Planning for Appropriate Care for the Bariatric Patient

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Planning for Appropriate Care for the Bariatric
Patient

• Robert G. Guest MSPT,Cert. MDT

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Bariatric

• The term bariatric derived from the Greek root
  baro (weight), suffix - iatr
  (treatment) and suffix ic (pertaining
  to).

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Obesity in the U.S.A.

• 64 adults being obese
• Numbers are rising from 19.4 in 1997 to 26.6 in
  2007
• Obesity-attributable medical expenditures
  estimate in 2003 reached 75 billion

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Eating Habits
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Life Style
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Diagnosis

• The Body Mass Index is widely accepted as the
  marker for excess body weight.
• Waist circumference (associated with central
  obesity) is another marker

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Body Mass Index (BMI)

• BMI Weight (Kg)/Height (M2)

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Body Mass Index Classifications

• Underweight lt 20
• Healthy Weight 20 - 24.9
• Overweight 25 29.9
• Obese ( Class 1 ) 30 34.9
• Obese ( Class 2 ) 35 40
• Morbid Obesity 40

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Health Conditions Related to Morbid Obesity

• Type 2 diabetes
• Heart disease
• High blood pressure
• Obstructive sleep apnea
• Acid reflux/Gerd
• Osteoarthritis
• Depression

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Problems

• Infrequency of bariatric admissions
• Myths fears
• Staffing
• Environment (space consideration)
• Equipment
• Maintaining dignified care for the bariatric
  patient

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Bariatric Admission

• Emergency vs Elective

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Guidelines for the Bariatric Admission

• Patient assessment
• Environmental assessment
• Staffing
• Equipment assessment
• Patient transport
• Discharge Planning

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Patient

• Present medical condition
• Past medical history
• Past surgical history
• Social history
• BMI score or patients trunk/pelvic width

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Body Shape
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Environment

• Know the measurements of doorways
• Arrange the room prior to the patients arrival
• Allow room for equipment, staff and furniture (if
  possible)
• Designated bariatric suite or private room

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Emergency Department
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Staff

• Appropriate staffing (teamwork)
• Education (patient and equipment)
• Communication (lift documentation tool)
• Maintain handling tasks in a safe and dignified
  manner

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Equipment

• Each unit should be aware of the standard weight
  limit for their equipment i.e. beds, chairs,
  wheelchairs, gurneys, mechanical lifts and
  treatment tables
• Use the proper equipment based on the patients
  weight, height and shape
• Choose the least physically demanding device to
  promote safety

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Equipment

• Bed
• Mechanical lifts (floor vs.ceiling)
• Non-friction sheets Air assistive device
• Turn position sheets/straps
• Commode bedpan
• Chair, wheelchair shower chair
• Blood pressure cuff abdominal binders
• ID wristbands, gowns, slippers linen

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Bariatric Bed Accessories?
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Owning vs.Renting Equipment

• Based on number of bariatric admissions
• Rental costs
• Space needed to store the equipment

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Patient Transport

• Map out routes
• Know the doorway and elevator widths
• Know the number of staff needed for the transport
• Communication amongst departments i.e. scheduling
  for a diagnostic procedure
• Have the appropriate equipment available for
  transport transfers

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Discharge

• Starts day one on admission
• Compose maintain a list of resources ie.
  healthcare facilities, transportation co.,
  community services available
• Inter-departmental, patient and family
  conferencing
• Transport requirements and standard weight limit
  of equipment
• Return rental equipment immediately after
  discharge

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Establish Bariatric Task Force

• Goal
• -Provide a safe environment of care for
  both the bariatric patient and healthcare worker.
  
  

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Bariatric Task Force Members

• Administration
• Nursing (licensed unlicensed)
• Rehabilitation PT/OT
• Plant Operations/ Bio-Medical department
• Laundry
• Purchasing

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Emergency vs. Elective Bariatric Admission

• Design a pathway flow chart
• Include patient, environment, staff, equipment,
  transport guidelines
• Pathway ends with safe discharge

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Questions
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Thank you

• rguest_at_kaleidahealth.org