Hard to handle: Risk rises as obesity surges

Take steps to help patients, protect HCWs

About one-third of American adults are obese. If trends continue on their current trajectory, by 2030, about half of all American adults will be obese.

Those sobering statistics have prompted a call to action to address the nation’s obesity epidemic. But they also underscore why hospitals need to be prepared to handle heavier patients.

The Veterans Health Administration is releasing a new bariatric toolkit to help hospitals handle obese patients in a safe and sensitive manner. (See editor’s note below).

“We must be able to care for obese patients on a daily basis,” says Judee Gozzard, RN, MSN, BC, safe patient handling coordinator at Bay Pines (FL) VA Healthcare System.

Bariatric equipment isn’t just for hospitals that offer gastric bypass surgery or other specialized bariatric care. Any hospital should be prepared to receive a severely obese patient, Gozzard says. More than 15 million Americans are severely obese with a BMI of 40 or above, and that population increased by 70% in the last decade.1

Hospitals will be admitting more patients with a BMI of 40 or 50 and above, but standard patient handling equipment often has a weight limit of 300 pounds, she says. “Once [severely obese patients] arrive at the hospital, you have to have specialized equipment to support their weight,” she says.

In fact, severe obesity leads to medical problems that complicate patient care, notes Traci Galinksy, PhD, research psychologist with the National Institute for Occupational Safety and Health in Cincinnati. Severely obese patients are susceptible to pressure ulcers, a risk that requires them to be turned frequently, and they often have cardiopulmonary issues that require proper positioning in bed, she says.

Galinsky is studying bariatric patient handling at 10 VA hospitals and hopes to produce recommendations for evidence-based practices. The NIOSH researchers also will quantify the proportion of patients who weigh more than 300 pounds and the frequency of bariatric patient handling.2

The VA developed a previous version of the bariatric toolkit in 2003 and updated it in 2006. Here is some advice shared by Gozzard based on experience with bariatric patient handling:

Use a scoring system to assess patient mobility needs. The new toolkit recommends using a scoring system to make it easy to identify the equipment and level of assistance each patient needs. A score of 0 means the patient is ambulatory and alert, although they still may use grab bars, a walker or some supervision as they stand or walk. A score of 1 indicates that a patient needs coaching as they use grab bars, a trapeze or a walker to move or reposition themselves. Patients with a score of 2 or 3 have limited mobility or need moderate help. Caregivers may use lateral transfer devices, sit-to-stand devices and chairs that have removable arms to make transfers easier.

Patients with a patient handling score of 4 are fully dependent. They can provide minimal assistance or they may be combative or confused. In those cases, caregivers choose from a variety of devices, including ceiling lifts, air-assisted lateral transfer devices, and repositioning slings.

Weight should be considered along with the safe patient handling score to determine the proper equipment, Gozzard says. If a patient is morbidly obese, a ceiling lift is the preferred device. Even with equipment, if the patient is unable to assist and they weigh 200 pounds or more, you should have additional caregivers to safely lift, move, or reposition, she says. In non-urgent situations, each employee should not lift more than 35 pounds of patient weight, she says.

Beware of borderline bariatric patients. Your staff will readily understand that they can’t handle a 600-pound patient without specialized equipment. But what about the 250- or 300-pound patient? “They often don’t go and get what they need because they don’t consider them bariatric,” says Gozzard. Employees should be educated about how weight interacts with mobility and cognitive impairments to determine what equipment and staff assistance is necessary, she says.

Have specialized beds available. Whether you rent or own, you should have ready access to special beds for bariatric patients. The beds are larger and have a 1,000-pound capacity. Ideally, the beds can be converted into a chair for powered transport. They also require a larger room with wide doorways.

Make sure all care is performed at the correct ergonomic height. Even with appropriate equipment, caregivers can be injured if they are using awkward postures. They should be working at waist to elbow height, says Gozzard. Even with equipment, more than one caregiver may be needed to assist. For example, lifting a leg into a sling may require more than one person because of the patient’s weight.

Have bariatric admission carts available. Sensitivity is an important aspect of bariatric care. You don’t want caregivers hunting for “big boy pajamas,” says Gozzard. If you have large capacity items stored on a special cart, they will be readily available and will make a bariatric admission occur more smoothly, she says.

(The VA toolkit is available at www.visn8.va.gov/visn8/patientsafetycenter/safePtHandling/toolkitBariatrics.asp.)

References

  1. Sturm R and Hattori A. Morbid obesity rates continue to rise rapidly in the United States. International Journal of Obesity online, September 18, 2012. Available at www.rand.org/pubs/external_publications/EP51074.html#abstract. Accessed on November 20, 2012.
  2. Galinsky T, Hudock S and Streit J. Addressing the need for research on bariatric patient handling. Rehab Nursing 2010; 6:242-247.