BARIATRICS

1. BARIATRICS Lesley Easthope Clinical Nurse Advisor ArjoHuntleigh

2. The term Bariatric is used to describe the field of medicine that focuses on the treatment of obesity and its associated diseases. A Bariatric person can be defined as anyone who has limitations on health and social care due to: • Weight • Size • Shape • Health • Mobility • Environmental access • Exceeds the safe working load and dimensions of a support surface, for example a mattress, bed frame, commode, etc.

3. Surgically a bariatric person has a BMI of 40 or a BMI of 35+ co morbidities Healthcare staff must be able to recognize, predict, prevent, treat & communicate the associated risk factors in the management of bariatric patients – patients, obstetric and adults

4. Bariatric management is a concept in service provision, implementing a whole systems approach. The concept encompasses not only all service delivery, police, fire brigade, ambulance, undertakers, hotels and retail businesses but also all life activities such as eating, sleeping, socialising, clothing, sports and sexuality All obese patients should be accorded their human rights and organisations should have systems in place that do not impinge these rights

5. Human Rights Act • Article 2 right to life • Article 3 right not to be subjected to inhuman or degrading treatment • Article 5 right not to be detained without due legal process • Article 8 right to private and a family life/diginty

6. The Occupiers Liability Act 1957 • Where a visitor to premises knows that a person has special requirements then they must take steps to ensure that the premises are safe sufficient to prevent harm to that person. Question: The foresight of such admissions

7. Regulatory Reform (Fire Safety) Order Bariatric and PUWER The Provision and use of work equipment regulations (1998) Is the equipment fit for purpose in the context of load Are staff trained to use it in relation to the morbid obese Maintenance schedule and replacement • Inclusion of the morbidly obese in A9 assessment • Evacuation of morbidly obese in an emergency

8. Issues around staff welfare • Managing those with borderline obesity /morbid obesity • Coping with unstable care environments • Coping with morbidly obese corpse • Prejudice against obesity

9. Bariatric Common Law Duty of Care • Can the employers/carers provider meet those obligations that have voluntarily created the duty of care • As a service provider we have a duty of care to ensure we are able to care for those individuals which we invite to receive treatment

10. Human Consequences • Increased morbidity and mortality 6% of all deaths • Reduce productivity and functioning Economic Cost £49.9 million • Increased healthcare costs NHS Cost £10 billion by 2050 • Discrimination What is that cost?

11. Health Survey for England

12. Assessment • Medical diagnosis • Co morbidities • Weight • Body mass index • Weight distribution / body dynamics • Skin integrity • Pressure ulcer classification (EPUAP) • Autar(DVT) risk assessment • Nutritional and Dietetic Assessment • Pharmaceutical assessment

13. Assessment cont’d • Mobility assessment • Handling activities • Equipment provision • Staffing resources

14. Functional Space Dept. Of Health Recommendations • Width 3.6m • Length 3.9m • Area 13.32m² Average dimensions • Width 3.93m • Length 4.23m • Area 16.61m²

15. Pressure Ulcers tragic, unnecessary, painful, expensivePREVENTABLE

16. The key to dealing with complexity in wound care lies in thorough and accurate assessment

17. How can we improvethe quality and throughput of care? Care is embedded in the environment, culture& history of the organisation, ward and team, as well as in the actions and working practices of staff. You cannot know, comprehend or predict actions and effects that are operating without considering the system as a whole (after Holden 2005).

18. Summary Clinical benchmarking A focus on preventative care Litigation risk Financial burden Recognition for best practice Improved Trust profile

19. Any Questions