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Safety and Transfer Training for the Bariatric Population. Objectives. Recognize risks of potential patient/ caregiver injury Identify when to use special bariatric patient-handling equipment/technology. Obesity Rates in the US 2010.

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Presentation Transcript
objectives
Objectives
  • Recognize risks of potential patient/ caregiver injury
  • Identify when to use special bariatric patient-handling equipment/technology

Charlene J. Anderson, Bariatric Nurse Care Coordinator

obesity rates in the us 2010
Obesity Rates in the US 2010

Charlene J. Anderson, Bariatric Nurse Care Coordinator

slide4
We have the responsibility to stay safe by using the appropriate equipment and patient transfer techniques.

Charlene J. Anderson, Bariatric Nurse Care Coordinator

employee dangers
Employee Dangers
  • Caregiver fatigue
  • Muscle strain and injury
  • Lost time from work
  • Lost income

Charlene J. Anderson, Bariatric Nurse Care Coordinator

assess the situation before you lift
ASSESS the Situation BEFORE You Lift
  • Right equipment?
      • NIOSH recommends the use of assistive devices when the weight to be lifted exceeds 35 lbs.
  • Right number of helpers?
  • Right position to help?

Charlene J. Anderson, Bariatric Nurse Care Coordinator

right equipment
Right Equipment?
  • Most standard hospital equipment is rated to accommodate 250-350 lbs.
  • Bariatric equipment in GSMC is rated to accommodate 400-1000 lbs. KNOW the limit for the item you select!

Charlene J. Anderson, Bariatric Nurse Care Coordinator

right number of helpers
Right Number of Helpers?
  • Don’t attempt to lift or reposition the bariatric patient alone!
  • Minimum of 2-3 caregivers

Charlene J. Anderson, Bariatric Nurse Care Coordinator

right position to help the key to lifting safely
Right Position to Help? The Key to Lifting Safely
  • NEVER use your back
  • Keep your back straight or slightly arched
  • Allow your legs to do the work
  • Never twist your body while lifting or placing the object down

Charlene J. Anderson, Bariatric Nurse Care Coordinator

body mechanics and the bariatric patient think ahead
Body Mechanics and the Bariatric Patient Think Ahead!!!
  • How heavy or awkward is the load?
  • How should I position myself to lift this load safely?
  • Do I need help from others?

Charlene J. Anderson, Bariatric Nurse Care Coordinator

transporting
Transporting
  • Use the appropriate transport vehicle
    • Wheelchair
    • Bed/stretcher (manual or power-controlled)
  • Get help when needed
  • Push…don’t pull

Charlene J. Anderson, Bariatric Nurse Care Coordinator

repositioning safety
Repositioning Safety
  • Involve the patient when possible
  • Provide assist devices as needed

Charlene J. Anderson, Bariatric Nurse Care Coordinator

patient injury friction or shear
Patient Injury: Friction or Shear

Charlene J. Anderson, Bariatric Nurse Care Coordinator

bariatric skin challenges
Bariatric Skin Challenges
  • Reaching certain areas of the body (esp. underneath the pannus)
  • Compromised circulation (less blood flow through fatty tissue, possibly diabetes)
  • Tissue breakdown from skin rubbing together
  • Large, deep skin folds
  • Physical mobility issues

Charlene J. Anderson, Bariatric Nurse Care Coordinator

resulting skin problems
Resulting Skin Problems

Most Common are:

  • Friction and shear injuries
  • Conditions related to poor toileting hygiene and incontinence
  • Pressure ulcers

Charlene J. Anderson, Bariatric Nurse Care Coordinator

nursing management to prevent skin problems
Nursing Management to Prevent Skin Problems
  • Select roomy clothing
  • Use corn-starch based powders, cotton, fabric, gauze or other materials to separate skin surfaces from one another
  • Reposition patient q2h (further manual repositioning of arms, legs, breasts, and pannus is often required)
  • Minimize high-Fowler’s and semi-Fowler’s position
  • Provide bariatric equipment that is wide enough to accommodate the patient. Side rails and arm rests can rub against skin causing breakdown.
  • Schedule toileting programs
  • Use wipes or spray no-rinse washes regularly after urination and defecation

Charlene J. Anderson, Bariatric Nurse Care Coordinator

nursing management to prevent skin problems continued
Nursing Management to Prevent Skin Problems….Continued….
  • Provide access to appropriately sized commodes (either patient room toilets or bariatric bedside commodes)
  • Apply a skin protectant product at the first sign of skin breakdown
  • Assess pressure points for skin integrity or signs of breakdown
    • Heels
    • Sacrum
    • Occiput (higher risk in obese population)
    • Between skin folds (thighs, rolls of skin)
    • Penis
  • Check placement of lines and tubes (to prevent falling between skin folds
  • Educate patient and S.O. caregivers regarding skin assessment and protection strategies

Charlene J. Anderson, Bariatric Nurse Care Coordinator

be familiar with equipment
Be Familiar With Equipment
  • Beds
  • Stretchers
  • Wheelchairs
  • Lifts and slings
  • Shower seats
  • Bedside commodes
  • Other

Charlene J. Anderson, Bariatric Nurse Care Coordinator

bariatric equipment for the nursing unit
Bariatric Equipment for the Nursing Unit
  • Extra large blood pressure cuffs – disposable vs. reusable
  • Wheelchairs
  • Beds
  • Chairs
  • Stretchers
  • Bed scales, step-on scales
  • Lifts
  • Bedside commodes
  • Shower seats

Charlene J. Anderson, Bariatric Nurse Care Coordinator

bariatric equipment for the or
Bariatric Equipment for the OR
  • Specialty OR tables
    • Side extenders
    • Foot boards
  • Positioning devices
    • Stirrups
    • Bean bags, vac packs
    • Bariatric length safety straps
  • Longer length instruments
    • Reusable instruments in trays
    • Disposable stapler/cutter units (lots of reloads!)
  • Other
    • Bougies, EGD tower (therapeutic scope for sleeves, diagnostic for bypass), etc.

Charlene J. Anderson, Bariatric Nurse Care Coordinator

bariatric gowns
Bariatric Gowns

Charlene J. Anderson, Bariatric Nurse Care Coordinator

slide22

Bariatric patients have unique emotional and physical needs that we must meet. Each staff member should provide care that is safe for both the patient and the caregiver.

Charlene J. Anderson, Bariatric Nurse Care Coordinator

references
References
  • US Obesity Trends by State, 1985-2010, U.S. Centers for Disease Control, http://www.cdc.gov/obesity/data/trends.html
  • Waters TR. When is it safe to manually lift a patient? Am J Nurs. 2007;107(8):53-58.
  • Cohen MH, Nelson GG, Green DA, et al. Patient handling and movement assessments: a white paper. Dallas, TX: The Facility Guidelines Institute; 2010.
  • Camden SG, Shaver J, Cole K. Promoting the patient’s dignity and preventing caregiver injury while caring for a morbidly obese woman with skin tears and a pressure ulcer. Bariatric Nursing and Surgical Patient Care. 2007;2(1):77-82.
  • 2 Krasner DL, Kennedy-Evans KL, Henn T. Infection control perspective - Bariatric skin care: Common problems and management strategies. Bariatric Times. 2006;3(2):16-17.

Charlene J. Anderson, Bariatric Nurse Care Coordinator