By B. Joyce Gilmore, RN
Is your facility prepared to accommodate bariatric patients? How about multiple bariatrics patients? As the obese popu-lation grows every year in America, this is something that health care facilities need to be aware of—but awareness is only part of the challenge. Taking appropriate action is equally challenging.
While some facilities are well prepared to treat bariatric patients, others appear to be holding back and hoping their existing equipment and clinical technology can cope. And then there is the staff, which may or may not be trained to treat obese patients safely and with dignity.
ACCOMMODATING LARGE PATIENTS Horror stories abound regarding the treatment of obese patients. For example, one bariatric patient was forced to travel to a hospital on the floor of an ambulance, and upon arriving was told there were no beds large enough to accommodate him. It is not uncommon, in a situation like that, to end up on a mattress on the floor. Nor is it uncommon to find that tests are not accessible since the technology was not designed to deal with their size or bulk.
SO WHAT DOES THIS MEAN? The rising obese population means that issues associated with bariatric patients require a wider range of staff understanding, preparation, training, and services. Most important, obese patients need to be treated with sensitivity and dignity.
Having a strategy in place before the admission of bariatric patients and after their release is crucial. This will assure that many common scenarios are eliminated: For example, there are no hospital gowns that fit, so sheets are wrapped around the patient, or two gowns are used; or patients are denied CT scans since the equipment is not big enough; or x-rays are unavailable since the penetration is not deep enough for accurate images. These unfortunate scenarios not only hinder prompt attention but also threaten the basic care that bariatric patients so desperately need.
HOW ONE FACILITY COPED WITH BARIATRIC PATIENTS Saint-Vincent Hospital in Ottawa is a facility dedicated to complex continuing care cases. For more than 70 years, Saint-Vincent Hospital has specialized exclusively in patients suffering from chronic conditions such as Parkinson's, traumatic head or spinal injuries, and multiple sclerosis. Nearly all of its patients require extensive assistance from caregiver staff members to move about the hospital, and as many as 90% of its patients use wheelchairs.
When it was announced that Saint-Vincent was scheduled to begin admitting bariatric patients, few people in the hospital had any experience with people of size. Thus, the staff reacted to the announcement with clear apprehension. Like every hospital that provides intensive or complex care, it is normal to find a variety of medical and practical equipment in the hallways, including linen carts, blood pressure machines, floor lifts, and wheelchairs. As a result, most staff members could not imagine how they would cope with the extralarge wheelchairs, beds, lifts, and other bariatric-sized equipment, not to mention the need to provide day-to-day lifting and repositioning assistance.
During the initial weeks following admission of their new bariatric patients, hospital administrators quickly recognized the importance of implementing a better lifting solution in order to prevent injuries to staff members and lighten their daily care activities. It was clear that caring for bariatric patients was taking more time and resources than for other patients.
The administrators at Saint-Vincent Hospital chose to install an overhead lift system in a single, specially selected room to be occupied by one of their first bariatric patients, a woman named Rachelle.
HELPING TO ACHIEVE MOBILITY For 3 long years, Rachelle had been confined to bed in her Ottawa apartment. She was unable to lift herself out of bed due to severe joint pain and an insurmountable weight condition. Her husband was her principal caregiver, her apartment was her prison, and her situation seemed hopeless. Rachelle was barely surviving, and every day was spent in misery.
Rachelle is not a person who minces her words. "Thank God for my lift," she said when I visited her. Looking up at the lift system mounted above her bed, she stated, "I honestly don't know how I lived without it." By supplying Rachelle with an overhead lift system, the hospital had found a way to allow her to move about and independently manipulate her position, and more important, to get onto a path toward effective rehabilitation and wellness.
With very little assistance from her nurses and caregivers, and with only an innocuous whirring from the lift motors above her, Rachelle is able to raise herself off of her bed and tilt herself from a recumbent position to a sitting position. Simply by manipulating the handheld controls, she can raise her torso and lower her legs until she is in a comfortable sitting position, and then she can lower herself gently into her wheelchair.
"Now I have my life back. Now I can get into physiotherapy and visit other patients. Now I have hope." After long years of hopelessness, Rachelle is on a path to improve her life.
One of Rachelle's nurses, a 30-year veteran, states, "Being here has dramatically improved Rachelle's quality of life. She has more self-control and a feeling of independence, and because of this we can give her better care. We can easily reposition her to prevent pressure sores and weigh her using our new equipment, and now we can get her on the road to recovery through regular physiotherapy treatments."
MEETING THE BARIATRIC CHALLENGE Looking after bariatric patients is not just a manual handling issue. The challenges are much more complex and involve a wide range of staff and service issues.
In most instances, one of the primary clinical and rehabilitative objectives of bariatric patients is reestablishment of so-called "normal" activities as quickly as possible, including standing, weight bearing, ambulation, and adoption of a structured exercise regimen. Once the patient is able to ambulate and exercise on a regular basis, the result is often decreased dependency on clinical services and improved quality of life. In some situations, when the patient is unable to stand or walk unassisted, bariatric ambulation assistance may be an absolute necessity in order to achieve the desired level of rehabilitation. A properly applied bariatric lift, for example, may enable a single therapist to accomplish tasks such as repositioning, performance of required clinical or rehabilitation procedures, body mechanics training, pedal edema management, and graduated progression through the stages of a structured exercise program. Typical results will include reduced body fat ratios, improved fitness, enhanced range of motion, and improvements in blood pressure, heart rate, as well as overall self-esteem.
Although bariatric equipment is available for rent as needed, having a selection of basic equipment on site is crucial to providing patients with appropriate and immediate treatment. One piece of equipment that is of high importance is a weighing scale. Without appropriate weight measurements, the staff is forced to estimate weight, which can affect prescription dosages and much more. Many new bariatric beds include a weight indicator, but roll-on and walk-on scales should be available to a facility handling bariatric patients.
As in the case of Rachelle, having a bariatric lift on site allows for patients to regain a sense of autonomy and independence—especially when they have been stationary for years. There are various types of bariatric lifts available for health care facilities, ranging from stationary overhead lifts like the one used by Rachelle, to mobile lifts that are available for use throughout facilities thanks to their easy-to-move design. Both types can be used for multiple tasks, and some lifts can handle ambulation, gait training, and rehabilitation assignments as well.
It is vital that health care facilities be equipped with bariatric beds, wheelchairs, and commodes so that obese patients can be accommodated comfortably, safely, and professionally—immediately upon arrival. When the equipment is not in use by bariatric patients, some of it can be redeployed throughout the hospital for other patients. The obese population is growing, and the stay of bariatric patients is longer than average. The smart long-term strategy to ensure their accommodation is to be prepared to meet their needs upon arrival, without having to search for rental equipment.
TRAINING FOR SAFETY With adequate training, caregivers can be better prepared to safely help bariatric patients use the resources available to develop independence and regain their autonomy. It is crucial, though, that proper training takes place beforehand so that the staff—and the patient—remain safe, and the patient can undergo the prescribed rehabilitation and physiotherapy treatments on their road to well-being.
When working with bariatric patients, safe lifting should be a high priority. Evidence-based statistics have shown that safe patient handling has proven to be a key component of caregiver injury prevention. One recently announced campaign, called Safe Lifting Environment, is designed to raise consciousness about injury prevention through safer patient lifting—by providing visual cues and educational materials to health care facilities free of charge.
The campaign Web site, www.safeliftingenvironment.com, enables nurses and administrators to access and order various safe-lifting logos, decals, and educational materials to remind health care professionals to lift safely at all times—no matter how busy they may be.
BENEFITS ABOUND The benefits that bariatric patients will experience from being in a properly equipped and staffed environment are numerous: improved safety, greater dignity, more peace of mind, and enhanced wellness. Moreover, the patient is now able to take control of one of the most important aspects of their rehabilitation—their mental attitude. With access to bariatric-sized beds, commodes, and wheelchairs, regaining mobility is more readily achievable. Now they can begin to rely more on themselves by utilizing the specialized equipment when they need to reposition themselves or cross the room. Slowly—and surely—they can begin to reestablish their autonomy.
For the staff, specialized training provides the confidence needed to handle bariatric patients safely. According to an administrative staff member at Saint-Vincent Hospital, once properly trained and equipped, the staff is better able to cope and the benefits are visible immediately.
"There's less need for more people," she states. "In other words, we don't have to hire more staff members to handle care for similar patients. Plus, now there are fewer injuries and less sick time, and our staff members are working much more efficiently. It's all around a much better situation, and the initial staff anxiety has disappeared."
By properly equipping the facility—and staff—for bariatric patients, there are immediate benefits including reduced patient turn-away, decreased staff injuries, and fewer absences because of the reduced injury rate. This translates directly to savings through lower employee turnover and reduced workers' compensation claims.
To implement an effective bariatric strategy, the long-term benefits for patients, staff, and the institution need to be taken into consideration, and buy-in needs to be universal, from caregivers to administrators. The bottom line is that when a facility and its staff are prepared to meet the needs of bariatric patients, everyone wins.
B. Joyce Gilmore, RN, is a graduate of the former Burbank Hospital School of Nursing, Fitchburg, Mass. She has worked as a clinical instructor at Cooley-Dickenson Hospital, Northampton, Mass, and the former Pondville Hospital, Norfolk, Mass. She is presently involved in health care administration.
