Manual handling in Bariatric care –Understanding the risks and looking for answers

In Australia, over 60% of adults are overweight or obese. This number steadily continues to rise, making obesity one of the biggest health concerns in the country.

The term “bariatric” refers to a person that is morbidly obese. This terminology refers primarily to measurements using the body mass index (BMI). The World Health Organisation (WHO) classifies a person with a BMI over 25 as overweight and a BMI over 30 as obese. What constitutes morbid obesity, however, is not consistent. Some classifications indicate a BMI of over 40, others look at greater than 45kg over the “ideal weight”.

The causes of obesity can be very complex, including not only diet and physical activity, but also things such as behaviour, genetics and socioeconomic factors. Associated with being overweight or obese are a number of health risks, including an increased chance of developing diabetes, cardiovascular disease and high blood pressure.

In addition to the considerable health risks that obesity presents to the individual, there are many health and safety risks for the health professionals looking after them. These risks are often compounded by the reality that many health professionals do not feel they have been adequately prepared to physically assist these clients.

Prior to assisting a bariatric client it is essential that a thorough assessment is conducted by a health professional. This assessment is used to determine the mobility and equipment requirements for that client. When looking at the movement patterns of bariatric clients, it is important to recognise that there will be differences. A larger body mass will cause a shift in the centre of gravity which will change the person’s ability to move and will also impact upon their balance, making them potentially more unstable. This change in balance may be further complicated by altered sensation in the feet due to poor circulation and an inability to see their feet due to a large abdominal pannus. Mobility can be further compromised by fatigue, reduced joint mobility and reduced muscle strength and endurance.

When working with bariatric clients there should be a clear written management plan outlining safe transfers for that person. It is essential to remember that at no stage should the carer be performing any unaided manual handling. This means that there must not be any lifting, lowering, pushing, pulling, moving, holding or restraining any of the client’s body weight unaided. When working with a bariatric client, it is essential to assess how much of the task they can perform on their own and then any hands- on assistance should be for standby directional guidance only. At no stage should the client pull on the carer, and the carer needs to be aware of allowing extra space around the client to allow for altered movement patterns. If the person is unable to assist with the task, then there should be a minimum of two to three staff members assisting with the appropriate equipment.

A number of decision making flowcharts exist for carers who provide assistance to bariatric clients. These flowcharts provide guidance on safety for tasks such as:
– bed to chair transfers
– lateral transfers
– repositioning in bed
– repositioning in a chair
(Baptiste ,2007).

In addition, the NSW government has put together a number of fact sheets and flowcharts that could be used as a guide for community care workers when dealing with bariatric clients (NSW Government, 2014).

With regard to bariatric equipment, there are a number of factors that need to be taken into consideration. Firstly, the size and space requirements of using and storing bariatric equipment must be considered when organising the trial and possible purchase of this equipment for an organisation. It is also essential that the safe working load (SWL) of all equipment meets the client’s specific needs. This should not be limited to SWL of slings and hoists, but also to beds, frames, commodes, wheelchairs, etc. It should be noted, that items such as motorized wheelchairs or bed movers may also be needed to assist staff with safe client movement. In addition, the use of specialised equipment such as the Mangar Elk lifting cushion, HoverMatt and HoverJack and in-bed patient turning systems such as the Vendlet V5 are becoming more widely used in industry. These pieces of equipment ultimately aim to minimise the effort of the carer when assisting bariatric clients either off the floor, with lateral transfers or with bed mobility and repositioning.

When looking at other ways to minimise the manual handling risks for carers working with bariatric clients, it is also necessary to determine whether hoist slings should be left on under a client. The aim of such a practice is to minimise the manual handling associated with putting slings on and taking them off repeatedly. There is much debate about whether it is clinically safe to leave slings under a client from a pressure/skin integrity point of view, however there is no conclusive evidence. As with all patient management, this decision should be based on individual assessment.

Finally, when staff are trained in safe manual handling techniques, it would be beneficial to include information about the specific requirements of the bariatric client. The use of simulation suits in training are also a useful way for training participants to identify with the specific movement restrictions faced by bariatric clients and would allow for practice in safe client handling in a simulated setting.

In summary, when staff care for obese or bariatric clients, the following things need to be considered:

  1. Staff must have access to appropriate and suitable equipment
  2. There must be adequate staff ratios to allow for the safe management of bariatric clients
  3. There needs to be appropriate policies and procedures in place at an organisational level to ensure safe work practices
  4. Workers must have access to training and information with regard to use of equipment, safe handling procedures and risk management.

References:

National Health and Medical Research Council, Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia, (2013)

Australian Bureau of Statistics, Australian Health Survey: First results, 2011-2012, (2012)

Baptiste, A. (2007). Safe Bariatric Patient Handling Toolkit. Bariatric Nursing and Surgical Patient

Care, 2(1), 17-45. http://www.liebertonline.com/doi/pdfplus/10.1089/bar.2006.9996

AUS big Fact sheets: http://www.ausbig.com.au/resources/bariatric-articles-and-information/aged-care

Fact Sheet 6 – Equipment required for the safe management of obese and bariatric clients in agedcare

Fact Sheet 4 – Needs and considerations of staff managing obese and bariatric clients in aged care

NSW Government, Family Community Services – Ageing, Disability & Home Care – Principles of handling the bariatric client (2014)

http://www.haccohs.adhc.nsw.gov.au/common_risk_areas/bariatrics/manual_handling

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