A path following
approach to
bariatric patient
transfers
Elissa Coates
National Clinical Manager
Risks of using normal equipment
• Patient:
• skin tears
• Pressure injury
• Increased dependency
• Decreased quality of care, comfort, dignity
• Longer length of stay
• Incorrect medication if weight is wrong
• Risk of injury from falls
• Staff:
• Increased handling and fatigue
• Increased risk of injury
• Morale
Challenges are still evident during the provision of care:
• in meeting the staffing needs for increased time associated
• amount of required workers to assist
• special skill knowledge required
• equipment availability
• Space and access issues
DILIGENT PHILOSOPHY
Our Philosophy
TM
Quality of Care
Maximisation of function
ArjoHuntleigh Mobility Gallery
Albert
Albert
Barbara
Carl
Doris
Emma
Essential components of a
bariatric safe patient handling program:
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Operational Procedure and Policy
Patient Assessment Tools
Communication Tools
Algorithms & Guidelines for safe patient handling (protocols).
Space & Environment Considerations
Appropriate Equipment Needs
Staff Training & Education reference tools
System for evaluation (injury tracking, patient feedback)
MaryLou Muir 2009
Bariatric Safe Patient Handling
Tools Reference Guide
• VISN 8 Patient Safety Center Of Inquiry, Tampa
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Assessment Form
Algorithms
Equipment Safety Checklist
Policy Template
Bariatric Technology Resource Guide
Medical Conditions Summary
Bibliography
Why Algorithms
• Useful for applying research to practice
• Can reduce unnecessary variation in practice
• Assists matching equipment to patient needs
• Standardises high risk tasks
• Communication is improved with standardised protocols
• Reduce staff feeling of being overwhelmed
Purpose Of Algorithms
• Tool/guide for care-planning safe patient handling for each patient
• Targeted to all caregivers directly involved in transfers
• Standardised decisions about safe techniques
• How many staff
• Which equipment
• Procedure
Algorithms for Safe Patient Handling Tasks
1.
2.
3.
4.
5.
6.
Transfer from bed to chair
and Toileting
Transfer from bed to
stretcher
Repositioning in bed
Repositioning in chair
Lifting a limb
Transporting
Algorithm #1 – Bariatric: Transfer to a chair
Equipment for Transfer to Chair
Albert : Self
Barbara : Floor to ceiling pole
Carl: Active lifter
Doris: passive lifter
or lateral device
Emma: Is out of bed seating a goal?
Seating Options
- SWL, seat dimensions, manoeuvrability
Slings Types:
Basic
Deluxe
Divided Leg
Hammock
Algorithm #2 – Bariatric Lateral Transfer
Lateral Transfers Options
• Slide sheets
• Lateral transfer chair
• Passive lifter
• Air assisted
Algorithm #3 – Bariatric Reposition in Bed
Bed Repositioning
Algorithm #4 – Bariatric Reposition in Chair
Options
Chair tilt
Slide Sheets
Passive lifer & sling
Algorithm #5 – Patient Handling Tasks
Requiring Sustained Holding of a Limb or Access to Body Parts
Holding of Limb or Body Part
• Limb Slings
Wt. of leg 16 % of body wt.
For a 140 Kg. person
Estimated leg wt. is 22 kg.
Recommendations for Hygiene Care
• Caring for abdominal folds
(pannus)
• Use flannel sheet method to
hold pannus up
• Dab with towel, powder
• Due not wipe skin as it may
tear
Algorithm #6 – Bariatric Transporting
Transporting the Bariatric Patient
Tips for Transport
• Map out route
• Measure doorways and elevators
• Match transport method with worker and patient abilities
• grab rails to be suitable to support bariatric patient
• Complex Patient Transport Vehicles
• Beds that expand and reduce may assist with access
Equipment Management Tools
• Checklist to track equipment
specs
REFERENCES
• Nelson A.L (2001) Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement. Tampa,Fl:
Veterans Administration Patient Safety Centre of Inquiry
• Nelson Audrey Protocols for SPHM For Bariatric Patients SPHM 2005
• The Guide To Handling People 5th Edition: Published by Royal college of Nursing and the National Back
Exchange
• Hahler, Barbara. Morbid Obesity: a Nursing Care Challenge. Med Surg Nurs 2002 11(2):85-90
• Nelson A.L (2001) Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement. Tampa,
Fl.: Veterans' Administration Patient Safety Centre of Inquiry
• Muir and Gerlach Canadian Nurse 2002
• Muir M, Chapter: “The bariatric patient” pg99-109, Guideline for Architects and Facility Space Planners, 2nd
Edition, Arjo Eslov Sweden 2005
• Muir M, Haney L, “Designing space for the bariatric patient” Nursing Homes Long Term Care Management;
Nursing Home Magazine; Nov 2004
• Waters TR. When is it safe to manually lift a patient? Am J Nurs. 2007;107(8):53–59.
• United States Department of Veterans Affairs. Safe Bariatric Patient Handling Toolkit. Updated January 14,
2009. http://www.visn8.med.va.gov/patientsafetycenter/safePtHandling/ToolKitBariatrics.asp
• Nelson A, Baptiste A. Evidence-based practices for safe patient handling and movement. Online J Issues Nurs.
2009:9(3).
• Nelson A, Motacki K, Menzel N. The Illustrated Guide to Safe Patient Handling and Movement. New York:
Springer Publishing Company, 2009.
• MARYLOU MUIR, CANADA
Bariatric Solutions