THE HANDLING OF BARIATRIC / HEAVY PATIENTS (over 25 stone/160kg) PROCEDURE Reference Approving Body Implementation date 11 Documentation Control Part of HS/SP/005 Senior Management Team Procedure for the Handling of Bariatric / Heavy Supersedes Patients Version 6 (HS/SP/005) in Manual Handling Policy A selection of Divisional & Non-Clinical Managers, Consultation Back Care Trainers, Health & Safety Leads, Trust undertaken Health & Safety Committee, Quality Risk and Safety Committee Date of completion of Equality Impact (in Manual Handling Policy) Assessment Date of Completion of We Are Here for You (in Manual Handling Policy) Assessment Date of Environmental (in Manual Handling Policy) Impact Assessment Target Audience All Clinical staff, Equipment library Supporting documents and references Review date March 2020 Lead Executive Author/Lead manager Further Guidance/Information Manual Handling Policy East Midlands Ambulance Service Bariatric person Discharge Assessment Medical Director Margaret Stone, Ergonomics Manager Margaret Stone, Ergonomics Manager ext 57616 / 62745 Neil Mart, Head of Organisational Quality, Risk and Safety Ext 76018 1
Paragraph Contents Page Number 1 Introduction & Background 2 2 Definition 2 3 Statement of Intent 3 4 Roles & Responsibilities 3 5 Information for Handling of Bariatric / Heavy patients at NUH Flowchart for Bariatric / Heavy patient admission at NUH Bariatric bed choice Decision process Flowcharts 4 6 Under 26.5 stone (168Kg) at NUH 7 Over 26.5 stone (168Kg) at NUH 8 Hoist Provision for Bariatric patients at NUH 9 Emergency Evacuation of a Bariatric patient at NUH 10 Manual Handling Equipment available at NUH 11 Appendix 1 East Midlands Ambulance Service Bariatric person 12-15 INTRODUCTION AND BACKGROUND The Trust recognises that all patients have individual clinical needs and therefore has a responsibility to ensure that the relevant resources are available to meet those requirements, and to safeguard the health & safety of staff. The Trust has also identified that there has been an increase in the number of clinically obese (Bariatric) patients attending both Queen s & City Campus as both in-patients and outpatients. DEFINITION The term Bariatric is used to refer to a person weighing over 25 stone (160Kg) and / or with a Body Mass Index (BMI) of more than 40. 2
However it is recognised that some people will not fit this definition due to individual variations of their size and body shape, but have similar problems to that of a Bariatric person. Therefore anyone whose weight / size and body shape causes manual handling issues for staff are included in the definition of a Bariatric person. STATEMENT OF INTENT These guidelines set out the Trust s arrangements for providing information on how to manage a bariatric patient during their stay; also how to access the appropriate equipment to move and handle patients. This Procedure document must be used in conjunction with the Manual Handling Policy. The guidelines and flowcharts have been developed so as to enable staff to care for all patients in an appropriate, sensitive and safe manner, maintaining their dignity at all times; and recognising the need for specialist equipment as appropriate. Whenever a patient is admitted to the Trust the following guidelines and flowcharts MUST be followed to ensure that the most appropriate moving and handling equipment is made available and practices are used. ROLES AND RESPONSIBILITIES Divisional Directors, Executive Directors, Divisional Nurses, Heads of Service, Ward, Clinic and Department Managers are responsible for ensuring that all staff working in clinical areas are aware of the guidelines and flowcharts. That staff are responsible for working to the information set out within it and sufficient resources are made available to ensure the safe moving and handling of the patient. Where specialist advice or planning is required staff should contact Ergonomics Manager (EM) for assistance. All health care professionals who are responsible for the admission / discharge of, or, for arranging admission / discharge of patients, including pre-assessment unit or outpatient clinic, are required to follow the guidelines and flowcharts. The member of staff who organises a patient s transfer to another ward / department is responsible for informing the Fire Officer / Site Matron and Ergonomics Manager of the patient s new location. The Site Matron is to be kept informed of the patient s location at all times to ensure that appropriate resources are allocated to an area in the event of an emergency evacuation being required. Assessment prior to discharge must be completed and the information obtained shared as required with the appropriate external agencies eg Ambulance Service & contracted transport service(appendix 1). On discharge, all equipment loaned to the ward must be cleaned and disinfected as per the Infection Prevention Control, Cleaning and Decontamination Policy and returned. If extra / specialist bariatric bed and hoist is required out of hours, the person in charge of the ward / dept can request these. from Medstrom direct. 3
Information for Handling of Bariatric / Heavy Patients at NUH (above 25 stone-160kg) All Patients must be weighed on arrival to the Hospital or within 24 hours of admission (unless there is a clinical justification for not doing so). Patients must have a Manual Handling Assessment completed within 24 hours of admission and / or before any attempt to undertake any moving and handling. This assessment should be kept up to date and MUST travel to all departments with the patient. If extra resources are required the Assessor MUST inform the appropriate Manager as soon as practicable so arrangements for assistance can be made. (Advice to be sought from Ergonomics Manager if appropriate). All equipment must be used in accordance with manufacturers guidelines and any training provided. Standard hospital equipment is suitable for use by patient weighing up to 160Kg (25 stone) with the exception of: o Bed-side chairs weight limit 114Kg (18 stone) o Commodes weight limit 127Kg (20 stone) o Beds Avant Guard 1200 190Kg (30 stone),evolution 150 168Kg (26.5 stone) Avant Guard 1600 (Critical Care) 210Kg (33 stone) For weight limits of equipment see Manual Handling Equipment List Page 11 Any equipment not available in the ward / dept should be borrowed from the Equipment Library, other ward areas or hired from approved companies identified on the list if required equipment is not available in the trust (Note: a cost code will be required prior to ordering). Staff should ensure that the Safe Working Load (SWL) is not exceeded when equipment is provided and used for the patient. When bariatric equipment eg beds are delivered out of hours, staff will receive training on its use by the contractor Medstrom as it is delivered. This training can be followed up on the next working day by contacting the equipment library to arrange training by the clinical advisor. The attached flowcharts outline the protocols to be followed for all Bariatric patients being admitted or attending as an outpatient. (For additional advice please contact the EM.) When bariatric beds are in use with other extra large equipment the patient requires, the available space around a standard bed area is insufficient to accommodate safe moving and handling. The bed at the side of the patient must be vacated to allow extra space to enable safe handling to take place. A bariatric patient should not be nursed in a side room unless the bed can easily be removed in the event of an emergency situation. If a gantry hoist is used request a repo sheet to assist with the movement of the patient for turning etc in bed (contact EM for more information)weighing facility available: Emergency Department QMC or Burns & Dialysis Units CITY (weigh-bridge) When arranging the patient s discharge: o Ensure that all appropriate agencies involved are provided a copy of the patient s manual handling assessment. 4
o o o If an ambulance is required for discharge, ensure that Ambulance Control is given sufficient time to arrange appropriate transport (up to 48 hours notice maybe required). Complete a Bariatric Person shared information sheet (Appendix 1) and send to EM and East Midlands Ambulance Service for review as soon as possible. If any other form of transport is required this should be booked early on the day required, providing all necessary information in relation to this patient including their weight. Following discharge, any equipment hired or loaned by the ward, must be cleaned / disinfected in accordance with the Infection Prevention Control, Cleaning and Decontamination Policy before being returned. Staff making a request for a Patient Escort to move a patient must provide details of the patient s size, weight and requirements, to enable the correct size equipment to be provided. A Mortuary technician must be informed when a deceased patient weighing more than 190Kg (30 stone) requires transfer to the Mortuary, to ensure that an appropriate method of transfer is arranged and suitable storage space is available. Note the patient may be stored in the Undercroft Mortuary (QMC) on their bed until such time as the funeral director can collect them from NUH. For information regarding the storage of patients at City campus out of hours please contact Bleep technician via switchboard available 24 hours a day. 5
Flowchart for a Bariatric / Heavy Patient s Admission at NUH Patient to be admitted (Person admitting this patient is responsible for informing the following staff as appropriate) Emergency Admission Pre-assessed Admission Out of Hours Normal working hours Immediately following Pre-Assessment Inform Site Matron Bleep 784 3000 On next working day Inform Ergonomics Manager Ext 62745 / 57616 Inform Fire Safety Manager Ext 62399 & DNM of patient s location within the Trust Out of Hours the Nurse in charge of the ward / dept can request delivery of bed/hoist from Medstrom. Inform Ward & Allied Healthcare professionals Inform Equipment Library to arrange appropriate bed / equipment Ext 64287 Manual Handling Assessment / Risk Assessment to be completed; to ensure appropriate equipment and No:s of staff are made available at all times Inform X-Ray department including Patient Escorts if patient is required to attend the department for investigations Inform Theatres including Patient Escorts if necessary to arrange use of the heavy-duty theatre table by bleeping the Theatre Co-ordinator NOTE: Out of Hours the Nurse in charge of the ward / dept can request delivery of bed/hoist from Medstrom. 6
Bariatric Bed Choice Decision Process at NUH Patient admitted weighing LESS THAN 168Kg (26.5 stone) All patients MUST be weighed on admission! (use ward scales / weigh bridge in ED) Avant Guard 1200 & (Weight limit 190Kg/30stone) Evolution 150 beds (weight limit 168Kg/26.5 stone) are the standard beds available for use at NUH Avant Guard 1200 bed Critical Care use Avant Guard 1600 beds (weight limit 210Kg/33 stone) Is the Patient too wide to turn on the bed? Avant Guard 1600 bed Yes Contact Equipment Library Ext 64287/59466 in Normal working hours (08:30 17:00) Call Porters (out of hours) OR if no bed available the nurse in charge of the ward / dept should contact Medstrom to request a heavy duty bed. Heavy duty beds include: Total Care bed ProAxis bed Joerns bed For weight limits see page 11 No Evolution 150 bed Remain on Avant Guard 1200 / 1600 or Evolution 150 Bed Note: Ergonomics Manager (EM) Ext 62745 / 57616 MUST be informed of ALL patients admitted weighing above 160Kg (25 stone) During normal working hours / as soon as practicable on next working day 7
Bariatric Bed Choice Decision Process At NUH Patient admitted weighing MORE THAN 168Kg (26.5 stone) All patients MUST be weighed on admission! (use weigh-bridges in ED, Burns & Dialysis Units) Does the Patient need pressure relief / Is the patient at high risk of pressure damage / unable to turn or have pressure damage? Out of Hours Locate appropriate bed from bed stores. If none available the nurse in charge of the ward / dept to contact Medstrom to request a bed. Joerns bed is suitable for patients who have a grade 3 or 4 pressure sore. Yes During Normal Working Hours (08:30-17:00) contact Equipment Library / Ergonomics Manager for suitable bariatric bed ext 64287 NB: If the patient is on a Joerns bed a Gantry Hoist is required. (2 bed spaces need to be available) Gantry Hoist is required for patients weighing over 300Kg/47 stone available from Medstrom Gantry Hoist ProAxis Bed Joerns Bed Note: Ergonomics Manager (EM) ext 62745 / 57616 MUST be informed of ALL patients admitted weighing above 160Kg (25 stone) During normal working hours / as soon as practicable on next working day NOTE: Out of hours the nurse in charge of the ward / dept can request delivery of bed / hoist from Medstrom. 8
Hoist Provision for Bariatric / Heavy patients at NUH Patient on ProAxis Plus / SMART bed Patient on Joerns bed No Is Patient above 300Kg / 47 stone? Yes Gantry Hoist required See Hoist Directory Available on Intranet in Health, Safety & Ergonomics webpages For listings of all hoists in the Trust including weight limits. Arjo Hoist Liko Hoist 2 bed spaces required Gantry Hoist Call Facilities Helpline or Switchboard (out of hours) to arrange removal of curtain rails (Priority1) Request Gantry Hoist from Medstrom (nurse in charge to request Out of hours) NOTE: Out of hours the nurse in charge of the ward / dept can request delivery of bed / hoist from Medstrom. 9
Emergency Evacuation of a Bariatric / Heavy Patient at NUH Bariatric beds should be situated in a bed space close to the corridor & MUST NOT be placed in a side room (exception in CCD) All patients MUST have a Manual Handling Assessment completed Patient sat in a chair Patient in Avant Guard 1200 Evolution 150 bed Avant Guard 1600 (Critical Care) Patient in ProAxis Plus or SMART /Joerns bed Is the patient independent? No Patient needs assistance ProAxis bed Yes Transfer into wheelchair or bed Joerns bed Lead to safety Move to safety At least 4 staff will be required to move a patient on bariatric beds Note Care must be taken when negotiating fire doors & lifts as the bariatric beds only just fit! 10
Description Manual Handling Equipment available at NUH Upto 114Kg 18 stone Between 120-158Kg 19-25 stone Between 165-254Kg 26-40 stone Between 260-317Kg 41-50 stone Between 324-381Kg 51-60 stone Avant Guard 1200 Bed 190Kg limit Avant Guard 1600 Bed (Critical care) 201Kg limit Evolution 150 Bed 168Kg limit Ultra-low bed (Montcalm) 222Kg limit Total Care Bed (Sport) 201KG limit ProAxis Plus / SMART Bed N/A N/A Joerns Bed N/A N/A 444Kg limit Heavy Duty Gantry Hoist NA NA NA Above 300Kg Bed Monkey pole 227Kg limit Hoists See Hoist Directory on Trust Intranet Health, Safety & Ergonomics Webpages Trolleys Standard 177Kg limit Trolleys Lifeguard 50 (in ED) No: 9 Trolley for transfer to 190Kg limit Mortuary Mortuary Traction trolley *Theatre table Alpha Star 222Kg limit *Theatre table Alpha Star+ 355Kg limit *Theatre table Eschmann 127Kg limit Manual *Theatre table Eschmann T20M 355Kg limit *Theatre table T50 Maternity 300Kg limit CT / MRI Scanner table 190-203Kg limit Chairs Standard Chairs Heavy Duty via Equipment Library Wheelchair foldable Wheel chair Portering / Public 190Kg limit Wheelchair Heavy Duty Equipment Library Commode Standard 127Kg limit Commode Heavy Duty via Equipment Library Available to Hire Slide sheets Emergency lifting sheet 127Kg limit Rotunda / Rota-stand Transfer board Patslide Zimmer frame Available to Hire Available to Hire Available to Hire *Weight limit on Theatre tables is dependant on the required position for surgery (see Manufacturer s guidelines) If required out of normal working hours the nurse in charge can request these direct from Medstrom. Some Bariatric equipment is available from the Equipment Library Please contact them in the first instance Equipment Available to Hire from: Nightingale Beds 01978661699/1 st Call Bariatrics 01279425648 cost code required prior to ordering 11
Form 1 Appendix 1 East Midlands Ambulance &/or other transport provider Bariatric Person Discharge Assessment Persons Name Address Contact Number Age Sex Details of the Persons Physical Characteristics (Please give as much information as possible) Weight Accurate or estimated please indicate Height BMI Body shape Level of Mobility Please give details Details of home environment/access Consider widths of: garden gates, paths, doors, steps, thresholds, hallways, stairs, room size Details of relevant medical conditions Equipment available on scene Form completed by Designation Individual consent: I hereby give my consent for the information on this form to be circulated to agencies that are or maybe involved in my immediate or future ambulance transportation. I also give permission for any photographs to be taken relevant to this risk assessment. Persons signature Date signed This form when complete must be sent to: 1. Ergonomics Manager, NUH. 0115 9249924 ext 62745 / 57616 2. Transport Liaison (East Midland s Ambulance Service & any other transport provider) 12
Form 2 Bariatric Person Discharge Assessment Patient / Service User Information 1. Who will this information be for? The information collected on the reverse of this sheet will be distributed amongst health and social service agencies who may at some time be involved in your transport requirements. 2. What is the purpose of this information? From time to time many of us require ambulance transportation. All employers have a duty of care towards their staff, which includes manual handling activities associated with moving and handling of people. This shared information sheet has been compiled to enable participating agencies to share details of risk assessments which have been conducted on the heavier people. As part of safer manual handling policy for our staff we along with other agencies across the East Midlands are collating this information.3. Do I have to take part? It is entirely your decision as to whether or not you wish us to share this information. If you decide to participate you will be asked to sign a consent (Form 1)4. What if I don t take part? A decision not to allow the information to be shared will not affect the standard of care you receive. 5. Why do you require personal information? We require basic information about your weight (accurate or estimated) and details of your mobility, plus any medical conditions, which may affect either. This information will be forwarded to the East Midlands Ambulance or any other transport provider. 6. Will someone visit me at home? An advisor from this service may visit your property to review access and its suitability for ambulance stretchers and any other equipment that may be required. This may involve taking measurements of such things as gateways, front and internal door widths, garden paths, slopes and surfaces. On occasions digital photos for future reference may be taken. All this information will help advisors establish a safe system of work for those potentially involved in your future handling. 7. Where will this information be stored? This information will be placed on their systems to enable an appropriate response to any future calls for assistance. If a call for ambulance assistance should be made on your behalf the normal service response will be enacted whilst at the same time having been alerted by the stored information, an ambulance containing specialist handling equipment of the heavier person would be alerted. This ensures the most suitably equipped vehicle is sent to assist as early as possible. Form Sent (please tick) If you require further information, please contact the East Midlands Ambulance Service NHS Trust, Beechdale Rd, Nottingham, NG8 3LL. Tel: 0115 9296151 or contact other transport provider. 13
Form 3 Bariatric Person Discharge Assessment To be completed by staff admitting the patient in readiness for discharge. Prior to admission, transfer or discharge consideration Patient s Name: should be given to the following points: Address: 1 2 3 4 5 6 7 8 9 10 Level of patient mobility, can they walk if so how far and can they negotiate steps? Any postural considerations? What specialist equipment will be required, including, hoists, slings, bariatric ambulance, Mangar Elk etc? Does the patient have their own serviceable wheelchair, if so will it fit through doorways? Number of staff required? A minimum clearance under the bed or chair of 14cm (5 1 / 2 inches) is required to enable the hoist to fit under. How does the patient normally move at home, is there a suitable serviceable hoist available can it be moved from room to room if necessary? If the patient is to be moved too or from bed and it s possible to use a mobile hoist, what alternatives are available? What are the widths of the doorways, they need to be at least 34 for a bariatric stretcher. Are there any steep or gravel drives to be negotiated are the paths suitable for either a stretcher or chair? Are there steps either inside or outside the property including thresholds which will need to be negotiated, if so what height? Comments: 14
11 12 13 14 15 Transport stretchers require approximately 7 feet clearance to turn 90 degrees; a wheelchair requires approximately 5 feet will this create any foreseeable difficulties? Will structural alterations be required to facilitate the safe removal or repatriation, if so who will assume responsibility for it? Will it be necessary to remove garden fences and posts, gates furniture? If planning to create better ambulance access has consideration been given to ground stability? Will it be necessary to move this patient downstairs, if so how is this proposed? Consider obtaining advice from EMAS & / or other transport provider. Additional information: Assessors Signature: Please print name: Agency: Phone Number: Date: On completion please send a copy to the Ergonomics Manager NUH and East Midlands Ambulance Service NHS Trust Phone: 0115 9296151 &/or other transport provider Date sent: Sent by: UNLESS THE PATIENT S SITUATION IS LIFE THREATENING DO NOT ASSUME THE FIRE AND RESCUE SERVICE WILL ASSIST. 15