planning for appropriate care for the bariatric patient robert g. guest mspt,cert. mdt
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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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• Underweight < 20
• Healthy Weight 20 - 24.9
• Overweight 25 – 29.9
• Obese ( Class 1 ) 30 – 34.9
• Obese ( Class 2 ) 35 – 40
• Morbid Obesity 40+
Body Mass Index Classifications
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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 patient’s 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 patient’s 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 patient’s 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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• 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
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
