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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

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Thank you

rguest@kaleidahealth.org