Larger patient size adds to ergo risk
Consider special needs of bariatric patients
When an obese patient who is fully dependent is admitted to your hospital, it doesn't matter how many health care workers try to work together to manually lift the patient. It cannot be done safely.
That is a message about ergonomics for bariatric patients that Kent Wilson, CIE, hopes to convey at the upcoming conference of the Association of Occupational Health Professionals in Healthcare, which will be held Sept. 17-20 in Denver.
In fact, Wilson, safety programs manager with Hill-Rom, the medical equipment company based in Batesville, IN, has seen instances in which three or four nurses suffered serious back injuries on the same day with the same patient. They planned to lift in unison, but invariable someone took on more of the weight. They then lost their grip, placing greater weight on one of their partners.
"It can be very deceiving and misleading about how effective that [group manual lift] can be," he says. "The weight is so far beyond a body's capability. That just can't be done."
Through workshops and breakout and poster sessions, the AOHP conference will highlight safe patient handling as well as influenza vaccination, the aging work force, behavioral health issues, and other safety concerns.
Wilson describes a "perfect storm brewing": With an epidemic of obesity in the country, hospitals are increasingly likely to care for patients who weigh 400 or 500 pounds or even greater whether they offer bariatric surgery. At the same time, the health care work force is aging, and is less capable of handling heavy loads, he notes.
"The weights are just so far beyond our capabilities; there's no amount of bending your knees or keeping your back straight [elements of proper body mechanics] that's going to protect you," he says.
In July, the Centers for Disease Control and Prevention reported that more than one-quarter (25.6%) of U.S. adults are obese, defined as a body mass index (BMI) of 30 or above. By that definition, a 5-foot-9-inch person weighing 203 pounds would be obese.
Here are some things to keep in mind to adapt to heavier patients:
- Assess the capacity of the overall patient environment. You may need to do some remodeling to make doorways wide enough. Does the toilet have a weight capacity? Does your lift equipment fit in the bathroom? "You can have a lot of good equipment, but if your environment doesn't accommodate it, it's as if it doesn't exist," says Wilson. Be sure you include an assessment of areas beyond the patient room, such as radiology, he advises.
- Check the weight limits on your existing equipment. Standard lifts often have a limit of 350 pounds or so. "We're seeing patients 600, 700, even 800 pounds on a regular basis. Many hospitals are not prepared to handle that," he says.
- Consider buying rather than renting equipment. Hospitals that rarely see very obese patients may choose to rent bariatric lift equipment on an as-needed basis. However, as the incidence of obesity rises, it makes sense to be prepared, Wilson says. "It's expensive [to rent bariatric lift equipment], and oftentimes it will not be on the spot when you need it. There will always be some delay," he says.
- Assess patient needs and injury history. How many patients of size are you treating? What patient handling injuries have your employees sustained or near-misses and what was the cause? "Without an assessment, you're guessing what your risk factors are and what your specific needs are," he says. For example, if you have high-cost or a high frequency of injuries that are related to repositioning in bed, you want to make sure your patient handling equipment includes devices to help employees safely perform that function.
- Set up patient assessment policies and algorithms. You'll need guidance for nurses and aides that directly addresses people of size. "The dependency description may change. You may have a very large patient who is able to stand and ambulate, but they may not be able to fully dress themselves without some assistance," says Wilson. That assessment should occur upon admission, he says.
- Reassess your patient needs periodically. If your surgeons begin offering bariatric procedures, you will obviously expect a surge in patients of size. But even if they don't, you may want to track how many patients of size you are seeing in your general population and the range of weights you're seeing. Make sure that your safe patient handling program keeps up with changes in your patient population, Wilson advises.
(Editor's note: More information on the annual conference of the Association of Occupational Health Professionals in Healthcare is available at www.aohp.org.)
When an obese patient who is fully dependent is admitted to your hospital, it doesn't matter how many health care workers try to work together to manually lift the patient. It cannot be done safely.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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