BAR IATRIC MANAGEMENT
Safe management of plus size patients
In the UK, there were approximately 900,000 obesity related hospital admissions from 2018 to 2019. Mary Muir provides a comprehensive guide to the safe management and transportation of plus sized patients throughout their care pathway.
According to the World Health Organization (WHO) there are now more than 1.9 billion adults aged 18 and over that are overweight,1 with 650 million people recorded as obese2 (approximately 13% of the world’s adult population),3
with 2.8 million dying every
year due to being overweight or obese.4 In the UK, there were around 900,000 obesity related hospital admissions in 2018 to 20195
£6.1 billion6
, costing the NHS an estimated and, by 2034, approximately
70% of adults will be overweight or obese.7 Furthermore, Public Health England links obesity to increased risks of coronavirus-related hospitalisation, intensive care and death.8 Caring for overweight or obese people is a key element for today’s health and social care providers9
available resources,10,11
, placing considerable pressure on The route to delivering
patient centred care and risk mitigation begins by predicting the challenges in all stages of the care process and preparing for them, considering the patient profile, building design, equipment, furniture and communication, as well as organisational and staff issues.
Terminology
When referring to the individual, the term ‘plus size’ is the preferred terminology as the word bariatric is the branch of medicine that deals with the causes, prevention, and treatment of obesity and does not encompass the individual’s holistic needs.12 Definitions, which focus solely on weight fail to allow for the fact that people are affected differently by excess weight, dependent on body shape,13
which impacts on equipment needs,14 space required and activities of daily living.15
Environmental and ergonomic considerations
As people are growing larger, there is a need to ensure patients receive safe, dignified and respectful care, without increased risk. Hignett and Griffiths in 200923
identified
five generic risks in the plus size patient’s pathway: l Individual factors including body shape, mobility, comfort and dignity.
Figure 1 identifies the correlation between BMI and waist circumference and the associated risk.21,22
OCTOBER 2020
l Building (or vehicle) space and design including furniture and fittings, accommodation, floor surfaces and safe
WWW.CLINICALSERVICESJOURNAL.COM l 43
Patients are considered morbidly obese when they have a body mass index (BMI) of 40 kg/m², or greater than 35 kg/m², with at least one serious obesity-related condition or being more than 45kgs over ideal body weight.16
An alternative measurement is the MUST tool (Malnutrition Universal Screening Tool) which estimates height by measuring the ulnar length and BMI category by measuring upper arm circumference.17
Health consequences Obesity is associated with reduced life expectancy, increased hospital stay and is a risk factor for a range of chronic diseases, including cardiovascular, type 2 diabetes, obstructive sleep apnoea, osteo arthritis, cancer,18 liver and respiratory19
and mental health.20
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