeBox14.6)

• Makerecommendationsregardingtherenovationofbuildingstowhichbariatricclientsareadmitted

• Educatestaffregardingmovingandhandlingbariatric clients

• Seekconsultationwheretherearedifficultiesinmovingandhandlingabariatricclient.Thiscouldbethemanualhandlingcoordinatororequivalentwithrelevantexpertise

• Holdregularmeetingsonthemanagementofbariatricclients

• Developareportingsystemforincidentsandaccidentswherebariatricclientswereinvolved.

14. SeeRobertson(2010)foranAustralianexample.

Box 14.6

Bariatric equipment access

RGH(aregionalgeneralhospitalwith30,000inpatients)decidedthatanequipmentpoolwouldbemoreeffectiveandwouldalloweachdepartmenttotreattheclinicalconditionsofthebariatricpatientsaswellasmanagethebeddingandpatientmovementneeds.RGHpurchasedfivesetsofbariatricequipmentincludingitemssuchasbeds,powerassistedbariatricwheelchairs,showerchairsandliftingmachinesofdifferentloadcapacities.


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Staff training and education

Movingandhandlingbariatricclientsposesanumberofchallengestohealthcarestaff.Organisationsthathavefewbariatricadmissionsmaynothaveenoughstaffwithbariatrictrainingandexperience.A‘cascade’approachisrecommendedwhereabariatricworkingpartyoramovingandhandlingcoordinatordevelopsthespecialistknowledgeneededforbariatriccare.Thisknowledgeisthencommunicatedtounitmanagersandstaffatregularintervals,suchasatbriefingmeetingsformanagers.

Informationaboutthebariatriccarepathwayforthefacilitycanbeincludedinmovingandhandlingtrainingforstaff,aswellasspecifictrainingonbariatricriskassessmentsandtheuseofbariatricequipment.Bariatricequipmentsuppliersmaybeabletoprovideassistancewithtrainingintheuseofrecentlypurchasedequipment.Theinternetalsohassomeinformationoneducationandtrainingmaterials(see‘Webresources’attheendofthissection).Theseresourcesshouldnotreplaceexperttrainingbutsupplementit,andselectionshouldbecarriedoutbyanappropriatelyskilledperson.

Monitoring and evaluation

Toassesshowwellbariatricclientshavebeencaredfor,monitoringandevaluationofclientcareshouldbecarriedout.Monitoringandevaluationproceduresshouldcover:

• Thecollectionofincidentandinjurydatatoidentifyclientsize(BMI,seatedhipwidth),weightandmobilitystatus(seeSection12Monitoringand evaluation)

• Areviewofnearmissesbythemovingandhandlingcoordinator,healthandsafetymanagerorbariatricworkingparty

• Clientsatisfactionandcomfortwithequipment

Staff training should cover moving bariatric clients

figure 14.3

Box 14.7

Staff training in bariatric care

Problemscanarisewithstaffbeingunfamiliarwithequipmentbecauseofinfrequencyofuse,highstaffturnoverortheemploymentofagencystaff.Trainingtoassessriskinadynamicenvironmentisalsoimportantsuchthatappropriatedecisionsaremadetocontrolriskatthetimeofpatient handling.


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• Themonitoringofbariatricequipmentneedsandthedevelopmentandupgradingofbariatricequipmentduringannualequipmentprocurementorcapitalexpenditurerequests.

Healthcareorganisationsarestronglyadvisedtomonitorthenumberofbariatricadmissions,andclientdemographics.Thesedatacanbeusedtodevelopabusinesscasefortheprocurementofequipmentandfurniture,stafftrainingandspace upgrading.

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14.4 Specific issues related to the care of bariatric clients

Thereareseveralissuesinbariatriccarethatcomplementtopicscoveredearlierinthissection.Thissectioncoversfouradditionalissuesandtopics.Theseare:

• Assistanceversusmobilityandrehabilitation

• Emergencyservices

• Communitycare

• Bariatricpregnantwomen.

Assistance versus mobility and rehabilitation

Apotentialconflictinthemovingandhandlingofbariatricclientsconcernstheneedtousehoistsandothermovingandhandlingequipmentwhilealsopromotingclientrehabilitationandmobility.Afocusonreducingrisksforbothstaffandclientduringmovementandhandlingmayresultintheclientbecomingdependentoncarersandequipmentandunabletomoveontheirowninitiative.Thismayleadtotheneglectoftheclient’smobilisationandrehabilitation.Thereneedstobeabalancebetweendevelopingabariatricclient’smobilityandusingmovingandhandlingequipmenttoensureclientandstaffsafety.Althoughthereisnosetformulatoachieveabalance,itisimportanttobeawareoftheseissues.

Emergency services

GiventheriseinthenumberofobesepeopleinNew Zealand,emergencyservicessuchastheambulanceandfireservicesfacethelikelihoodofhavingtotransportbariatricclients.Ambulanceandfireservicesandfuneralworkersfaceanincreasedriskofinjurieswhenmovingbariatricclients.Theymayhavelimitedaccesstoliftingequipmentandthereisoftenlimitedspacewithinwhichtomoveortransferclientssafely.Fortheseandotherreasons,itisacknowledgedthatinthecaseofanemergencythecorrectmovingandhandlingproceduresandtechniquesmaybedifficulttoapply,andtheremaybeaplaceforwellintentionedimprovisation.Nevertheless,itisstronglyrecommendedthatathoroughriskassessmentbeconductedwheneverpossible.

Operationalstaffinemergencyservicesneedtobetrainedinmovingandhandlingtechniquestoensurethatlow‑risktechniquesareused.Ifhoistsorotherequipmentareused,acompetentpersonisneededtooperateandmaintaintheequipment.AllequipmentshouldhavetheSWLsclearlyvisible.Equipmentfailurewhenmovingandhandlingbariatricclientscanresultinsignificantinjurytotheclientsandthepeoplecaringforthem.

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Stepsshouldalsobetakentoprotecttheprivacyanddignityofbariatricclients.Theprocessofremovingclientsfromtheirhomescanattractcuriousonlookers,especiallyifdoorsneedtoberemovedandwallscutopen.Policeassistancemayberequiredtoclearonlookersandplacesheetsoverwindowsifrequired.

Clientmovingandhandlingmaybecompromisedwhenworkinginconfinedareasthatmakeaccesstotheclientdifficult.Specificfactorstoincludeintheriskassessmentpriortomovingandhandlingabariatricclientare:

• Theweightandsize(BMI,seatedhipwidth)oftheperson

• ThesizeandSWLofequipment

• Theuseofequipmentinrestricted spaces.

Anotherrisktostaffisthatofcrushinjurieswherehandsorlimbsbecomepinnedbetweentheclientandahardsurfacesuchasawallorfloor.Thisisarealriskiftheclientsuddenlymovesorfallswhilebeing moved.

Hospitalsandemergencyservicesmayneedtomeettodiscussprotocolsandspecificarrangementsformovingandtransportingbariatricclientsinanemergency.Transferringabariatricclientfromavehiclecouldposeseriousdifficultiesiftherearenoappropriateprotocolsregardingequipmentandservicesonarrivalatthehospital.

Manymobilefloorhoistswillnotbesuitableformovingbariatricclientsfromvehicles,becausetheirliftarmsmaymakecontactwiththevehicle’sdoororthevehicleroofcouldpreventtheclientbeingliftedupofftheseat.Somemobilehoiststhathavetelescopicarmsandretractablestrapscouldbeused,buthoistshaveweightlimitationsthatmustbecheckedwiththeclients’weights.IdeallyhospitalambulancebaysandtriageareaswillhaveceilinghoistsinstalledwiththemaximumavailableSWLsclearlyvisible.

Amongemergencyservicesthatmayneedtotransportormovebariatricclients,thereshouldbeacommonspecialemergencycodetosignify‘bariatricandurgent’sothatwhentheambulanceoranotherservicearrivesatthescene,theyhavesuitableequipment.Ambulances,hospitals,fireemergencyteamsandpoliceshouldsharethiscommoncode.

Furtherreadingontransportingbariatricclients,includingcasestudiesforambulance,fireandfuneralservices,areavailableontheSafeWorkAustraliawebsite(see‘Webresources’attheendofthissection).

Ensure door openings are adequate for bariatric clients

figure 14.4

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Community care

Considerationshouldbegiventoabariatricclient’sdischargefromafacility.Poorpreparationfordischargecanbedisastrousfortheclientandtheirfamily.Thiscouldresultinpoorrecoveryoraworseningoftheircondition,whichcouldleadtore‑hospitalisation.

Topicsthatneedtobeassessedanddealtwith(changesmade,equipmentorservicesprovided)beforeaclient’sdischargeare:

• Thehomeenvironmentaccessandspace,especiallyifnewequipmentistobe installed

• Whatequipmentisneeded

• EnsuringthatequipmentandfurnitureusedbytheclienthaveadequateSWLs

• Movingtheclientupanddownrampsinawheelchair,whichmaybehighriskandneedspecialarrangements

• Homesupportservicesfortheclient–homesupportworkersmayrequirespecifictrainingbeforetheclient’sdischarge

• Communicationwithotheragenciesandservices–ensurethattheappropriatenotificationsandreferralshavebeenmadebeforedischarge,suchastotheclient’sgeneralpractitioner,homesupportagenciesandthecommunitynurse.

Bariatric pregnant women

Bariatricpregnantwomenmayhavespecificrequirements(e.g.lithotomy,poles,waterbirths)thatrequirepriorplanningandadditionalfacilitiesforbirthingsuitesandservicesforpregnantwomen.

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References and resourcesAustralianSafety&CompensationCouncil.(2009).The Bariatric Journey in Australia:

Hospital case study.Retrieved21February2011fromwww.safeworkaustralia.gov.au.

Camden,S.G.(2006).Nursingcareofthebariatricpatient.Bariatric Nursing and Surgical Patient Care,1(1),21‑30.doi:10.1089/bar.2006.1.21.

Hignett,S.,Chipchase,S.,Tetley,A.,&Griffiths,P.(2007).RiskAssessmentandProcessPlanningforBariatricPatientHandlingPathways(RR573).Loughborough:LoughboroughUniversity.

MinistryofSocialDevelopment.(2010).TheSocialReport2010.Accessed21February2011fromwww.socialreport.msd.govt.nz/health/obesity.html.

Muir,M.,&Archer‑Heese,G.(2009).Essentialsofabariatricpatienthandlingprogram.OnlineJournalofIssuesinNursing,14(1),5.

QueenslandHealth.(2010).ThinkSmartPatientHandlingBetterPracticeGuidelines(2nded.).(OHSMS2‑22‑1#38).Brisbane:QueenslandHealth,OccupationalHealthandSafetyManagementSystem.(SeePartB:InformationSheet–MovingandHandlingtheBariatricPatient).

Robertson,H.(2010).ManagingObeseandBariatricPatientsinanAcuteHospitalSetting:Theimportanceofestablishingabariatricworkingparty.PaperpresentedattheBiennialConferenceoftheAssociationforManualHandlingofPeople,October2010,Sydney,Australia.(Retrieved15February2011fromwww.changechampions.com.au/resource/Hal_Robertson.pdf.)

Rush,A.(2002).OverviewofBariatricManagement.Retrieved19August2010fromwww.safeliftingportal.com/hottopics/bariatrics.html.

Rush,A.,&Cookson,K.(2011).Peoplehandlingforbariatrics,asystemsapproach.InJ.Smith(Ed.).TheGuidetotheHandlingofPeople:Asystemsapproach(6thed.)(pp.193‑225).Middlesex,UK:BackCare.

Wignall,D.(2008).Designasacriticaltoolinbariatricpatientcare.JournalofDiabetesScienceandTechnology,2(2),263‑267.

Web resources

Safe Work Australiahaspublishedaseriesofreportsonhandlingbariatricclientsforhospitalsandforambulance,fireandfuneralservices.Itshomepageis:www.safeworkaustralia.gov.au.Onthehomepage,clickonPublications.AccessthereportsusingthePublicationssearchboxwiththekeyword‘bariatric’.

Pressure Ulcer Prevention and Management Guidelines(Factsheetforseverelyobesepatients)(Australia)

www.health.qld.gov.au/psq/pip/docs/pup_obese.pdf

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Supplyingrehabilitationservicesforbariatricpatients(UnitedStates)

www.rehabpub.com/issues/articles/2007‑10_04.asp

Bariatric rehab(UnitedStates)

www.bariatricrehab.com/home.html

Fat Bias in Safe Patient Handling(patientperspectivesonbariatricpatienthandling)

www.washingtonsafepatienthandling.org/images/meetingrockv5.pdf

Overweight and Obesity Trends Among Adults(UnitedStates)

www.cdc.gov/nccdphp/dnpa/obesity/trend/index.htm

NIH Obesity Education Initiative: Clinical Guidelines(UnitedStates)

www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf

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Appendix 14.1 Chart for calculation of BMI – use height (centimetres) and weight (kilograms)

Height155cm

1׳5160cm

3׳5165cm

5׳5170cm

7׳5175cm

9׳5180cm

11׳5185cm

6’1190cm

3׳6Weight BMI BMI BMI BMI BMI BMI BMI BMI

80kg 33 31 29 28 26 25 23 22

90kg 37 35 33 31 29 28 26 25

100kg 42 39 37 35 33 31 29 28

110kg 46 43 40 38 36 34 32 31

120kg 50 47 44 42 39 37 35 34

130kg 54 51 48 45 42 40 38 36

140kg 58 56 51 48 46 43 41 39

150kg 62 59 55 54 49 46 44 42

160kg 67 63 59 55 52 49 47 44

170kg 71 66 62 59 56 53 50 42

180kg 75 70 66 62 59 56 53 50

190kg 79 74 70 66 62 59 56 53

200kg 83 78 74 69 65 62 58 53

210kg 87 82 77 73 69 65 62 58

220kg 92 86 81 76 72 68 64 61

230kg 96 90 85 80 75 71 67 64

240kg 100 94 88 83 78 74 70 67

250kg 104 98 92 86 82 78 73 69

260kg 108 102 96 90 85 80 76 72

270kg 112 105 99 93 88 83 79 75

280kg 117 109 103 97 91 86 82 78

290kg 121 113 107 100 95 90 85 80

300kg 125 117 110 104 98 93 88 83

310kg 129 121 114 107 101 96 91 86

320kg 133 125 117 111 104 99 93 89

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