Here's What You Need to Safely Work with Bariatric Patients $0.00

Here's What You Need to Safely Work with Bariatric Patients

By: By: Rebecca Moore | Apr 18, 2019
Here's What You Need to Safely Work with Bariatric Patients

As a healthcare professional, your main goal is the safety of your patient. However, have you ever stopped and considered the implications your actions have on your own health? Over the last few years, considerable attention has been given to the injuries healthcare providers have experienced while providing patient care in long-term care settings, especially while working with bariatric patients.

“The task of caring for the bariatric patients is challenging; it puts workers at risk for injuries during repositioning and nursing care activities that assist patients in meeting their daily activity needs, such as hygiene, bathing, ambulation and dressing changes. Muir and Gerlach have identified costly injuries related to bariatric patient handling activities.”1

Here’s the bottom line: in order to provide the best patient care, you must first take care of your own health. In this article, we’ll explore the best ways to avoid injury risk while working with bariatric patients in long term care.



Injury Risk Factors For Clinical Staff


Bariatric patients involve more hands-on assistance from a team of qualified clinical professionals to perform daily tasks. Some of the most high-risk activities that can lead to injury of both the patient and the clinician include:2

  • Transferring patients to and from different rooms
  • Supporting the patient to stand upright
  • Picking up the patient, especially if there is only one clinical aide present
  • Lifting patients who are confused
  • Weighing a patient
  • Moving a patient up in bed
  • Repositioning a patient in a bed or a chair
  • Changing an incontinence product
  • Dressing/undressing a patient
  • Giving a bed bath
  • Applying anti-embolism stockings

When performing any of these tasks, clinical staff should be aware that what works for some bariatric patients may not work for another. Some patients may require more help (and more force) to perform the task, and on the other end, may have more consequential, unexpected movements that involve more counteractive force.2 Performing the same motions repeatedly without a substantial break can also cause clinical staff to fatigue, leaving them at a greater risk of using poor mechanics during a task, therefore sustaining an injury. Finally, assuming positions that place stress on the body like reaching above shoulder height, kneeling, squatting, leaning over a bed, bending or twisting the torso while lifting is one of the greatest risk factors for injury.2

Of all of the listed tasks, however, experts warn that elevating a limb, which can be necessary for dressing change, is an especially dangerous task that might be overlooked. “One leg is approximately 16% of a person’s total body weight. It is recommended that the spinal loading be limited to forces below 3400N, which is about 35 pounds. The weight of a leg of a 350-pound patient would be 62 pounds.”1 While it may seem that lifting one limb is a one person job, this could result in significant harm to a clinician.

These tasks can even become more dangerous depending on the environment in which they’re performed. For example, if you are trying to work with a patient in a room that is limited in space, has uneven floors or surfaces or has environmental hazards that can be tripped over or slipped on, there is an increased risk of injury for both the clinical staff and the patient.

In order to protect yourself and your patients from injury during any of these tasks, utilizing proper body mechanics and safe patient handling best practices can significantly lower your risk. Let’s review a few.

Proper Body Mechanics to Reduce Injury Risk for Clinical Staff


While body mechanics alone will not completely save you from injury, developing healthy movement patterns is the best starting point. If you want to learn how to utilize body mechanics to use your body in an efficient and careful way, here are the top three tips from experts:2

  1. Establish a Firm Base of Support:To ensure you have adequate balance and power, give yourself a comfortable and athletic stance.
  2. Keep Your Body in Proper Alignment: Align your body so there are no twists or contortions needed from your neck, trunk or extremities to complete the task. This will ensure that you can efficiently use your strength with as little musculoskeletal strain as possible.
  3. Remember Lifting Fundamentals: Instead of bending at your lumbar spine and generating power from your back, bend your knees into a squat and lift with your legs, glutes and core. Maintain your posture! For less strain on your arms during a lift, keep the patient as close to your body and base of support as possible.


“Should I Lift a Patient On My Own?”


While these body mechanics fundamentals will undoubtedly help you better serve your patients (and yourself), most experts advise against assisting a bariatric patient single handedly. According to the Occupational Safety and Health Administration (OSHA), “More than 30 years of research and experience shows that relying on proper body mechanics or manual lifting techniques alone is not effective to reduce back and other musculoskeletal injuries. A comprehensive safe patient handling program that combines management commitment, employee involvement, policies, mechanical equipment, training and maintenance is needed.”3

Further confirming this sentiment, the Centers for Disease Control and Prevention (CDC) recommends that clinical staff review Dr. Thomas Waters’ article, When is it Safe to Manually Lift a Patient?


“When lifting a box or other inanimate object, the lifter can usually get quite close to the object, which helps minimize strain caused by reaching while lifting. It is usually not possible to get as close when lifting a patient. In order to accommodate the added space needed when lifting a person, Dr. Waters increased the equation’s minimum horizontal distance of 10 inches (between the lifter’s spine and the object) to 14.5 inches (between the lifter’s spine and the patient). After including this change in the equation, he determined that under the assumption of an otherwise “ideal” patient handling situation, the maximum recommended weight limit is 35 lbs.”4


While body mechanic training can help staff prepare for assisting bariatric patients, it’s clear that the body alone is not enough to safely assist or transfer a patient. Some solutions to mediate both employee and patient injuries include:5

  • Use of specialized bariatric equipment designed for higher weights
  • Staff training on mobility and handling procedures and use of specialized equipment
  • Patient/resident assessments during the admission process and by nursing staff while in the patient care area
  • Development and use of patient/resident bariatric algorithms (flow charts that guide the worker on what to do during care when handling bariatric patients)
  • Mobility and handling policies specific for bariatric care

Safety Checklist for Patient Handling


When it comes to your safety and the safety of your patients, you need to cover all of your bases. Luckily, the Ohio Nurses Association’s CE4Nurses published a presentation that outlined the B.E. S.A.F.E.R. method of patient handling tasks and building a culture of safety. Follow this checklist prior to any task with a bariatric patient!6

B - Bariatric Assessment


✓ Assess the patient’s ability to assist due to medical reasons, fatigue, medications, etc.

✓ Discuss the task with the patient

✓ Ensure that the patient is medically stable for the activity

✓ If the patient has weight bearing capability, determine the stronger side to transfer to

✓ Assess patient’s level of assistance:

  • Independent: Patient performs task safely, with or without staff assistance, with or without assistive devices
  • Partial Assist: Patient requires no more help than stand by, cueing, or coaxing, or caregiver is required to lift no more than 35 pounds of the patient’s weight
  • Dependent: Patient requires nurse or caregiver to lift more than 35 pounds of the patient’s weight, or is unpredictable in the amount of assistance offered. In this case assistive devices should be used.

✓ Determine patient’s weight-bearing capacity, upper extremity strength level of comprehension/cooperation of the task,height/weight and conditions that may affect the task, like joint replacement, respiratory/cardiac compromise, history of falls and more


E - Equipment Assessment


✓ Assess the type of equipment available/needed for the task

✓ Measure the weight capacity of the needed equipment

✓ Understand the appropriate operation of the needed equipment

✓ Determine the level of assistance required to safely use the equipment

✓ To avoid interrupting care, have the correct size equipment easily accessible

✓ Remember that one size of bariatric equipment does not fit all bariatric patients; ensure the equipment meets the specific needs, body type and weight of the patient

Don’t know where to start when it comes to equipment? Bonus checklist! Here are a few products that you will definitely need for the safe handling of bariatric patients:7

S - Space Assessment


✓ Evaluate the environment for potential barriers/hazards and remove, if possible

✓ Map out a route

✓ Consider the size of doorways and equipment if the patient handling activity involves traveling

✓ Determine the amount of space needed to accomplish the patient handling task including the maneuverability of equipment and assistive personnel



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A - Assistive Personnel


✓ Determine the number of staff needed to perform the task safely

✓ Routinely obtain the appropriate support staff and equipment/patient handling aids to assist with turning, repositioning, lifting, or transferring the patient

✓ Encourage patients to assist in their own transfers whenever possible to help reduce risk

F - Formulation of the Plan


✓ Establish a plan for the patient handling activity based on the assessment of the patient equipment and space

✓ Seek input from the patient and family on successful strategies they may have employed to manage safe maneuvers in other settings

✓ Minimize, if possible, how many actions/transfers are required to accomplish the task

✓ Consider privacy and comfort issues

✓ Identify a task leader

✓ Review the sequence of the task with all assistive personnel

E - Execution/Evaluation of the Plan


✓ Have the leader direct the patient handling activity

✓ Use proper body mechanics, recognizing that using proper mechanics are not always possible and does not guarantee protection against injuries

✓ When finished, the team should debrief and identify any modifications needed to improve the procedure

✓ Document/revise the patient’s plan of care to describe the components of the patient handling activity

✓ Obtain feedback from patients regarding their comfort and experiences during the task

R - Respect for the Bariatric Patient


✓ Use special care in situations that require exposing the patient; close the door or use privacy curtains, and keep the patient covered

✓ Demonstrate respect and sensitivity to the patient

✓ Recognize that bariatric patients can experience psychological impact or emotional responses associated with discrimination and prejudice

✓ Effectively interact with your patients to promote comfort, safety, respect and compassion



We Want to Help You Help Others


We understand and appreciate your diligence with patient safety, but want to encourage you to take care of yourself: not just for the sake of your patients and the longevity of your career, but for the quality of your life overall! Do you have additional questions about safely working with bariatric patients, long-term care best practices or any general clinical questions that we can answer? Reach out through our “Ask a Clinician” portal, and we will connect you with a qualified clinical expert! At Performance Health, we’re proud to build a support system for clinicians to learn and thrive together.

Resources

  1. http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol142009/No1Jan09/Bariatric-Patient-Handling-Program-.aspx
  2. https://www.alvinisd.net/cms/lib/TX01001897/Centricity/Domain/4363/Body%20Mechanics%20and%20Safe%20Patient%20Handling.pdf
  3. https://www.osha.gov/dsg/hospitals/documents/3.1_Mythbusters_508.pdf
  4. https://www.cdc.gov/niosh/topics/safepatient/default.html
  5. https://www.leadingage.org/corporatepartners/safe-handling-bariatric-patients-and-residents
  6. https://www.ce4nurses.org/wp-content/uploads/2017/03/BE-SAFER-3-6-17pptx.pptx
  7. http://www.asphp.org/wp-content/uploads/2011/05/Baraiatrice-SPHM-guidebook-care-of-Person-of-Size.pdf
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