Solutions to Challenges Associated with Bariatric Patients

Transcription

1 Solutions to Challenges Associated with Bariatric Patients Manon Labreche, PT, CEAS 2, CHC Injury Prevention Manager Tampa General Hospital Lynda Enos, RN, MS, COHN-S, CPE Ergonomics Consultant HumanFit, LLC.

2 Case study presentation Case studies and lessons learned to meeting care needs of Bariatric patients and reduce the risk of staff and patient injury. Disclaimer: there may be many solutions for the case studies presented, however this is what worked for these patients with the equipment available at the time at TGH and Oregon Health & Science University Hospital.

3 Case Study 1 (2011) 52 year old female 910 pounds Severe lymphedema Admitted for chest pain and multiple wounds Lived at home prior to admission with family Bed ridden X 2 years Refused admission to multiple nursing homes due to weight and immobility.

4 Case Study 1 (2011) Bariatric Equipment available at TGH in 2011: Portable ceiling lifts (440 pounds capacity) Few rooms with permanent ceiling lifts (800 pounds capacity) Standard floor lifts (600 pounds) & 2 bariatric floor lifts (1000 pounds) 39 hover matts Mesh turning slings & regular limb holding slings Bariatric suite (commodes, walkers, recliner, wheelchairs etc) Bariatric beds with sides which expend to 48 (did not go into chair position) Biggest challenges?

5 Challenges: 1. Positioning patient for wound care & cleaning Solution: hover matt mesh turning sling (turned sideways) Lift team placed slings and assisted. Moved to room with permanent ceiling lift (turning is 25% of pt weight)

6 Challenges: 2. Lymphedema treatment Solution: Limb holding slings Floor lift & ceiling lift Lift team co-treat with PT/OT post nursing care Lift team applied wrap when patient turned on side during nursing care, then PT/OT came in and completed Treatment in supine position. TGH bought a full body sleeping bag lymphedema system.

7 Challenges: 3. Inserting catheter: Solution: Removed foot board Used hover matt to move patient towards foot end of bed Used two limb holding slings around upper thigh with ceiling lift on one side and floor lift on the other. Raised legs up while nurse inserted catheter

8 Challenges: 4. Supine to sit: (once patient 600 pounds after 3-4 months) Solution: Used mesh positioning slings to raise patient up in supine and turned 90 degrees to edge of bed with another mesh sling placed under and between legs (like a diaper) To maintain sitting edge of bed: anchored second mesh sling to sit to stand lift on opposite side of bed, placed dycem on floor.

9 Eventually progressed to one positioning sling

10 Challenges: 4. Sit to stand: Solution: Used foam bed bolster to block knees. Placed walker backwards and held it down while patient attempted sit to stand activity.

11 Case Study 1: Outcome After 10 months of admission: Weight 600 pounds Patient able to stand for ~30 seconds Patient admitted to nursing home for further rehab (3 months) Patient discharged home and still living at home in 2016 Article in Am J SPHM June 2015, vol 5, no 2 Lessons learned: central supply now has bariatric hover matts and bariatric limb holding slings. Started process to obtain support for a bariatric bed which converts to a chair position. Research sit to stand devices for bariatric patients

12 Case Study 2 (2013) 50 year old female 725 pounds Admitted to rehab s/p fall at home with left leg weakness, left hip pain and LBP. PTA: Lived at home and was ambulatory PMHx included: lymphedema, HTN, diabetes type 2, hypothyroidism.

13 Challenge: 1. Supine to sit: Limited by pain, poor endurance and SOB Took > 15 mins supine to sit then pt too fatigued and in pain to ambulate. Unable to ambulate for 2-3 weeks Sustained a PT injury trying to collapse the bed Solution: Obtained support to trial Bed which converts into chair position.

14 Challenge: First day in bed which converts to chair: ambulated 20 feet Other benefits: improved positioning for eating, dressing, able to breathe easier when upright.

15 Case study 2: Outcome After 1 week with new bed: Ambulated > 150 feet with supervision Able to egress from side of the bed with minimal pain and SOB Discharged home Obtained support after trial to implement to bariatric bed which converts into chair which was also more user friendly to expand and collapse bed to provide nursing care. Bariatric sit to stand added to bariatric rental agreement: (Worked with the vendor to make a wider footplate)

16 Case study 2: Patient perspective

17 Case study 3 (2015) 48 year old female 525 pounds Admitted for CP and LE swelling PMHx: anxiety, severe knee pain, depression, diabetes, HTN, fibromyalgia Admitted from a nursing facility, pt non compliant Nursing facility refused pt for D/C For 4 months case mgmt. unable to find a place to d/c pt due to weight and immobility. If she could stand and pivot, she could be d/c d to a nursing home.

18 Challenge: 1. Sit to stand and transfer training Pt independent supine to sit, but unable to get her to stand due to bilateral knee pain and anxiety. Tried bariatric sit to stand but was too painful for knees Solution: Received hospital approval to trial tilt bed X 30 days to progress weight bearing. Pt tilted twice per day and increased angle and time each day (started at 30 degrees for a few minutes) After 3 weeks, stood 3 X/day, 80 degrees X 10 mins each

19 Case study 3: Outcome After 4 weeks using tilt bed: Patient able to stand Accepted into nursing home and discharged Lesson learned: needed a better device to guard transfer from bed to commode and progress ambulation= purchased two floor lifts with ambulation arms and sling.

20 Case Study - AJ 32 year old Found living in a barn in rural Oregon Being cared for in Intermediate/Rehab care center 900lb on admission increased to 1260lbs Could weight bear but used electric wheelchair 4 carers injured at one time lifting pannus

21 Case Study - AJ Transport to hospital - 18 firemen and a truck with a winch Admitted to local hospital 1000lb dual ceiling lift capacity only CMS panel would not approve DME funding for lift equipment unless AJ lost weight!! Hospital and lift vendor paid to build 3 motor ceiling lift system on a 3 point frame around the bed Bed vendor supplied special extra, extra - wide bed Bariatric mesh turning sling and limb sling

22 Task: Wound & Peri-Care Limb sling(s) with ceiling or powered floor lift

23 Task: Foley Cath & Peri-Care Universal seated sling with ceiling lift

24 Task: Wound Care Pannus sling with or without ceiling lift

25 Task: Wound & Peri-Care Pannus with seated sling and ceiling lift

26 Task: Standing Transfer Powered sit to stand with/without harness

27 Task: Ambulation Walking vest with ceiling lift

28 Other Tasks Weighing Ceiling lift scale 600lb and 1000lb powered floor lifts with scale 800lb sit to stand with scale Lift from floor Hoverjack Ceiling/Floor lift

29 Other Tasks Repositioning/lateral supine transfers in non-lift rooms - Hovermatt extra wide Proning Ceiling lift technique; Hovermatts

30 Other Tasks In bed mobility - Bari trapeze; ceiling lift hanger bar; hanger bar with seated sling at edge of bed Standing transfer and ambulation patients under approx lb:ceiling lift with seated sling

31 Challenges with bariatric patients Having the right equipment to handle the bariatric population not only reduces injuries, but it also: reduces length of stay increases patient satisfaction promotes skin integrity enhances patient safety Decreases pain Learn from each case and continue to advance your program. Work with your facility to obtain approval for bariatric equipment. It takes time and persistence, but is well worth the effort. Bariatric patients are all unique and have various barriers (pain, anxiety, pre existing conditions, discharge plans etc,) but if you have a strong team working together, you can make the impossible, possible.

32 Summary It takes a team approach, careful planning and communication to develop and use SPH solutions for Bariatric patients One Size Does Not Fit All! Resources Comprehensive Review of SPHM Articles from : Section 12. SPHM and Bariatrics. American Journal of Safe Patient Handling and Movement, 6, (1):S Safe Patient Handling Equipment Purchasing Checklist. American Journal of Safe Patient Handling and Movement, 3, (1): S1-16. Healthcare Recipient Sling and Hanger Bar Compatibility Guidelines, American Association for Safe Patient Handling and Movement. AASPHM.org. April

33 Questions? Manon Labreche Lynda Enos