The medical journal The Lancet found that the rate of obesity in Australia is increasing faster than anywhere else in the world. The 2014 study shows that almost one quarter of children and two thirds of adults in Australia are overweight, suggesting that Australia’s healthcare system should be both well-equipped and prepared to deal with the growing rate of obese patients (1).

Patients who are obese or severely obese come under specialist bariatric care. Bariatric patients will fit two or more of the following criteria (2);

• Patient will weigh 120 kilograms or more
• Patient body mass index (BMI) is 35 or more
• Patient’s hip width will be 51 centimetres or more when seated

These measures are in place to offer the patient the safest and most dignified manner of care. Bariatric patients are dealt with separately as their care requires detailed planning beforehand, some specialist equipment and extra nursing staff.

Related CPD Training: Care of Clients with Bariatric Needs - Developed by the Royal District Nursing Service

Special requirements for bariatric patients

As opposed to patients who have a lower body weight, bariatric patients are more susceptible to health conditions and diseases, and can even have a reduced life span of up to fifteen years depending on the intensity of their condition. Chronic illnesses, skin conditions, heart disease, depression, cancers, obstructive sleep apnoea are just a few conditions which affect bariatric patients; however all indicate the need for special medical care (3).

Skin conditions are the most prevalent in bariatric patients as they have increased skin folds, larger abdomens and may have difficulty in maintaining hygiene and toileting standards. This can lead to rashes and ulcers in deep tissue folds, fluid retention and poor blood circulation. The skin also becomes more prone to infections and tearing, therefore as nurses handle and deliver care to bariatric patients additional care is required to prevent further skin damage (3).

In principle though, bariatric patient handling should be no different than regular lower weight patients. However as size, weight and body dynamics of bariatric patients vary greatly than from a lower weight patient, handling and moving practises need to be specially considered.

Bariatric patients will weigh over 120 kilograms; some patients may even be non-ambulant requiring extra assistance. Therefore there is a potential risk for injuries to nursing staff and patients if any attempt is made to manually lift the patient. Proper equipment, systems and procedures have been set in place to ensure a safe working environment and deliverance of care, for both the patient and the healthcare team.

All patient care should be discussed with the patient, and their carer if necessary beforehand to preserve patient dignity. This allows for the patient to share any of their concerns also, especially in regards to handling and moving requirements.

Bariatric patient assessment

When there is a planned patient hospital admission, detailed information and patient requirements should be obtained from the referring clinic or doctor. This allows for moving and handling equipment to be obtained and set up before admission. If the patient is admitted on an emergency basis, a moving and handling assessment should ideally be completed on arrival (4).

A detailed patient assessment will require cooperation from patients themselves and possibly carers and family members. The assessment should consider the following factors and patient ability (4);

• Patient weight on admission to hospital
• Ability to bear own body weight
• Whether the patient is able to move in bed
• Mobility or requirements when being transferred
• Any skin conditions
• Personal hygiene and toileting needs, whether any assistance is required
• Patient seating and whether assistance or special chairs are required

Once a detailed assessment is carried out, any required specialist equipment should be made available or kept on standby as and when required. This includes specialist beds, chairs, commodes, hoists, wheelchair and walking frames which can support a bariatric patient’s weight (4).

Nurses are at a high risk of strains, sprains, musculoskeletal injuries and overloading weight on the spine when caring for bariatric patients. Everyday nursing activities such as caring for patient hygiene, bathing, assisting in patient mobility and dressing changes all require nurses to assist in repositioning the patient.

Nurses and healthcare staff should not lift patients under any circumstances as it is a major health and safety risk. It can often be necessary to lift a patient limb during dressing changes; hence it is advised that a mechanical hoist is used in order to do so. It is estimated that one leg is equivalent to approximately sixteen percent of a person’s overall body weight, which clearly exceeds a safe lifting load in bariatric patients. It is also essential that healthcare staff is aware of the weight capacity of the specialist equipment, to avoid injury or harm to patients and staff (5).

There are multiple electrical devices available to weigh bariatric patients such as ward chair and wheelchair scales, and hoists. Each weighing device will differ in the maximum amount of weight it can hold therefore careful consideration should be taken before the patient is weighed. Reasons for weighing the patient should always be discussed with the patient beforehand, as to preserve patient dignity (4).




Sources:

• The Lancet
• AusBIG
• Nursing World
• NHS
• Nurse Uncut