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 •Numbers are rising from 19.4% in 1997 to 26.6% in 2007 •Obesity-attributable medical expenditures estimate in 2003 reached $75 billion . Eating Habits . Life Style . 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) 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+ . . 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 . Bariatric Admission Emergency vs Elective . Guidelines for the Bariatric Admission • Patient assessment • Environmental assessment • Staffing • Equipment assessment • Patient transport • *Discharge Planning . Patient • Present medical condition • Past medical history • Past surgical history • Social history • BMI score or patient’s trunk/pelvic width . Body Shape . . . 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 . . Emergency Department . . Staff • Appropriate staffing (teamwork) • Education (patient and equipment) • Communication (lift documentation tool) • Maintain handling tasks in a safe and dignified manner . . 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 . . . . . . . . . . . . . . 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 . . Bariatric Bed Accessories? . Owning vs.Renting Equipment • Based on number of bariatric admissions • Rental costs • Space needed to store the equipment . 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 . . Establish Bariatric Task Force Goal: -Provide a safe environment of care for both the bariatric patient and healthcare worker. . Bariatric Task Force Members • Administration • Nursing (licensed & unlicensed) • Rehabilitation PT/OT • Plant Operations/ Bio-Medical department • Laundry • Purchasing . Emergency vs. Elective Bariatric Admission • Design a pathway flow chart • Include patient, environment, staff, equipment, & transport guidelines • Pathway ends with safe discharge . Questions . Thank you firstname.lastname@example.org .