BAR IATRIC MANAGEMENT
working load, spatial constraints or access/ egress concerns, lift size and mortuary capacity.
l Equipment provision including fit, weight and size capacity and effort of movement.
l Inter organisation communication – including emergency management and evacuation plans.
l Organisational culture, human resources, policies and staff competency.
Addressing these five risks will help to support care, reduce work related injuries and improve financial outcomes.24
to fully dependent (Emma) (Figure 3). The Mobility Gallery becomes an important interdisciplinary communication tool, making it possible to discuss choices in care and rehabilitation appropriately.27
Body shape and weight distribution Assessing the body shape of a plus size person is essential when it comes to equipment provision. Incorrect assessment and measurement may lead to incorrect equipment choices. Each body shape (Figure 4) presents unique care challenges. As illustrated in figure 5, a large android
Figure 225
shows an overview of the working areas for different equipment: A. Patient walking at the bedside. B. Ceiling lifts. C. Transfer to a seating device with two carers.
D. Sling lift. E. Working area for carer.
The blue areas show required working areas to facilitate different transfer activities and provide adequate access for the patient, equipment and carers.
Functional mobility assessment To assist carers during the assessment of their patient’s mobility, the Mobility Gallery could be used to consider exposure to physical overload and recommendations for appropriate equipment for safe patient care.26
pannus28
may impede a person’s movement, sitting, standing and walking and pose challenges during the hygiene process. The complications of a pannus, especially grade 3 or higher, is the effectual shortening of the person’s seat depth, reducing the ability to sit supported and cause musculoskeletal changes, which can compromise balance throughout mobility. Additionally, hip width can vary considerably between people with different body shapes. In selecting equipment, although the safe working load might be adequate, the width of the equipment may pose an entrapment risk.
The patient journey To reduce the risks identified by Hignett and Griffiths,29
consultation with key Patients
are assessed according to their degree of functional mobility, identified within the gallery: from the most independent (Albert),
stakeholders from health, social care and the emergency services forms an integral part of the risk management process. These include: l Clinical specialists – manual handling,
Figure 2
tissue viability, resuscitation, falls lead, dietetics and nutrition, speech and language therapy and psychology;
l Outpatient and inpatient care settings – A&E, imaging, anaesthetics, intensive care, surgery, theatres and recovery, and maternity care etc;
l Physiotherapy and occupational therapy; l Porters – interdepartmental transfers; l Risk management, EBME and architects;
l Procurement; l Discharge co-ordinator; l Community health and social care services – treatment centres and general practitioners;
l Funeral, mortuary and cremation services to name but a few.30
A triage, treat, transfer and discharge plan should be in place to support appropriate care pathways.31
The following
will explore in more detail the patent’s journey from admission to discharge in a hospital setting.
Figure 3 Figure 4
Transportation needs Transportation to hospital might be the first occasion where risk factors present themselves in the patient’s pathway. For example, for an emergency or planned admission there can be physical and logistical difficulties in getting the patient out of the domestic or care setting and transporting them to the hospital. As part of the interagency communication for an emergency or planned admission, the referring agency should inform the admitting department of the patient’s impending admittance, so that they can plan accordingly.
Figure 5 44 l
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Admission To support the patient’s care, the referring agency would advise on the patient’s past medical history, clinical presentation and body dynamics. The receiving clinical environment needs to have available an appropriate bed space, identity bracelet, dignity gown, blood pressure cuff, bed,
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