CHO Bariatric Friendliness - Health PEI · HMS Office Supplies Global product 500 lbs/226kg...

CHO Bariatric Friendliness

Prepared by: Sarah Fullerton, MSIP Coordinator West August 2018

MSIP MusculoSkeletal Injury Prevention

2 Prepared by: Sarah Fullerton, MSIP Coordinator West – August 2018

Community Hospitals West Community Hospital O’Leary & Western Hospital

Index

Definition of a bariatric patient……………………………………………………….…Page 3

Questions to ask prior to transfer of patient to CHO………………………….Page 4-5

Consult information……………………….…………………………………………………..Page 6

How to set up a room for a bariatric patient at CHO……………………….….Page 7-8

CHO Bariatric Equipment Pictures, Weight Capacities & …………………...Page 9-13 storage locations PCH Bariatric Equipment……………………………………………………………………..Page 14-16

How to weigh a bariatric patient………………………………………………………….Page 17

Tips for working with bariatric patients……………………………………………….Page 18

Care and Compassion for Bariatric Patients…………………………………………Page 19

Maintaining Dignity for Bariatric Patients………………………………………..….0

TLR Logos………………………………………………………………………….………………..Page 21-22

Repositioning Logos……………………………………………………….……………………Page23-24

CHO Bariatric Equipment Inventory…………………………………………………….Appendix A

Calculating Body Mass Index (BMI) Handout………………….……………………Appendix B

TLR Program Bariatric Enhancement Module………………………………………Appendix C

Power point on bariatric patients………………………….…………………………….Appendix D




Definition of a Bariatric Patient

Any patient, patient or patient receiving services from Health PEI who meets one

or more of the following criteria:

Exceeds the weight of 300 lbs

Exceeds the Body Mass Index (BMI) of 34

Exceeds hip width of 24 inches seated or 34 inches lying down

Exceeds the safe working load or size of equipment (i.e. lifts, stretchers, beds, toilets, etc.)

In conjunction with one or more of the following:

Limitations in health, functional mobility and/or ability to perform personal cares

Physical and/or psychological risk factors and/or medical conditions that could jeopardize the safety of the worker and/or themselves during transferring, lifting or repositioning

Note: Refer to appendix B for more details on how to calculate a patient’s Body

Mass Index (BMI)




Questions to ask prior to transfer of a bariatric patient to CHO

The following questions would be helpful for nursing staff and rehab staff when

planning for a bariatric patient admission:

1. What is the patient’s weight?

2. What type of bed is the patient using? a. Is it a standard bed or a bariatric bed? b. If it is a bariatric bed, is the width expanded any?

3. What type of mattress is the patient using?

a. Foam mattress or air mattress?

4. What is the patient’s repositioning abilities? a. How is the patient being turned from side to side? b. Can they bridge? c. How are they being moved to the sides of the bed? d. How are they being boosted?

5. What repositioning equipment is being used?

a. Ceiling lift? 2-point carry bar or 4-point carry bar? b. Repositioning sling? – standard size (ie. 600 lbs capacity) or bariatric

size? (ie. 800 lbs capacity or 1000 lbs capacity) c. Maxislides? d. Turning sling? e. Wedges?

6. How is the patient transferring and what equipment is being used for

transfers? a. Mechanical lift – is 2-point or 4-point spreader bar being used? b. What transfer sling type is being used? c. What transfer sling size is being used?

7. Can the patient sit at the edge of the bed unsupported?

8. What is the patient’s weight bearing status?




9. Is the patient able to stand?

10. What is the patient’s TLR logo at present? a. Note: Bariatric patients are never a 1-person transfer.

11. What mobility equipment is the patient using?

a. Wheelchair? – what width? b. Walker? – what style? c. Cane?

12. How is the patient toileting?

a. Bedpan? b. Commode chair? – Stationary commode or shower commode chair? c. Tena products? What style? What size?

13. How is the patient being bathed?

Shower commode chair/wheel in shower?

Bed bath?




Consults

When a bariatric patient is admitted at CHO, the following people should be

consulted:

1. Sarah Fullerton, MSIP Coordinator West Occupational Therapist Phone: 432-2586 (PCH office), 439-4430 (cell) Email: [email protected]

Note: Please phone or email Sarah if you are putting in a consult on Cerner so she knows to look for the consult.

2. CHO/WH Occupational Therapy

Phone: 859-8878

3. CHO/WH Physiotherapy Phone: 859-0258

mailto:[email protected]




Setting up the Bariatric Room

Room 133 is to be used as a bariatric room. The room is to be a private room with only one bed in it.

Room 129 is to be used as the alternate bariatric room. The room is to be a private room with only one bed in it.

Room 133 and 129 have ceiling lifts that are the Maxisky 600 from Arjohuntleigh. These ceiling lifts have a weight capacity of 600 lbs.

If a bariatric patient will require the repositioning sling and ceiling lift for repositioning, the room should be setup with the bed rotated in line with the ceiling lift tracking. See diagram on next page for how to set up the room. If they do not require the repositioning sling and ceiling lift, the bed orientation would not have to change.

The CHO bariatric bed has an 1100 lbs weight capacity. The bed can be used as a standard bed width and length or it can be expanded in width and length. Each side of the bed can extend outward. Only make the bed as wide as needed for the patient, to minimize staff reaching when doing cares. Consider the patient’s comfort and the space needed to turn the patient on their side when determining the appropriate width.

When the width is expanded on the bariatric bed, there are mattress bolsters that can be positioned on the bed frame to increase the width of the mattress surface.

Bariatric linen is available in the equipment storage closet across from room 133.

If the room is setup as pictured on next page, the footboard of the bed will need to be removed for ceiling lift transfers when the patient is being transferred from bed to chair or wheelchair and vice versa. The footboard should be put back on the bed prior to raising the head of the bed or the mattress will move downward on the bedframe.




Room 133 Set up as a private bariatric patient room

Bariatric Bed

Chair

Bathroom

Door




CHO Bariatric Equipment

Equipment Brand/Model Weight capacity/dimensions

Location

Bariatric Bed

Rotec Serie 2000

1100lbs/498 kg capacity 36”-54"wide depending of if sides extended.

In equipment room across from room 133

Mattress bolsters

Rotec Matelas Dauphin 800HD

800lbs/362 kg capacity 80" long 8" wide bolsters

In equipment room across from room 133

Bariatric Linen

Fitted sheets, top sheets, Johnny shirts and soaker pads

N/A In equipment room across from room 133

Stretcher with scale Stryker 465 lbs/210 kg capacity

Sim Lab room





Location

4 point spreader bar for ceiling lift

Arjohuntleigh 1000 lbs/453 kg capacity In equipment room across from room 133

Maxisky 600 ceiling lift

Arjohuntleigh 600 lbs/272 kg capacity Rooms 133, 129, 99 & 98

Portable floor lift

BHM/Arjohuntleigh 600 lbs/272 kg capacity Parked outside equipment room across from room 133

Bariatric Transfer Sling Arjohuntleigh Hammock sling Size XL

550 lbs/249 kg capacity On shelf with bariatric linen in equipment storage room across from room 133





Location

Blue repositioning sling

Waverly Glen 800 lbs/362 kg capacity On shelf with bariatric linen in equipment storage room across from room 133

Green repositioning sling

Arjohuntleigh 600 lbs/272 kg capacity On shelf with bariatric linen in equipment storage room across from room 133

Limb sling

Arjohuntleigh 250 lbs/113 kg weight capacity

Equipment closet (Room # 116) with all standard sized slings

Purple maxislides

Arjohuntleigh Weight capacity: N/A

Equipment closet (Room # 116) with all standard sized slings





Location

Orange Maxitube

Arjohuntleigh

Weight capacity: N/A Equipment closet (Room # 116) with all standard sized slings

Bariatric stationary commode

Invacare 650 lbs/249 kg capacity 23” wide

Equipment storage room across from room 133

Step stool for staff to use if needed when assisting

bariatric patients

Unknown *For staff use only. Not for patient use.

Equipment storage room across from room 133

Bariatric wheelchair

Lawtons Invacare Tracer IV

350 lbs/158 kg capacity 22" wide

In Occupational Therapy Storage Room





Location

Bariatric furniture

HMS Office Supplies Global product

500 lbs/226kg capacity 23” wide

In Occupational Therapy/ Physiotherapy gym

Bariatric walker

ERP Group 500 lbs/226kg capacity In Physiotherapy equipment closet

Bariatric cane

ERP Group 500 lbs/226kg capacity In Physiotherapy equipment closet

Bariatric staircase

500 lbs/226kg capacity 6” steps

In Physio gym

Note: Refer to Appendix A: CHO Equipment Inventory for further details on equipment




PCH Bariatric Equipment

To inquire about borrowing any of PCH’s bariatric equipment, please contact:

Sarah Fullerton, MSIP Coordinator West Office phone: 432-2596 Cell phone: 439-4430 Email: [email protected]

Equipment Brand/Model Weight capacity/dimensions Bariatric Bed and Foam Mattress

Arjohuntleigh AtmosAir (foam style) mattress

1000 lbs/453 kg capacity Can expand to 36” wide, 42” wide or 48” wide

Bariatric Air Mattress

Arjohuntleight MaxxAir mattress

1000 lbs/453 kg capacity Can expand to 36” wide, 42” wide or 48” wide

Broda chair

Broda 600 lbs/252 kg capacity




Equipment Brand/Model Weight capacity/dimensions Shower commode chair

Broda 800 lbs/362 kg capacity 27" W x 21" D x 22" Seat height, tilt, elevating feet, removable arms

Transfer sling (padded)

Arjohuntleigh 1000 lbs/453 kg capacity

44” wide

32” high

4 loops attach

Individual leg loops

Transfer sling (non-padded)

Arjohuntleigh MAA8000-L (Bariatric Large)

1000 lbs/453 kg capacity

55” wide

41” high

4 loops attach

Bariatric Walking Sling

Guldmann





Equipment Brand/Model Weight capacity/dimensions Turning sling

Guldmann


Air pal

Air pal 32N blue style


Bariatric orange maxislides

Arjohuntleigh Weight capacity: N/A




How to weigh a bariatric patient

The bariatric bed at CHO does not have a scale

No ceiling lifts at CHO have a scale

The Ergolift 600 floor lift has a scale that can be used to weigh a bariatric patient

Weighting a patient using the floor lift (Ergolift 600)

1. The floor lift has a weight capacity of 600 lbs. 2. Position an appropriate sized repositioning sling under patient in bed. 3. Zero the floor lift’s scale. 4. Attach the repositioning sling to the floor lift’s spreader bar. Position the spreader bar

with one side where the sling loop attaches toward the head end of patient and one end toward the foot end of patient. This will allow for all the top end loop to attach to one side and the bottom end loops to attach to one side.

5. Raise the patient until they clear the bed mattress and weigh the patient. 6. Ensure that you weigh the weight of the repositioning sling after obtaining the patient’s

weight. Subtract the sling weight to get the true patient weight.

Note: you could also attach the repositioning sling to the spreader bar of the floor lift prior to weighing the patient and zero the scale with the weight of the sling on it. Then, when you weigh the patient, you will get the true patient weight, because the sling weight has already been accounted for.




Tips for working with bariatric patients

1. Maximize equipment use

a. Use limb slings for lifting limbs

b. Use limb sling to lift the legs when positioning leg sections of sling under patient

c. Maxitube or maxislides can be put under legs to slide legs across bed

d. Use ceiling lift and repositioning sling for patients requiring assistance with

repositioning. Their weight exceeds the safe working load for staff to reposition

them using slider sheets.

2. Check equipment weight capacities to ensure equipment is safe for patient’s weight

3. Always wait until enough caregivers available -never put yourself at risk!

4. Pushing bariatric patients in broda chairs, wheelchairs, etc. a. Staff, students, or volunteers should not be pushing bariatric patients manually

over large distances. b. When pushing a bariatric patient in a broda chair or in a wheelchair, having more

than one staff member push the patient is recommended. 5. Limiting reaching when provide cares when patient is in wider bariatric bed

a. Lower bed to an appropriate height and put one knee up on the bed. This allows

you to get closer to the patient and to work in your comfort zone.

b. Only make bariatric bed as wide as needed Do not reach over bed rails. c. Position patient closer to side of bed before turning. Patient can be lifted and

brought closer to the side of the bed using a ceiling lift with repositioning sling.

The bed may need to be moved when the patient is lifted depending on how the

ceiling lift tracking is installed.

6. Moving bariatric commodes a. Bariatric equipment can be difficult for staff to move given the weight and size of

the equipment. b. When moving bariatric commodes, ask for help from a co-worker. Each staff

member can carry one side of the commode while remaining in their comfort zone.

7. Repositioning a. If a bariatric patient requires assistance with repositioning, staff are not to boost

or turn the patient using slider sheets. Bariatric patients’ weight exceeds the recommended weight for using slider sheets or maxislides. If a patient can reposition themselves with the help of slider sheets or maxislides, then they are acceptable to use.

b. If a patient requires assistance with repositioning, a repositioning sling and ceiling lift should be used.




Care and Compassion for Bariatric Patients

(Taken from TLR Bariatric Enhancement Module, SASWH –TLR 2016)

When caring for bariatric patients, both physical and psychological health should be considered.

Issues of self-esteem are usually apparent in bariatric patients and they may become easily

offended by comments or procedures that health care workers deem as kind. Concerns about

staff safety can affect how the bariatric patient is cared for as workers may be reluctant to

assist with the handling and mobility of a bariatric patient.

Workers should investigate alternative methods to approaching the bariatric patient to ensure

compassionate care is provided. Good communication skills can increase trust between the

patient and the care provider. When moving a bariatric patient, some strategies that may be

helpful are listed below:

1. Use non-offensive terms such as “weight”, “excess weight” or “body mass index.” Terms

like “excess fat”, “obesity”, “large” or “heavy” may be hurtful or offensive. It may be

beneficial to ask the bariatric patient what terms he or she prefers.

2. Talk to the patient. Showing consideration and offering empathy (e.g., understanding

compassion) will help build a good rapport. Bariatric patients are already aware of their

struggle with their weight. Being sensitive to this may help them feel more respected.

3. Emphasize that the bariatric patient’s comfort is important when a moving technique is

being performed.

4. Thoroughly explain the moving technique to the bariatric patient and other workers

involved. Bariatric patients may be leery of the workers’ and/or equipment’s ability to

support their weight. By providing them with as much information as possible, the

patient’s distrust may be reduced.

5. Ask the bariatric patient how they perform specific tasks. Have the patient demonstrate

how he or she gets out of bed, mobilizes, performs activities of daily living, etc.

6. Focus on the safety of the bariatric patient and the workers, not the obesity.

7. Ensure healthcare workers are appropriately trained in operating equipment.

Source: TLR Bariatric Enhancement Module, SASWH –TLR 2016




Maintaining Dignity for Bariatric Patients

1. Always remember the person behind the disease and use patient centered care. 2. Privacy is very important, particularly if the patient has body image sensitivities. 3. Remember to complete the patient’s weight in a private location. 4. Ensure gowns, clothing, and blankets fit and cover the patient. 5. Avoid all comments related to sizes of equipment or other inconvenience to staff related

to work space or work load. 6. Ensure that proper bariatric equipment is available, accessible, and utilized when the

need is presented. 7. Care for the bariatric patient as a person, not just with his/her obesity. 8. Bring injury concerns or any safety concerns to the attention of the supervisor or

manager in private, instead of discussing them in public spaces or in front of the patient. 9. Use bariatric care as an opportunity to train staff on the many uses of bariatric

equipment and encourage them to seek methods of care to maintain the patient’s integrity.

10. Adjust equipment to fit each patient’s needs, know when each piece is appropriate, and know how to use it.

11. Learn from the patient and family members about the patient’s capabilities and how he/she typically does certain tasks.

12. Take steps to communicate important information to all who will provide care to the patient.

13. Learn from the patient and family members about the patient’s capabilities and how he/she typically does certain tasks.

14. Take steps to communicate important information to all who will provide care to the patient.

15. Protect the patient’s dignity and prevent the patient/family from needlessly feeling like a burden or unwanted

Source:

http://www.washingtonsafepatienthandling.org/images/best_practices/sph_bpguide_chpt5.pdf




TLR Logos

The TLR assessment is applicable to bariatric patients. Bariatric patients are to be assigned a

TLR logo to indicate how they are to be safely transferred.

Note: Never this logo for a bariatric patient given their size.




Repositioning Logos

Bariatric patients are to be assigned a bed repositioning logo to indicate how they are to be

repositioned in bed safely.

Logo name Logo Image Criteria

Independent

The patient/resident has the physical and mental capability to reposition self in bed.

Verbal Guidance

The resident/patient has the physical capability to reposition self in bed but requires verbal guidance and/or physical cueing.

1 Person - Minimal Assist

The patient/resident requires minimal assistance to reposition self in bed, e.g. positioning of slide sheet /tube, raising bed rail, adjusting bed to trendelenburg bed position, etc. (Repositioning must be supervised or side rails must be up.)

Minimum 2 Person Assist -

Slide Sheets that Stay on the Bed

*Not recommended for bariatric patients

The resident/patient requires moderate to total assistance to reposition self in bed and meets the following criteria:

weighs less than 200lbs/90kg*

does not move a lot in bed

Note: Slider sheets are only appropriate for a bariatric patient if the patient is using them to facilitate moving themselves. Staff are not to use the slider sheets to move the patient as the load is too heavy for staff.




Minimum 2

Person Assist -Removable Slide

Sheets *Not recommended for bariatric patients

The patient/resident requires moderate to total assistance to reposition self in bed and weighs less than 250lbs/113kg.*

Note: Slider sheets are only appropriate for a bariatric patient if the patient is using them to facilitate moving themselves. Staff are not to use the slider sheets to move the patient as the load is too heavy for staff.

Minimum 2 Person Assist - Ceiling Lift with Repositioning

Sling

*3 staff recommended for bariatric patients

The resident/patient requires total assistance to reposition self in bed and meets one or more of the following criteria:

has a BMI of 34 or greater

weighs more than 250lbs/113kg*

requires frequent repositioning

fills the width of the bed

has multiple medical attachments/complications

has a mattress that is not conducive to other repositioning devices/techniques

Minimum 3 Person Assist - Ceiling Lift with Repositioning

Sling

Patient/resident requires total assistance to reposition self in bed, weighs over 300lbs/136kg* and meets one or more of the following criteria:

has attachments that need managing during the move

has a pannus that needs positioning by one or more staff during the move

has behaviours/fears that need attention during the move

their general condition or size warrants extra caution

*Please note: Patient weights are provided as a general guideline. Staff will need to make a

clinical decision in consideration with all other factors.

CHO Bariatric Friendliness - Health PEI · HMS Office Supplies Global product 500 lbs/226kg...

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