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Planning for Appropriate Care for the Bariatric Patient. Robert G. Guest MSPT,Cert. MDT. Bariatric. The term bariatric derived from the Greek root baro (weight), suffix - iatr (treatment) and suffix – ic (pertaining to). Obesity in the U.S.A. 64% adults being obese

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bariatric

Bariatric

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

obesity in the u s a

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

diagnosis

Diagnosis

The Body Mass Index is widely accepted as the marker for excess body weight.

Waist circumference (associated with central obesity) is another marker

body mass index bmi

Body Mass Index (BMI)

BMI = Weight (Kg)/Height (M2)

body mass index classifications
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
health conditions related to morbid obesity
Health Conditions Related to Morbid Obesity
  • Type 2 diabetes
  • Heart disease
  • High blood pressure
  • Obstructive sleep apnea
  • Acid reflux/Gerd
  • Osteoarthritis
  • Depression
problems
Infrequency of bariatric admissions

Myths & fears

Staffing

Environment (space consideration)

Equipment

Maintaining dignified care for the bariatric patient

Problems
bariatric admission

Bariatric Admission

Emergency vs Elective

guidelines for the bariatric admission
Guidelines for the Bariatric Admission
  • Patient assessment
  • Environmental assessment
  • Staffing
  • Equipment assessment
  • Patient transport
  • *Discharge Planning
patient
Patient
  • Present medical condition
  • Past medical history
  • Past surgical history
  • Social history
  • BMI score or patient’s trunk/pelvic width
environment
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

staff
Staff
  • Appropriate staffing (teamwork)
  • Education (patient and equipment)
  • Communication (lift documentation tool)
  • Maintain handling tasks in a safe and dignified manner
equipment
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
equipment39
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
owning vs renting equipment
Owning vs.Renting Equipment
  • Based on number of bariatric admissions
  • Rental costs
  • Space needed to store the equipment
patient transport
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
discharge
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
establish bariatric task force
Establish Bariatric Task Force

Goal:

-Provide a safe environment of care for both the bariatric patient and healthcare worker.

bariatric task force members
Bariatric Task Force Members
  • Administration
  • Nursing (licensed & unlicensed)
  • Rehabilitation PT/OT
  • Plant Operations/ Bio-Medical department
  • Laundry
  • Purchasing
emergency vs elective bariatric admission
Emergency vs. Elective Bariatric Admission
  • Design a pathway flow chart
  • Include patient, environment, staff, equipment, & transport guidelines
  • Pathway ends with safe discharge
thank you

Thank you

rguest@kaleidahealth.org