St George/Sutherland Hospitals And Health Services (SGSHHS) … · 2016-05-09 · St George/Sutherland Hospitals Clinical Business Rule SGSHHS CLIN_242 Approved by: Clinical Governance

Clinical Business Rule SGSHHS CLIN_242

Approved by: Clinical Governance Document Committee Date: December 2013 Page 1 of 18

St George/Sutherland Hospitals And Health Services (SGSHHS)

BARIATRIC ICU PATIENT – NURSING MANAGEMENT CONSIDERATIONS Cross references (including NSW Health/ SESLHD policy directives)

Bariatric Patient – Management Of The SGSHHS CLIN059 Occupational Health & Safety Issues Associated with Management of the Bariatric (Severely obese) Patients NSW GL 2005_070 BMI Calculator for Adults St George ICU Risk Assessments and Safe Work Practices 2013 \\sesahs\chn\STG\Critical Care and Surgery\intensive care unit\ICU Risk Assessments

1. What it is A guide to identify the risks that are encountered during the admission and management of Bariatric Patient when delivering quality ICU care that ensures the health, safety and welfare of both patient and staff members.

2. Risk rating Low

3. Employees it applies to All staff who work within The St George Hospital Intensive Care Unit

4. Why the rule is necessary

To ensure all staff are aware of the challenges when caring for a bariatric patient and the suggestions for planning manual handling tasks with the appropriate choice of equipment and techniques that should be used.

5. Who is responsible Director of STG ICU

Contents

6.1 Introduction ....................................................................................................................... 2 6.2 Definition........................................................................................................................... 2 6.3 Admission of a Bariatric Patient into ICU........................................................................... 2 6.4 Identification of bariatric patient ....................................................................................... 3 6.5 Calculation of Body Mass Index (BMI) .............................................................................. 3 6.6 Space requirements & Bed Allocation in ICU .................................................................... 4 6.7 Weighing a Bariatric Patient .............................................................................................. 4 6.8 Equipment and Safe Working Load (SWL) ........................................................................ 4 6.9 ICU Manual Handling Plan ................................................................................................ 6 6.10 Staffing Requirements .................................................................................................... 6 6.11 Physiological Changes in Critically Ill Bariatric Patients .................................................. 6 6.12 Repositioning the Bariatric Patient .................................................................................. 7 6.13.1 Pressure Area Care ..................................................................................................... 7 6.13.2 Skin Integrity and Pressure Area Surveillance ............................................................. 8 6.13.3 Managing patients Heavy Limbs .................................................................................. 9 6.13.4 Holding back Adipose Tissue / Pannis / Stomach apron .............................................. 9 6.13.5 Repositioning the Head and Neck ................................................................................ 9 6.14 Log Rolling the Bariatric Patient ...................................................................................... 9 6.15 X-Ray ............................................................................................................................ 9

http://www0.health.nsw.gov.au/policies/gl/2005/pdf/GL2005_070.pdf

http://www0.health.nsw.gov.au/policies/gl/2005/pdf/GL2005_070.pdf

http://www.health.nsw.gov.au/obesity/Pages/bmi.aspx




6.16 Transport of the Bariatric Patient................................................................................... 10 6.17 Inter- Hospital Transfer of a Bariatric Patient ............................................................... 11 6.18 Mobilising / Bed / Chair / Falls Risk .............................................................................. 11 6.19 Transfer of care from ICU ............................................................................................. 11 6.20 Management of the deceased bariatric patient .............................................................. 12

Appendix 1 .............................................................................................................................. 13 6.1 Introduction

Bariatric patients present unique challenges for care in the ICU setting. There is a need to identify effective assessment strategies and an essential resource guideline for optimal nursing care within the critical care environment. Caring for the Bariatric ICU patient should be achieved using a multidisciplinary approach, thus, involving consultation with all staff. 6.2 Definition

Bariatric is a term used to describe patients who have a high body mass index (BMI). High BMI occurs when a person’s weight is excessive for their height. Weight combined with an atypical body mass contributes to an increased risk of injury to staff during patient handling. A definition of a bariatric patient also includes:

• Patients weighing greater than 120kgs • Patients with a BMI index greater than 35 • Patients whose size and body shape means that they do not fit into standard equipment and furniture

6.3 Admission of a Bariatric Patient into ICU

A bariatric patient may be admitted as: 1. An emergency admission to ICU from ED, OT or a ward area 2. An elective admission in which the patient has attended a pre-admission clinic

Important information may be available prior to admission to STG ICU including the patient’s weight, disability and level of mobility. Communication of an impending emergency admission from the operating theatres and the emergency department should include an estimation of weight, the equipment required for admission including a bariatric bed and mattress. It is imperative that communication occurs between NUM / In-Charge in ICU, ED & OT prior to admission. On admission a Manual Handling Care Plan needs to be completed to ensure accurate documentation and communication occurs between nursing, medical and allied health staff. It may also be necessary to notify the STG ICU OH&S Coordinator for critical care and medicine that a bariatric patient has been admitted to the unit for assistance.




6.4 Identification of bariatric patient It is imperative that an accurate estimate of weight is obtained to ensure correct equipment and manual handlings aids are selected and used 17. All patients admitted to STG ICU should be weighed on admission and a calculation of BMI attended – see cross references. If possible, pre-admission assessment is imperative. It may be possible for the ICU Medical or nursing staff to review the patient in ED or OT prior to transfer. This additional information should be communicated to the ICU I/C or NUM for planning purposes. This may not be possible for an emergency admission. It is common that a patient coming from home has not been weighed for some time, or that the patient may misinform carers about their weight to avoid anticipated discrimination. 6.5 Calculation of Body Mass Index (BMI)

Body Mass Index (BMI) is calculated by dividing the patient weight (kg) by the height in metres squared (m2). For example 100 kg divided by (1.4 x 1.4) = 51 BMI. A classification is then given depending on how high the BMI (as per the table below).

These body mass index (BMI) numbers are used world-wide, by the World Health Organization(WHO), to track the world-wide epidemic of obesity. (http://www0.health.nsw.gov.au/policies/gl/2005/GL2005_070.html). BMI in children changes significantly with age and can differ between genders, therefore any BMI calculation for children and adolescents must be adjusted for age and sex. Please refer to the NSW Health website for further information. There are limitations when using the BMI weight categories for example, people with a lot of muscle bulk, can have a high BMI. Muscles are relatively heavier than fat, and a high BMI can be misleading. However, the implications and risks to staff in relation to occupational health and safety are the same. A BMI calculator is available via NSW Health website for easy calculation of index. The link is located within this CBR cross references. 6.6 Body weight distribution

Apple distribution – carry their weight high and often have proportionately slim legs Pear distribution – carry their weight low and often have proportionately slim arms and

upper trunk Bulbous gluteal region – carry a lot of their weight in the bulbous region. Altered posture in

both lying and sitting

International Standards BMI Underweight <18.5 Normal 18.5 – 24.9

Overweight 25 – 29.9 Obese (Grade 1) 30-34.9 Obese (Grade 2) 35-39.9

Morbid/Severe Obesity (Grade 3) > 40

http://www0.health.nsw.gov.au/policies/gl/2005/GL2005_070.html




6.7 Space requirements & Bed Allocation in ICU

Consideration should be given to the space requirements and the proximity of adjoining bed spaces when admitting an obese patient, adequate space is required for additional equipment and staff. 10

Within STG ICU the recommended bed space to admit an bariatric patient in ICU is Bed 1, 5 & 8 as the dimensions for these bed spaces are greater

Bed Space Location Bed Space Width

Bed1 431cm

Bed5 375cm

Bed 8 331cm

If these bed areas are already occupied it is possible to use bed space 4 and 11 as there is improved access for equipment at either side of the bed space. Isolation of a bariatric patient in ICU in a single room is difficult due the limitations on the width of the door frame at 106cm. Currently the Huntleigh Contura 1000 bariatric bed is one of the only bariatric beds available for hire that will fit through the frame of the STG ICU single room doors. 6.8 Weighing a Bariatric Patient

It is essential that an accurate admission weight is obtained on each bariatric patient, this will ensure correct equipment is used with the appropriate safe working load. It may be possible to plan the task to ensure that limited moves occurs, such as combining the task of weighing with mattress change or sheet change. The task of weighing the ICU patient can be achieved using a supine lift, using the available lifter with a flat sling or Jordon Frame if required. Please refer to the available SWP for supine lift. Further considerations are referred to in this document and included in 6.14 repositioning the bariatric patient. 6.9 Equipment and Safe Working Load (SWL)

When planning manual handling procedures in a bariatric patient the needs of the patient and staff should always be considered. The SWL of equipment is essential to determine its suitability for bariatric patients. All equipment will have a SWL specified by the manufacturer / supplier and permanently marked on the equipment 12,

http://www0.health.nsw.gov.au/policies/gl/2005/GL2005_070.html ). Ensure all components of the equipment has an adequate SWL as some lifters can take patients weighing up to 300 kg, however, flat slings and hoist slings may have a lower SWL.

http://www0.health.nsw.gov.au/policies/gl/2005/GL2005_070.html




Bariatric patients may have the same weight, but may have very different equipment needs due to their weight distribution and body shape 9 .The dimensions of all equipment should also be considered as some manual handling aids may have a suitable SWL and the width may not be adequate due to the patients weight distribution.

The SWL of the Stamina lift (bed mover) also needs to be considered when moving a bariatric patient in the ICU and between departments.

Within STG ICU the available equipment for bariatric patients includes:

All staff need to be familiar with the available equipment and the corresponding manufactures guidelines, available risk assessments and safe work practices.

STG ICU Bariatric Manual Handling Equipment Register

Equipment

Components Location SWL

ICU Beds Arjo Main Unit 220kg

Cairwave Mattress Hire 280kg

Kratos 320 Active Mobility Lifter

Seated sling Flat sling - grey - white fabric

(for use with metal slats)

Jordon frame with chains

Main Unit 320kg

Scaletronix Hydraulic Lifter Lifter White fabric slings Metal slats Jordon frame with chains

Back of storeroom

200kg

Alpha Twin Boom Promed Lifter

Lifter Alternative hooks Lifting sling

Main unit 230kg

HT Roller Pump and trolley Storeroom 272kg

Hovermatt Pump and trolley Disposable Mats Reusable Mats

Storeroom 544kg

Sara 3000 (Stand up lifter) Lifter Slings Back Corridor 200kg

Shuttle Chair Procedure room 454kg

Susan Chair Back Corridor 200kg

Samarit Rollboard 1 Board Storeroom 180kg

Stamina Lift (bed mover) Corridor 500kg




If the patient’s weight exceeds the SWL of the available equipment listed within the above table hiring of equipment should be investigated. Hire equipment list is available in appendix 2 of this CBR. 6.10 ICU Manual Handling Care Plan

On admission a manual handling care plan will be completed for each bariatric patient on admission by the ICU nursing staff caring for each individual patient. This will provide all staff with an accurate guideline for managing all aspects of the bariatric patient’s care. The plan is located on the STG ICU Clinical Information System (CIS) under Assist charts (Orange Tab). The plan should be based on risk assessments and safe work practices associated with the manual handling tasks to be achieved. It will be reviewed regularly, modified as appropriate for each individual patient, particularly when the patient’s health status changes. A copy of the current SWPs and RAs are available on the CIS under the ICU Nursing Policies and Procedures and via \\sesahs\chn\STG\Critical Care and Surgery\intensive care unit\ICU OH&S. A hard copy version of each RA and SWP is located underneath the ICU white board. 6.11 Staffing Requirements

The management of the bariatric ICU patient presents serious nursing resource demands, as dependent obese patients require more nursing time to complete tasks and additional staff members to achieve the completed task 9,16. Sufficient numbers of staff must be provided to assist with the manual handling tasks of the bariatric patient 6. It is imperative that at the time of admission the STG ICU NM, I/C or NUM considers the current acuity of the unit and the number of team rolls already occurring and their frequency. The number of patients and the number of nursing and orderly staff on each shift must be also considered. It is the responsibility of the STG ICU I/C, NUM or NM to identify the admission of a bariatric patient and calculate the staffing required. The I/C, NUM then must notify the ICU Nursing Co-Director or the AHNM if a change in staffing is required. 6.12 Physiological Changes in Critically Ill Bariatric Patients

Bariatric patients have physiological changes attributable to obesity that may be relevant in critical illness. These include cardiovascular, pulmonary and immunological changes that predispose them to respiratory failure and aspiration, abdominal compartment syndrome and thromboembolic disease 2,8. Further examples of physiological changes include:

Pulmonary complications –impaired gas exchange, decreased chest wall and lung compliance, increased work of breathing. A decrease in lung compliance is exacerbated when patients are positioned supine and may lead to an increase in atelectasis 2,8.

Gastric volume of the stomach is also larger in obese patients, including the large pannicus and increased intra-abdominal fat resulting in high intra-abdominal pressures 2.




Each bariatric patient should be evaluated for their acuity and ability to tolerate the supine position for an uncertain length of time, whilst manual handling tasks are untaken. The reverse trendelenburg position should also be considered along with maintaining the head of bed (HOB) elevation at > 30 degrees, assisting in prevention of aspiration 2

6.13 Repositioning the Bariatric Patient

Repositioning the bariatric patient may assist in preventing further complications when these patients are critically ill. However, there are considerations needed prior to repositioning the patient including:

Airway Protection / Intubation Conscious / Unconscious Mobility and strength Difficulties when turning in bed Pannis Limited range of movement Sweating and maceration of tissue Fragile skin/skin ulcers

Prior to commencing patient repositioning consideration and evaluation should be given to:

A plan for moving each bariatric patient formulated by the leader of the task The task and technique to be used The appropriate equipment and SWL The number of moves required The number of staff required The time required to complete the task 6.13.1 Pressure Area Care Regular pressure area care is essential in the bariatric patient, to assist the STG ICU has the following risk assessments and safe work practices available for review when performing PAC including:

1. Supine lift 2. Repositioning unconscious patient up in bed 3. Repositioning unconscious patient in bed – Rolling on side 4. Lateral Transfer 5. Mattress Change 6. Log Rolling – workplace instruction 7. Head Holding

The following table illustrates the different manual handling tasks that may be required when repositioning a bariatric patient and the choice of available equipment. The SWL should be reviewed prior to deciding on the appropriate equipment.




Manual Handling Task

Equipment

Lateral Transfer Roll Board Hovermatt Pat Slide – spinal patients

Supine Lift Flat Sling (Lifter)

Jordon Frame (Lifter)

Up the bed

Hovermatt Flat Sling (Lifter)

Rolling in Bed

Hovermatt HT Roller

Mattress Change

Lateral Transfer Supine Lift

Xray

Hovermatt Supine Lift

A further important consideration when repositioning a bariatric patient is the width and distance of reach for the staff assisting. Bariatric beds are often wider than regular hospital beds, making it necessary for staff to reach to assist the patient. For this reason and to ensure the safety of staff, consideration should be given to the use of the hovermatts. 6.13.2 Skin Integrity and Pressure Area Surveillance Skin integrity can be problematic in the bariatric patient as multiple skinfolds can lead to a build up of moisture, posing a threat to skin integrity 8,18. An assessment of skin condition should occur when the patient is in the anterior position by examining between skin folds, under breasts, in axillary region and under pannis. When the patient is side lying it is necessary to assess the back, buttocks and neck 8. Limited mobility, difficultly turning, decreased vascularity within adipose tissue and increased weight also contribute to pressure ulcer risk 8. Yeast infections are also common in skin folds, the anterior and posterior folds should be inspected, cleansed and dried as needed 4,5. Incontinence associated dermatitis (IAD) may also occur on buttocks, perineal area and between folds 5. Powder should not used as it is abrasive and can clump, especially within skin folds 2,18 . Moisture within skin folds can be absorbed by pads or dressings 18. Heels should be reviewed regularly as obese patients impose increased kg per square cm of pressure against the bed 4. The best skin care management is daily inspection and scheduled turning, including the repositioning of chest tubes, foley catheters and drainage tubes to ensure they are not hidden in skin folds where they can cause skin erosion and ulceration 2 .




6.13.3 Managing Heavy Limbs When repositioning heavy limbs in bed consideration should be given to:

Assistive equipment for staff including slide sheets, lifter and hovermatts Task to be achieved and length of time required The use of foam wedges to assist in repositioning

It is important to note that it may be unachievable to ask the patient to assist by taking the weight of their own limbs while attending to a task, bariatric limbs can weigh 30% or more of the patients body weight, depending on the patients weigh distribution 9. 6.13.4 Holding back Adipose Tissue / Panniculus Adiposus (Apron) Consideration should be given to lifting or holding back adipose tissue / pannis to allow inspection and allow air flow 5. Extra personnel may be required to ensure adequate visualisation of the pannis area and the skin integrity 18. Consider the trendelenberg position if the patient is able to lie with head down, however, this should be kept to a minimum time frame. 6.13.5 Repositioning the Head and Neck One of the most difficult areas to access is behind the head and neck as these areas often become macerated from posterior collections of sputum and saliva and constant pressure 4. The bullhead configuration of the head and neck in the obese patient makes turning difficult, a manual turn and frequent visual inspection is necessary to avoid an occipital pressure ulcer.

6.14 Log Rolling the Bariatric Patient

All staff within STG ICU should refer to the STG ICU work place instruction (WPI) for the management of spinal immobilisation, the ICU risk assessment and safe work practice for log rolling and head holding. When log rolling bariatric patients in bariatric beds, staff should be aware that the patient weight can give added momentum, and appropriate staff numbers should be on both sides of the bed. It is particularly important that the abdominal apron is not allowed to roll over the edge of the bed as it can pull the patient off the bed (http://seslhnweb/SGSHHS/Business_Rules/Clinical/documents/B/Bariatric_Management_CLIN059.pdf). 6.15 X-Ray

Imaging in an obese critically ill patient can be a challenge, as increased radiation may be required and the use of multiple cassettes to cover the chest or abdominal views resulting in additional exposure to X-rays 18. Inadequate soft tissue penetration makes the interpretation of portable radiographs difficult 8. Consideration should be given to the possibility that a patient may not be able to fully assist in moving themselves forward for a chest examination. In the case where a patient cannot provide assistance, the task may be facilitated via the use of equipment including lifters and Hovermatts. If additional cassettes are required the patient should




be lifted in the supine position to allow for the correct placement. Care should be taken that the appropriate number of staff are on hand to assist and facilitate the task. 6.16 Transport of the Bariatric Patient

Critically ill ICU patients may need to be transported from ICU to other locations within the hospital for medical imaging and procedures, which may not be available in ICU 4. There are a number of considerations that can enable a safe and efficient intrahospital transport of the critically ill obese patient15.

Pre-transport Considerations Determine whether the procedure can be completed, if attending computerized tomography

(CT) scan the ICU team must ensure the patient will fit into the CT gantry (circumference of the tube) and if the patient meets the weight capacity limits of the scan table.

- The STG Radiology Department CT scan table has a gantry of 70cm and a SWL of 220kg

- STG Nuclear Med Department has a CT scan table with the same dimensions.

Consider if it is necessary to move the patient from one surface to another and the length of time the patient may be required to lie on the procedure table 15.

Careful planning of the most efficient route to the receiving department, the lift capacity and weight restrictions may also need to be considered

Determine if the bariatric bed has an internal drive mechanism or gzunda / stamina lift for safe transport 12.

Ensure only essential equipment is taken on transport Please refer to the STG ICU guidelines for safe transport / CBR

Transport Considerations Communicate with the receiving department and ensure there are adequate staffing levels

to maintain safety of both the patient and the staff and ensure safe manual handling practices.

Investigate the pressure mattress the patient is placed on and ensure the mattress will remain inflated for the length of the transport. Some low flow pressure relief mattresses currently available do not have a battery back up and will deflate on transport, such include the arjo-huntleigh bari breeze mattresses. It may be necessary to investigate a battery back up for these type of mattresses if possible.

Head of bed elevation at least 30 degrees may assist on transport to ensure adequate ventilation 15.

Ensure the receiving department has the necessary equipment available with a SWL adequate for the bariatric patient. Equipment such as the Hovermatt may be used on transport to assist lateral transfers. Please refer to the STG ICU safe work practice 2013.

Velcro straps may also be available to ensure the patient remains secure on the scan table. Please ensure these straps have the appropriate length to ensure the velcro remains secure.




As the cross-sectional area of an obese patient is larger the area to be imaged is greater and therefore these patients may have longer scan times 18. 6.17 Inter- Hospital Transfer of a Bariatric Patient

Transportation of a bariatric patient between hospitals may be necessary for specialist procedures or admission to another ICU unit. This can be problematic for both road and air ambulance as strict aviation rules and regulations govern the patient loading mechanisms, ambulance stretchers, restraining equipment and the plane 12, http://www0.health.nsw.gov.au/policies/gl/2005/GL2005_070.html) Communication with the NSW Retrieval Services prior to the booking is essential to ensure logistics of transfer and receiving hospital are aware of the impending admission and necessary equipment and safety requirements are made. 6.18 Mobilising / Bed / Chair / Falls Risk

When considering the mobilisation of bariatric patients several steps need to be considered prior to moving out of bed, including:

1. Physiotherapy review 2. Falls Risk Assessment 3. A plan for the manual handling task - how to achieve the move, time required, the use of

lifters, slings, lateral transfer, hovermatt and bariatric chair. 4. Refer to the STG ICU RA and SWP for transferring a patient from bed to chair 5. Safety needs of the staff and the number of staff required to complete the task 6. It is responsibility of the bedside nurse to notify the ICU I/C or NUM of the planned task and

move. When lifts and slings are used to move obese patients care must be taken to avoid increased pressure, shearing and pinching of the skin 2. Visual inspection is necessary to ensure the patient fits the width of the sling and chair. It may be necessary to hire additional equipment for the bariatric patient as they begin mobilisation. Equipment such as bariatric commodes, bariatric stand assist lifts and fore arm supports are available for hire. Please refer to the STG Bariatric equipment list. Assisting patients to weight bear is considered a high risk task for staff, if the patient appears to slip and fall, caregivers should not attempt to break the fall 11,4,18 . Staff should attempt to move any items out of the way that might cause injury and try to protect the patients head from striking any objects or the floor 11. Care should also be taken by staff when assisting a patient to turn sideways and sit on the side of the bed, no manual handling of the patients weight should occur including the legs 4. 6.19 Transfer of care from ICU

To ensure there is a timely discharge of patients from ICU consideration should be given to the receiving unit/ward and their equipment, patient positioning and isolation, beds and acuity of the patient.




The ICU NUM or I/C will discuss the likelihood of discharge and consult the STG bed flow managers, allied health, ICU liaison CNS and receiving ward NUM. A copy of the individual patient’s ICU manual handling care plan will be available for the wards to review on ICU discharge, to ensure communication occurs relating to the manual handling tasks and equipment required. Consideration should be given to any hire equipment that may have been used to ensure the companies are aware of the discharge of the patient from ICU. It is the responsibility of the NUM or I/C in ICU to contact the companies to ensure cost is transferred to the receiving ward. 6.20 Management of the deceased bariatric patient

If the death of a bariatric ICU patient is expected or impending communication with the hospital mortuary staff is essential. If after hours the AHNM will be notified to ensure the Coroners Department and / or Funeral Services are aware of the necessary requirements. It is important to consider the manual handling requirements, including staffing requirements, number of patient moves that may be necessary, size of the concealment trolley and use of lifting equipment. The STG Mortuary staff have advised that if the patient is bariatric and it is not reasonable to place in a body bag, the patient should be transported on the ICU bed with a sheet and blanket to cover the patient. The service lifts should always be used in this instance to access the ground floor.

The SWL of the STG concealment trolley (GT) is 130kg The width of the GT trolley is 58cm The patient should be positioned with their head at the peddle end STG Mortuary has a fridge door width of 108cm.

If the patient is greater than the above dimensions it is possible to place the current Huntleigh Contura electric bed in the mortuary freezer without damaging the electrics.




Appendix 1

"' ill 0

..c "' .... ::;j 0 ..c ....

·~ ~ c

:.a .... 0 u .... ..c ~

1 "' ~ c ::;j 0

Cl.

~ "' ill c 0 ....

00

"' E ~ ~

..£ ~ .5 .... ..c ~

~

NSW GOVERNMENT

Health South Eastern Sydney Local Health District

Aim for the Healthy Weight Range

Weight for Height Chart for Men and Women Aged 18-64

{st/lb) kg

(23/6) 150 ~ Copyright The Australian Nutrilion Foundation Inc: . 2001

(22/0) 140 *BMI35

(20/5) 130

(18/9) 120 *BMI30

{17/3) 110

{15n) 100 *BMI25

(14/2) 90

(12/6) 80 *BMI18.5

(11 /0) 70 *BMI17

{9/4) 60

{7/9) 50

{6/3) 40

(4n) 30

140cm 15Dcm 16Dcm 17Dcm 18Dcm 19Dcm 20Dcm

(4'7") (4'11") (5'3") (5'7'') (5'11") (6'3") (6'7")

Height in Cen tim etres (Feet & Inches)-without shoes

• Body Mass Index (BMI) = Weight (kg) Heigh!Z (metres)

Optimal ltedtlt tltroJtglt frxxl varidlj alfd plt1fsict11 ttetivttlf A Nutrition/.

f"""' ustra 10 www.nutritionaustralia.org




Appendix 2 STG ICU Bariatric Hire Options and Contact Details

Suppliers

Contact Details

Bariatric beds Hire

Mattress hire

Bariatric - shower chairs/ Commode

Bariatric sling lifters

Bariatric Stand up lifters

Arjo-Huntleigh

24Hr Rental Hotline

1800 007 368

x x x x

Prius

02802057

05 04133262

80

x x

Statina health care

9457 0040

x x x

Active Mobility Systems

02 9649 1575

x x x

AAMK-Watercomfort

9531 1699

x x x

Bosshard

1800 806 637

x x x x

Able Rehab - Rehab Hire

9646 7200

x

http://www.arjohuntleigh.com/au

http://www.arjohuntleigh.com/au

http://priushcs.com/

http://www.statina.com.au/



http://www.activemobility.com.au/



http://www.watercomfort.com.au/



http://www.bosshardmedical.com.au/

http://www.ablerehab.com.au/favicon.ico







Henry Care

8700 3888

x x x

Patient handling Australia

1300 137 875

x x

Pegasus Wooltec

02 9601 6909

x x x

http://www.henrycare.com.au/

http://www.henrycare.com.au/

https://www.pegasushealthcare.com/search.php?zoom_query=wooltec

https://www.pegasushealthcare.com/search.php?zoom_query=wooltec




7. Compliance evaluation

Q1: The term bariatric means? A: Bariatric is a term used to describe patients who have a high body mass index (BMI). High BMI occurs when a person’s weight is excessive for their height. Weight combined with an atypical body mass contributes to an increased risk of injury to staff during patient handling. Q2: What is a Manual Handling Care Plan? A: A manual handling plan is a document completed by the ICU nursing staff to ensure a summary exists of the plan of the requirements for safe handling bariatric ICU patients. This plan is located on the CIS and summarises the appropriate equipment and manual handling tasks required for each bariatric patient. This plan may be transferred with the patient to ensure accurate communication occurs at transfer of care. Q3: The term panniculus refers to? A: A dense layer of fatty tissue growth, consisting of subcutaneous fat in the lower abdominal area. Quality Evaluation ICU OH&S monthly report presented at the STG ICU Quality

Assurance Meeting and the ICU Nursing Practice Committee Meeting.

Monthly surveillance audits of IIMS system including OH&S trends presented at the STG Critical Care & Medicine Leadership Meeting.

STG ICU Manual Handling Champions education sessions and in-services to ensure correct techniques and equipment has been used by the staff in relation to the individual manual handling tasks.

8. Keywords Bariatric Patient: Patients who have a high body mass index (BMI). High BMI occurs when a person’s weight is excessive for their height. Manual Handling Care Plan: A manual handling plan is a document completed by the ICU nursing staff to summarise the plan of managing bariatric ICU patients. Equipment and Safe Working Load: The SWL of equipment is essential to determine its suitability for bariatric patients. All equipment will have a SWL specified by the manufacturer / supplier and permanently marked on the equipment.

9. External references 1. Baptise, A.2007. Technology Solutions for High Risk Tasks in Critical Care. Critical Care Nursing Clinics of North America. 19: 177-186.

2. Charlebois, D. Wilmoth, D. 2004. Critical Care of Patients with Obesity. Critical Care Nurse. 24:19-27

3. Cowley, S.P, Leggett, S.(2010) 16: 262-267. Manual Handling Risks associated with the care, treatment and transportation of bariatric patients and clients in Australia. International Journal of Nursing Practice. 16: 262-267.

http://en.wikipedia.org/wiki/Fatty_tissue




4. Davidson, J.E, Kruse, M.W, Cox, D., Duncan, R. 2003. Critical Care of the Morbidly Obese. Critical Care Nursing Quarterly. 26, 2: 403-422.

5. Gallagher, S.M. 2002. Obesity and the Skin in the Critical Care Setting. Critical Care Nursing Quarterly. 25,1:69-75.

6. Hignett, S. Griffiths, P. 2009. Risk Factors for moving and Handling Bariatric Patients. Nursing Standard. 24, 11: 40-48.

7. Hignett, S, Griffiths, P. 2009. Manual Handling risks in the Bariatric (obese) patient pathway in acute sector, community and ambulance care and treatment. Department of Human Services, Longhborough University, Loughborough, UK. 33. 175-180.

8. Honiden, S. MCardle, J.R. 2009. Obesity in the intensive Care Unit. Clinical Chest Medicine. 30: 581-599.

9. Muir, M Heese, G.A. 2008. Safe Patient Handling of the Bariatric Patient: Sharing experiencing and Practice Tips when using Bariatric Algorithms. Bariatric Nursing and Nursing Surgical Patient Care. 3.2: 147-158.

10. Mulvihill, E. 2006. Guidelines for the Care of the Bariatric Patients. NHS Dartford and Gravesham. PCD41.

11. Muir, M Heese, G.A. McLean, D. Bodnar, S. Rock, B.L 2007. Handling of the Bariatric Patient in the Critical Care: A case study of Lessons learned. Critical Care Nursing Clinics of North America. 223-240.

12. NSCCAHS. Bariatric Patient Management Plan Guidelines. 2008. Northern Sydney Central Coast. GE2008_011.

13. Princes of Wales Hospital and Community Health Services. Work Health and Safety and Manual Handling Risk Assessment of Bariatric (Severely Obese) Patients CBR 2012.

14. Queensland Health Guidelines for Patient Handling Facility/ Unit Risk Assessment Tool User Guide. 2012.

15. Roland, D. Howes, C. Stickles, M. Johnson, K. 2009. Safe Patient Intrahospital Transport of Critically Ill Obese Patients. Bariatric Nursing and Surgical Patient Care. 5, 1: 65-70.

16. Rose, M.A. Baker, G. Drake, Engelke, M. MCauliffe, M. Pokorny, M. Pozzuto, S, Swanson, M, Waters, W. Watkins, F. 2006. Nurse Staffing Requirements for care of the Morbidly Obese Patient in the Acute Care Setting. Bariatric Nursing and Surgical Patient Care. 1, 2: 115-121.

17. Southey, S. Bariatric Patient Policy. 2009. NHS Trust. Ashford and St Peters Hospitals. 1-41.

18. Wilkelman, C. Maloney, B. 2009. The Impact of Obesity on Critical Care Resource Use and Outcomes. Critical Care Nursing Clinics of North America. 21: 403-422.

10. Relevant committee approval

Workforce Safety and Injury Management Service




11. Patient information brochure (or related material)

N/A

12. Consumer Advisory Group (CAG) meetings and secretariat

N/A

Approval for (Insert Clinical Business Rule Title) * N/A where appropriate

*Specialty/Department Committee

Workforce Safety and Injury Management Service Chairperson name/position Kevin Robertson OHS coordinator December 2013

*Specialty/Department Committee

STG ICU Nursing practice Committee Chairperson name/position Sarah Jones CNC ICU December 2013

*Nursing/Midwifery Co-Director

Julie Cosgrove NCD Critical Care and Emergency December 2013

*Medical Co-Director approval

A/Prof Theresa Jacques ICU December 2013

Executive Sponsor Name/Position: Dawn Fowler CGM Critical Care and Emergency Signature Date December 2013

Contributors to ClBR development e.g. CNC, Medical Officers (names and position title/specialty)

Revision and approval history Date Revision number Author (Position) Revision due Dec 2013 0 Kate Powell and Phillip

Mackay ICU NUMs Dec 2016

Director of Operations Ratification

Name Cath Whitehurst Signature Date December 2013

Documents

St George/Sutherland Hospitals And Health Services (SGSHHS) … · 2016-05-09 · St George/Sutherland Hospitals Clinical Business Rule SGSHHS CLIN_242 Approved by: Clinical Governance