Clinical advisor: Anita Rush on bariatric care

In the August issue, HES questioned if trusts were procuring appropriate bariatric equipment. Providing appropriate care for these patients is complex and can only be done well by taking a holistic approach to patient care.  Anita Rush.

Bariatric management is a new concept in service and equipment provision. It started for me some years ago when I was tasked to provide equipment and home care for a bariatric patient in their domestic environment. The lessons I learned from that experience and the knowledge I gained from doing a Masters degree in Health Ergonomics enabled me to recognise that managing bariatric patients was full of challenge’s  including financial and human resources, equipment design, knowledge and training and environmental constraints.

Bariatrics is not just about providing the right equipment. It is about placing the bariatric patient at the centre  thinking out of the box and taking a holistic approach to patient care. The fact that most bariatric patients cannot tolerate lying down due to breathing impairment, may have skin problems, suffer from lack of self esteem or have other related medical problems means that sound clinical assessments and robust policies and procedures need to be in place to ensure safe systems of work.

A good guide is to base the procurement of bariatric equipment on 70% clinical need and 30% financial considerations. The selection of equipment should be done in a systematic way and form part of the risk assessment process. Equipment reviews should not only consider the needs of the bariatric patient but also include local and national statistical data, prevalence, adverse incidents and near misses.

In addition, the equipment must be fit for purpose. If the caregiver using the equipment cannot position themselves in a safe and comfortable posture to assist the patient to move, then there is an increased risk that the caregiver will suffer a musculoskeletal injury. But selecting appropriate equipment will reduce the inherent risks associated with handling bariatric patients and ensure the well being of both patients and staff.

It is essential when assessing and designing equipment for bariatric patients that their body dynamics (height and body type), mobility and weight (most bariatric patients will underestimate their weight) are taken into account. For example, when looking at beds the weight of the mattress, its height, and the weight of the patient’s spouse (if applicable) need to be considered in relation to the weight and height of the patient. In addition, in some cases the back of the bed will need to regress to accommodate the bulbous gluteal region.

But it is not only the patient with whom the equipment needs to be matched up. Different types of equipment also need to be compatible with each other. For example, if a hoist cannot lift high enough to get a patient easily on or off a bed, there is a risk of pressure damage to the patient due to shearing and to the nurse of musculoskeletal disorders as they drag the patient over the bed. If the patient is mobile then the bed needs to go low enough for them to lift their legs into bed  it’s well known that bariatric patients often do not go to bed as they cannot raise their legs high enough to get into bed.

When a bariatric patient is placed in a ward, they can take up to two bays, so it is important to assess whether there is enough space to accommodate them, whether the lift will be able to take the combined weight of the equipment and the patient and if the floor will also take the weight, particularly if on upper floors. There also needs to be enough room to enable the use and manoeuvrability of equipment and to accommodate at least four carers’ ideally at least 1.5 metres between the walls of the room and the equipment. The floor space should also be big enough for other equipment, such as mobile or gantry hoists, glide-about commodes, wheelchairs, stretchers (in acute environments) and the fallen patient.

So, how can procurement specialists, manufacturers, professionals and end users working within the health and social care environment contribute to providing the right environment and appropriate equipment provision to enhance the bariatric person’s self esteem and ensure that staff are competent in using the equipment supplied?

One thing that is essential is proper training. Knowing how to use the equipment is paramount to the safety of both the patient and the professionals using the equipment. Efficient training in conjunction with manufacturers should be competence-based and part of the procurement package.

I also think that bespoke equipment will be required to meet individual needs. Procurement specialists, manufacturers, end users and health professionals need to work alongside organisations and equipment designers to reduce the inherent risks associated with managing bariatric patients, influencing equipment and environmental design for current and future users.

Good work is being done by many manufacturers who over the last few years have responded well to the needs of bariatric patients, designing equipment using a systematic framework of data collection from end users and professionals that has enabled their design to be reviewed and improved. But we have a long way to go. It is time to think more laterally, to take a real look at today’s environment, and design equipment that is fit for the purpose  for appropriate and safe bariatric care.


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