Just as obese patients face a challenge to their medical care, the medical community faces an overwhelming challenge to provide quality care, prevent injury to patients and staff, and limit associated costs. Home health caregivers are seeing more bariatric patients as this population makes every attempt to remain in their modified home environment.

My many years in health care have taught me that anything can be accomplished and improved if there is an effective process in place. Quality care for bariatric patients depends on an effective process that yields a predictable outcome. Just one obese patient can pose an overwhelming challenge without an effective care delivery strategy in place.

The key is to position yourself ahead of the trend by developing your own bariatric program and planning and preparing your infrastructure with the appropriate environment, individualized protocols, staffing policies, equipment, and trained professionals. Promote quality clinical outcomes, ensure patient safety, and prevent caregiver injury by following these five steps:

Step 1: Assess your facility. Conducting a general physical plant assessment, including width of doorways, space surrounding toilets, and weight capacity of waiting area furniture, can help identify simple modifications that will safely accommodate your bariatric patients and their families. The average facility doorway can be 40 to 43 inches wide.

Stock oversized equipment such as bed frames, wheelchairs, lifts, walkers, and commode chairs. Bariatric equipment needs to be moved easily from one area to another, and preplanning with your bariatric equipment vendor will provide a valuable perspective. In addition to structural measurements, investigate community resources, such as radiology, rescue, and emergency services, that can adequately accommodate bariatric weight and width.

Step 2: Develop criteria-based protocols. Meet with your interdisciplinary team. You can use staff members that are already on board to organize and plan your program. If available, include your pharmacist, wound specialist, physical therapist, occupational therapist, respiratory therapist, dietician, clinical manager, and vendor. Most important, start with goals. Goals define and allow you to measure the desired outcomes of your bariatric program. Goals may include “Eliminate back injuries within 4 weeks.”

Develop individualized protocols and procedures. Protocols standardize methodologies to assess and provide optimal bariatric care. Clear, concise information minimizes the unnecessary cost of common and predictable complications. Best practices will support your goal of “eliminating back injuries” by stating, “Mechanical lifts will be used for all patient lifts and transfers.” Written procedures should describe how the mechanical lift is performed in a step-by-step format.

An appropriate “emergency preparedness and evacuation” plan is often omitted from the initial program. Don’t forget to update your emergency protocol regarding evacuation of a patient with special mobility needs. Patients with bariatric beds in the home should be well instructed on how to lower the extralarge side shelves in an emergency.

Step 3: Identify and obtain appropriate supplies and equipment. Assess and evaluate supply needs. Clinical procedures remain the same for the bariatric patient, but special equipment is essential to perform a procedure safely and accurately. For example, a blood pressure reading is important for all patients; however, an improperly fitting cuff can cause a falsely elevated reading and result in incorrect treatment. Facilities caring for bariatric residents must have appropriate supplies readily available in sufficient quantity prior to accepting admissions.

Select and standardize your bariatric supplies, such as longer needles (up to 5 inches in length), IV supplies, tracheotomy tubes, larger blood pressure cuffs, gowns, slippers, and incontinence products to name a few disposable supplies.

The health care industry is gradually accepting the reality that manual lifting and transferring of patients are high-risk activities for workers and patients. Correctly sized equipment is not an option, it is essential. Safe turning, lifting, and repositioning of heavy patients require oversized equipment with adequate width and weight capacity.

Right-size equipment can im-prove a patient’s functional ability and reduce his dependence on staff members. Bariatric beds come in a variety of widths and lengths with specialty mattresses, trapezes, lift and transfer systems, scales, wheelchairs, shower/commode chairs, and walkers. Fre-quent staff in-servicing is critical to the success of your program.

Step 4: Provide staff training and education. From the onset, bariatric patients are more challenging because diagnosis is difficult and treatment procedures are technically more complicated and time-consuming. The components of your educational program may include a basic review of anatomy and physiology with a focus on care issues related to managing excess tissue. For example, excess fat on the rib cage and chest prevents the chest wall from expanding fully. Therefore, caregivers should know to position bariatric patients in a semi-Fowler position to allow them to inhale and exhale more effectively. There are high-risk, yet predictable conditions associated with obesity including diabetes, hypertension, and cardiovascular disease. Anticipate these comorbidities ahead of time to ensure your clinical team is knowledgeable and has the correct products on hand.

Sensitive Issues
A session on sensitivity and attitude is basic. We live in a society where a negative attitude toward obesity is the last socially acceptable form of discrimination. Bias and discrimination occur toward the obese in critical areas of living including employment, education, and medical care. The obese patient has had years of negative experiences. Give your staff members the opportunity to discuss their feelings and concerns about caring for bariatric patients and practice tactful management of the unique challenges they will encounter.

Step 5: Implement, review, and evaluate. The facility is ready, the program is written, and staff is trained. Now develop a system for monitoring and evaluating the system.

Training staff on proper techniques for safe transferring and positioning is a key component in a successful bariatric program. Your program goal to “eliminate back injuries in 4 weeks” must be measured. Specialized transfer techniques were covered in detail with all personnel who would be responsible for repositioning and transferring patients. Bariatric beds, lifts, commodes, walkers, and trapezes not only support an ergonomically based injury prevention program, but also minimize back injuries. Frequent in-services on proper use of the equipment is a priority in the planning process.

As the bariatric population grows, issues of caregiver injury and patient safety are increasingly important in the face of the current nursing shortage, the focus on minimizing health care costs, and the increasing acuity of our patients. With a well-planned bariatric program, HME providers can supply the equipment that improves clinical and financial outcomes, as well as provides a safe environment for caregivers and patients. The number of obese patients is increasing, and we must be proactive in identifying the resources and equipment that will provide quality outcomes. DP

Carolyn Brown, CWS, is director of clinical services at Sten+Barr Medical Inc, Tampa, Fla. She can be reached via e-mail: cbrown@stenbarr.com.