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The rise in obesity in America has increased the risk of injury for health care workers and has created an ergonomic challenge, as hospitals treat patients who exceed the weight limits of traditional lift equipment. Hospitals that provide services to bariatric patients, such as gastric bypass surgery, have a clear need for special ergonomics equipment. But because morbidly obese individuals often have serious health conditions, other hospitals are increasingly likely to treat these patients.
Hospitals should be aware of the limits of their transfer equipment, usually from 300 to 500 pounds, and should have a contingency plan for coping with larger patients, says Guy Fragala, PhD, PE, CSP, director of environmental health and safety at the University of Massachusetts Medical Center in Worcester. "If they get a patient who comes in and they don’t have the proper equipment to deal with it, they’re going to have injuries," he says.
That is exactly what happened at Pitt County Memorial Hospital in Greenville, NC, when health care workers needed to care for a 600-pound patient. "We were in no way prepared. We had people injured," recalls Patricia Dalton, RN, COHN-S, administrator of occupational health at the hospital, which is part of the University Health Systems of Eastern Carolina. "It was just a nightmare." The hospital immediately formed an interdisciplinary team to look into the issues and equipment needed for treating the bariatric patient.
The first stumbling block is finding appropriate equipment. When Northeast Georgia Medical Center in Gainesville began offering a gastric bypass procedure, physicians and managers anticipated that patients would not exceed 450 pounds. Lift equipment had a maximum weight of 600 pounds. But the hospital has handled patients of 650 pounds and higher.
"A lot of times, you can’t see all the needs that are going to present themselves until you get into it," says employee health manager Barbara Bevilaqua, RN, COHN-S. "We’re always looking for new equipment."
Ergonomics experts advise hospitals to locate a source of equipment and to have a contingency plan, even if the current patient population doesn’t include bariatric patients. (See "Ergonomic resources for bariatric patients," in this issue.) "[Health care workers] should never try to move bariatric patients without assistance technology," says John Lloyd, PhD(c), MErgS, CPE, director of the biomechanics research lab at the James A. Haley Veterans’ Hospital in Tampa, FL. "The patient could become combative, or the situation could change in the middle of a procedure in which they become more dependent or less dependent."
Although the number of such patients nationwide is small, transfers of bariatric patients are "responsible for a large number of injuries among nursing professionals," he says. Hospital staff should be aware of the weight limitations of their current lift and transfer equipment and should consider the options of renting equipment or buying special devices. "There are many companies that can get the equipment to you in just a couple of hours," says Lloyd, who coordinated the development of a Technology Resource Guide for the VA’s Patient Safety Center in Tampa.
Lloyd also cautions employee health professionals to determine the true weight of the patient, either from available medical records or a bed-based scale. "We had a patient at the VA nursing home in Tampa who came in and claimed to be 1,000 pounds. As a result, the staff refrained from using some of the handling equipment," he says. "When we were actually able to weigh the person, we found out he was only 450, and we have equipment to handle that."
Some hospitals have turned to innovation to solve ergonomic problems. At Pitt County Memorial Hospital, engineers in plant operations worked together with an in-house ergonomist to design a motorized patient transfer device to assist in the transfer of bariatric patients from ambulances to the hospital. The device is self-propelled and adjustable. "We would have bought them if there had been anything on the market that worked," says Dalton. "We couldn’t wait until they were designed."
Dalton also discovered a product that uses seven-inch straps beneath the patient and allows for incremental movement. The product, made by AryCare of Shalotte, NC, makes it possible to turn the patient easily for skin care or bed changes.
"The straps stay under the patient all the time on the bed," says Gene Smith, president and CEO of AryCare and designer of the product. "They are coated with lambs’ wool. We’ve had patients on these straps for 10 years who have never had bed sores."
At Salem (OR) Hospital, Mary Ellen Ramseyer, RN, manager of employee health, discovered the Hover Matt air mattress, which is useful in turning or moving a patient in bed or for lateral transfers, she says. "In a normal situation, with a 200-pound person on a Hover Matt, it becomes extremely easy for one person to move that person," she says. "It doesn’t take much effort at all." Custom mats can be ordered for larger beds, or nurses can use two regular-sized mats, she says.
Equipment innovations are likely to improve as companies strive to meet the needs of this portion of the patient population. Almost one-fourth of Americans have a body mass index above 30, according to federal health surveys. People with a body mass index above 30 are considered morbidly obese.
Health care workers also need education on good body mechanics, how to use lift equipment, and team work to minimize the chance of injury, says Rick Barker, CPE, manager of patient and caregiver safety for Hill-Rom in Batesville, IN, which produces a bariatric bed and chair device.
The serious health care needs of bariatric patients make the availability of lifts and transfers even more important, notes Dalton. "If you’re going to accept these patients — whether they’re coming here for that [gastric bypass] procedure or not — these are not healthy people," she says. "They might just as well show up on your doorstep for an appendectomy, heart attack, or stroke. You can’t say you’re not going to take them, because there’s no one else to take them."