Handling Bariatric Patients and Residents with Care

Because of lifestyle choices and high caloric/fat meals, the average healthcare patient's size and weight are increasing while the worldwide population's average body weight continues to rise. There is currently a need to investigate how healthcare workers may provide outstanding patient/resident care and safe bariatric patient handling while preventing injury to themselves or the patient/resident. Understanding what obesity and bariatrics are, the potential for injury, and the many approaches to control these injuries is crucial as part of an effective risk management program.

What exactly is obesity?

Obesity is defined by the World Health Organization (WHO) as "abnormal or excessive fat buildup that may damage health." Patients are categorised as underweight, healthy weight, overweight, obesity I (30.0–34.9 kg/m2), obese II (35.0–39.9 kg/m2), and obese III (40kg/m2) using the body mass index (BMI), which is defined as weight in kilograms divided by height in meters squared. It's worth noting that, while BMI can be used to determine obesity, it only provides limited information on muscle mass against fat tissue, which explains the overlap between those who are "overweight" but whose excess weight is mostly made up of lean body mass.

The American Medical Association (AMA) divides obesity into three categories: Grade I (30-34.9), Grade II (35-39.9), and Grade III (> 40).

Type 2 diabetes, coronary heart disease, gallstones, hypertension, stroke, and some types of cancer, such as endometrial, breast, prostate, and colon malignancies, are all pathologic illnesses linked to obesity. Obesity causes a variety of health risks, but not everyone who is obese will develop these medical conditions due to "obese survivorship," which refers to the idea that only a few people become chronically ill or disabled as a result of their obesity, while the majority of people live their lives in relative health despite their excess weight.

What exactly is bariatric surgery?

Obesity and its related diseases are dealt with by the specialty of medicine known as bariatrics. Bariatric surgery, medical weight reduction management algorithms, and nutritional support are some of the services provided by bariatrics specialists within supporting healthcare systems. While some patients have achieved significant long-term weight loss by dietary changes, increased physical activity, or pharmacological therapies on their own, others may require more severe intervention in the form of bariatric surgery or drugs. Even after using these rigorous measures, many people who have surgeries or start pharmaceutical regimens still struggle to maintain a healthy body weight as their metabolism adjusts to their new diet and lifestyle. As a result, all personnel, regardless of speciality or degree of training, must be aware of how to transport and handle patients/residents properly.

For healthcare providers, injuries resulting from patient handling activities are a constant concern. This is largely owing to the rising weight of patients/residents who require care, as well as a trend in the acute care setting toward fewer physically demanding duties. In fact, it's been estimated that 40-75 percent of nursing staff injuries happen during patient transfer and mobility activities (such as standing transfers, bed mobility maneuvers, and patient repositioning). As a result, a population whose average body weight exceeds what was previously thought to be "average" will see even more injury incidents among healthcare personnel. As a result, it's vital that everyone involved in the care of bariatric patients/residents - doctors, nurses, respiratory therapists, physical/occupational therapists, dieticians, and others – has a basic grasp of what might go wrong while moving and positioning these people.

What are the potential dangers?

Muscle strains or tears, lacerations, compressive neuropathy resulting in local paresthesia or frank paralysis, slips/falls on wet floors with subsequent trauma such as hip fractures or lumbar spine injuries, loss of balance due to unstable surfaces beneath one's feet leading to uncontrolled falls onto lower body regions such as the pelvis, iliac bones, femur, tibia, or feet, or shear injuries can all result from patient handling activities. Many of these risks are exacerbated by the fact that obese patients/residents frequently have one or more comorbidities (i.e., conditions other than obesity), such as osteoarthritis (joint degeneration), degenerative lumbar spine disease, and other pathologies that put them at risk for musculoskeletal injury if they are moved incorrectly.

What do you mean when you say "incorrectly?"

It is critical to clarify two essential ideas when addressing patient handling activities: forward transfer and lateral transfer. When a person pushes an object (such as a patient/resident) forward and away from their body, it is called a forward transfer. Lateral transfer happens when a person moves an object (such as a patient/resident) across their own body laterally (i.e., left or right). Both of these transfers can be accomplished with either right or wrong technique.

The following critical components are included in the safe handling of bariatric patients and roper technique for both types of transfers:

1) Get as close to the thing as possible so that you may easily reach it;

2) Maintaining excellent posture and avoiding low-back ailments by keeping your back straight.

3) bending at the knees rather than the waist;

4) Always keeping the object near to your body;

5) maintaining the center of gravity above the support base; and

6) Before moving the patient or resident, communicate with him or her about what you're about to do.

How can you tell if you're doing it wrong? When the handler bends at the waist instead of maintaining his back straight and his knees bowed, this is known as bending at the waist. The handler is putting undue strain on the low-back muscles in this manner, which might lead to damage over time. Also, observe that she has decided to shift her patient across the bed rather than staying close to the bed and completing a thorough lateral transfer across her own body, which adds to the lack of stability in this position.

What is the best way to go about it? When the handler bends at the knees while maintaining the back straight and near to the object, there is little risk of injury from inappropriate technique. Also note how much more stable this position is as a result of the handler's decision to move the patient across the back of his own body rather than beyond it.

The most important thing for any healthcare worker to remember is that patients/residents should never be moved in a way that causes them discomfort or makes them feel unsafe; if they do not feel safe with how you are moving them, they will resist, regardless of how much they need your assistance (or even want it). Remember, if you think you're working too hard, you're definitely working too hard! As a result, in order to undertake safe patient handling activities, it is frequently necessary to call for a bariatric equipment service or medical equipment service, use correct equipment (i.e., gait belts), and/or minimize the number of healthcare professionals required.