Planning for Appropriate Care for the Bariatric Patient

1. Planning for Appropriate Care for the Bariatric Patient Robert G. Guest MSPT,Cert. MDT

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

3. 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

4. Eating Habits

5. Life Style

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

7. Body Mass Index (BMI) BMI = Weight (Kg)/Height (M2)

9. 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

11. Health Conditions Related to Morbid Obesity • Type 2 diabetes • Heart disease • High blood pressure • Obstructive sleep apnea • Acid reflux/Gerd • Osteoarthritis • Depression

12. Infrequency of bariatric admissions Myths & fears Staffing Environment (space consideration) Equipment Maintaining dignified care for the bariatric patient Problems

13. Bariatric Admission Emergency vs Elective

14. Guidelines for the Bariatric Admission • Patient assessment • Environmental assessment • Staffing • Equipment assessment • Patient transport • *Discharge Planning

15. Patient • Present medical condition • Past medical history • Past surgical history • Social history • BMI score or patient’s trunk/pelvic width

16. Body Shape

19. 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

21. Emergency Department

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

25. 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

39. 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

41. Bariatric Bed Accessories?

42. Owning vs.Renting Equipment • Based on number of bariatric admissions • Rental costs • Space needed to store the equipment

43. 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

46. 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

48. Establish Bariatric Task Force Goal: -Provide a safe environment of care for both the bariatric patient and healthcare worker.

49. Bariatric Task Force Members • Administration • Nursing (licensed & unlicensed) • Rehabilitation PT/OT • Plant Operations/ Bio-Medical department • Laundry • Purchasing

50. Emergency vs. Elective Bariatric Admission • Design a pathway flow chart • Include patient, environment, staff, equipment, & transport guidelines • Pathway ends with safe discharge