Guidelines call for special care with bariatrics

These are some excerpts from the special guidelines that PHT Services, an insurer in South Carolina, provides to client hospitals that perform bariatric surgery:

  • Laparoscopic Adjustable Gastric Banding (LAGB) and Roux-en-Y (RYGB) procedures will be the only bariatric surgical weight loss procedures permitted under the underwriting guidelines.
  • Hospitals performing bariatric surgery must have a comprehensive program that includes preoperative, perioperative, and postoperative components. The surgery program will not meet the underwriting guidelines until hospital administration and the medical staff has approved a written program adopting the "minimum requirements" contained in the guidelines.
  • Regardless of whether restrictive or combined restrictive-malabsorptive procedures are utilized, follow-up is imperative to monitor for potential serious sequelae and operative failure. These operations should only be performed within the setting of an obesity treatment program committed to maintaining long-term follow-up for evaluation of outcomes.
  • Hospitals providing bariatric surgery services must have a mechanism to remain informed of standards from state, federal, and professional organizations. Hospital policies and procedures will be updated to ensure compliance whenever regulations/standards change.
  • Careful preoperative evaluation and patient preparation are critical to success. Patients should have a clear understanding of expected benefits, risks, and long-term consequences of surgical treatment. Surgeons must know how to diagnose and manage complications specific to bariatric surgery. Patients require lifelong follow-up with nutritional counseling and biochemical surveillance. Surgeons also must understand the requirements of severely obese patients in terms of facilities, supplies, equipment, and staff necessary to meet these needs, and should ensure that the specialized staff and/or multidisciplinary referral system is included in treatment of these patients.
  • A bariatric surgery team must be appointed that includes the following positions: program coordinator, medical director, anesthesia coordinator, pharmacist, dietitian, physical therapist, exercise physiologist, surgical services representative, behavioral health representative, and respiratory therapist. In addition, there must be a physician risk officer who works in collaboration with members of the risk management team and the bariatric surgery team to improve patient and worker safety.
  • A plan of care should be addressed in the policies and procedures of all units that will be involved in the care of the bariatric patient, including specialized training and documented skills checklists on staff.
  • In the interest of worker and patient safety, special lifting and moving equipment will need to be acquired and used for all lifting and mobilization of the morbidly obese patient population. The following steps are required:

1. Formal assessment of needs, including a written report and evaluation of current patient lifting equipment available, and evaluation of the need for additional equipment necessary for lifting morbidly obese patients.

2. Acquisition of necessary equipment.

3. Education of staff.

4. Ensure caregivers within the unit are provided education and training on patient mobility assessment form, protocols, equipment, and assist devices.

5. Ensure equipment is utilized appropriately. Identify, report, and correct potential ergonomic risks that may affect patient mobility (i.e., broken beds, equipment, etc.).

6. Develop administrative controls to annually evaluate equipment needs.

7. Utilize patient mobility equipment, assistive devices, and obtain staff assistance whenever possible.

8. Training on the equipment prior to use.

9. Report any barriers or limitations with patient mobility protocols to the licensed nurse or charge nurse. These may include unavailable equipment, assistance unavailable, or lack of training for equipment.

10. Shift to shift assessment, evaluation, and updating any changes and communication of patient's mobility status and subsequent care plan updates to reflect changes in patient's condition.

11. Provide education and training on patient mobility assessment form, protocols, and equipment or assist devices, and ensure it is utilized appropriately.

12. Analyze training and effects on safe patient mobility for employees and patients, and present results to safety committee.