As described in our last post, obesity is a condition affecting more and more Americans yearly, and the reality of its impact upon healthcare functionality must be faced. Bariatric patients face many severe barriers to quality care, particularly when it comes to emergency medical services, radiology needs, and surgery. In this second article, we now move on to a more optimistic topic: how these problems might be solved. Below are some pointers on how bariatric patients can be better served and cared for in a way that also increases the effectiveness and safety of medical team members.

 

Be proactive

The key to effective and safe bariatric patient handling is to be prepared prior to admission.[1] General operational policies as well as those specific to each care unit must be developed and made clear to medical staff members in order to minimize confusion, inconsistency, and harm to patients or staff members.[2]

  • Equipment specific to bariatric patients needs to be in stock and available, including bariatric beds with an expandable deck, total lift systems, full body slings, wheelchairs in varying widths and depth, stretchers with a 1,000 pound capacity, larger commodes and washbasins, and sit-stand devices.[3]
  • A bariatric mobility admission assessment should be created so as to determine a patient’s level of disability as well as what kind of team will be needed for them, and a plan should be identified to determine a patient’s needs “door to door.”[4]
  • Pre-surgery, surgeons should obtain a chemistry panel, order a chest radiograph and electrocardiogram, test pulmonary function, notify anesthesiologist and operating room personnel before the patient’s arrival, and make sure the operating room is stocked with suitable equipment.[5]
  • Finally, post operation, bariatric patients should spent time in the ICU for close monitoring, fluid intake should be documented, ambulation should begin on the first postoperative day, and other physicians should be kept in the loop during the patient’s recovery.[6]

 

Increased bariatric training

Because of the unique challenges facing bariatric patients undergoing emergency medical attention or surgery, medical team members must be trained specifically on how best to treat them. Protocols need to be put into effect to guarantee healthcare professionals are provided with training and education on how to use bariatric equipment, how to identify when assistance is required with mobility, techniques for patient lifting, and how emergency procedures – like CPR – should be performed on bariatric patients.[7] Medical staff and first responders should practice with heavier manikins and specially designed water-filled bariatric rescue manikin suits that replicate the weight and movement in body tissue associated with the morbidly obese.[8] Additionally, learning how and when to ask bariatric patients how best to help them can lead to safer, more successful maneuvers as well as stronger working relationships.

 

Treating with dignity

Medical staff members must be trained to reconsider the bias they may hold regarding obesity so as to strengthen trust, and ultimately safety, with bariatric patients. Studies have found that many healthcare professionals have negative attitudes towards bariatric patients; the stigma surrounding obesity can cause medical staff members to express reluctance when assisting bariatric patients or treat them disrespectfully.[9] This treatment is not only insulting and outright wrong; it often incites shame, and causes a patient to lose trust in their medical team, making them less likely to report problems they may experience.[10] A lack of communication can mean harm to the patient or the providers assisting them, so building a relationship built on respect is extremely important. Staff members must be trained to identify and eliminate prejudicial language, body language, and terminology so as to create barrier-free care to patients and their families.

 

Investing more in bariatric needs

With obesity on the rise, bariatric patients are only going to become more frequent visitors to hospitals. Having over a third of the adult population lacking access to quality care, including proper imaging machines and ambulances, is unjust, dangerous, and inexcusable, so factoring bariatric needs into a medical budget is a necessity. Medical facilities must prioritize purchasing and providing the proper equipment, training, and machines necessary so as to treat all patients properly without putting their own staff in danger.

 

Though obesity is a topic many find uncomfortable to talk about, current trends suggest it’s a condition that we can no longer ignore. Investing in appropriate equipment, machines, and ambulances, providing comprehensive training, and enacting proactive measures are essential to breaking down the significant barriers bariatric patients and their caregivers face in healthcare settings in this century.

 

 

 

[1] Muir, Marylou and Gail Archer-Heese, “Essentials of a Bariatric Patient Handling Program,” NursingWorld.org, Jan 2009, http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ ANAPeriodicals/OJIN/TableofContents/Vol142009/No1Jan09/Bariatric-Patient-Handling-Program-.aspx

[2] Severson, Lori and Ian Chuang, “Ten Safety Steps to Enhance Bariatric Patient Care,” Lockton Companies, January 2012, http://www.lockton.com/Resource_/PageResource/MKT/Ten%20Steps%20to%20Enhancing %20Care%20for%20Bariatric%20Patients_FINAL_i_reduced.pdf

[3] Muir and Archer-Heese, “Essentials”

[4] Severson and Chuang, “Ten Safety Steps”; Thomas, Shirley A. and Mary Lee-Fong, “Maintaining Dignity of Patients with Morbid Obesity in the Hospital Setting,” Bariatrictimes.com, April 15, 2011, http://bariatrictimes.com/maintaining-dignity-of-patients-with-morbid-obesity-in-the-hospital-setting/

[5] Jackson, Richard A. and James D. Perkins, “Risks and remedies when your surgical patient is obese,” OBG Management, October 2007, http://www.mdedge.com/obgmanagement/article/62867/risks-and-remedies-when-your-surgical-patient-obese

[6] Ibid

[7] Thomas and Lee-Fong, “Maintaining Dignity”

[8] Long, Will, Brett McGary, Edward Jauch, and Don Lundy, “EMS Challenges of bariatric patients – Part 2,” Carolina Fire Rescue EMS Journal, Oct. 14, 2011, http://www.carolinafirejournal.com/Articles/Article-Detail/articleid/1767/ems-challenges-of-bariatric-patients

[9] Thomas and Lee-Fong, “Maintaining Dignity”

[10] Ibid