BAR IATRIC MANAGEMENT


carry out an individual assessment of the size of the patient, the bathing system, and the appropriate hoist for the transfer into and out of the bath. Carers need to feel confident that hygiene routines ensure dignified handling of the person in a safe environment. Having access to the right resources may promote functional mobility for some patients rather than resorting to passive methods such as bedpans and bed baths.


Toileting and showering With all care activities, the choice depends on an assessment of the patient’s functional mobility. For toileting, a commode/hygiene chair, rather than a bedpan, is a better alternative for mobile patients. A commode / hygiene chair at the bedside promotes movement, helps patients maintain skin integrity and normal bladder and bowel function. If the patient is able to walk to the bathroom, it is important to consider the weight capacity and dimensions of the toilet seat and surround. Having a commode/ hygiene chair that can be used over the toilet will provide adequate weight capacity and dimension to allow the patient to use the bathroom. Unfortunately, accidents can occur in the bathroom area, so an evacuation plan, including space for equipment and carers, is required.


Rehabilitation Rehabilitation focuses on improving independence while preventing secondary complications, which places the patient at risk of immobility related consequences. Early mobilisation begins with repositioning in bed for respiratory,54


skin health,


functional activities of daily living and psychological wellbeing. Positioning is paramount for eating and drinking. Where indicated, speech and language therapy may be involved to address the malnutrition needs of the patient and assess their swallow function following intubation55 or neurological injuries.


The use of a limb sling can be utilised as evidence suggests that a leg weighs 17.55%56


and an arm 5.1%57 of a


person’s weight. This adjunct to rehabilitation helps to support passive and active range of motion, maintaining joint mobility, muscle strength and tone.58 In bed verticalisation or a bariatric tilt table allows weight-bearing activity, assisting with muscle activation, proprioceptive feedback and also has a number of other physiological benefits.59,60 Using a ceiling lift and sling to place the patient in a seated position on an appropriately sized ball for activities to challenge balance, improve dynamic weight bearing and stability activities help to improve functional mobility.61,62


Care in the community A wide range of services may be involved in supporting a plus size patient in the community setting. Good communication and collaborative working between the different agencies involved is essential in providing the optimum level of care while meeting health and safety requirements. Environmental risk factors include: l Door widths and access to/from the property l Weight limits of


– floors and ceilings where equipment is going to be installed


– domestic furniture e.g. beds and armchairs – domestic toilets


l Equipment storage l Evacuation process


Emergency evacuation The evacuation procedure in a fire or a major incident should be the same for all patients, considering the premises suitability to accommodate a bed evacuation; facility and emergency services communication plan and the number of staff required for the evacuation.


46 l WWW.CLINICALSERVICESJOURNAL.COM About the author


Mary Muir, marketing manager, Arjo UKI, BA (Hons), Dip N (Lon), FAETC, Patient Handling Cert, SRN (Retired). Mary has 34 years’ experience of working in a variety of clinical and educational roles within the NHS, before joining Arjo in 2004, where she has worked as a clinical specialist, sales, contract and marketing manager. Mary has presented and published on a variety of clinical topics including the management of plus size people.


OCTOBER 2020


The centre of gravity can be altered with plus sized patients due to body morphology.63


In the event of death The use of an ambulation


sling in conjunction with ceiling track hoist can help patients to mobilise. Commonly identified areas of dysfunction are problems with centre of gravity, dynamic sitting balance and general stability in stationary positioning. The use of ambulatory slings and walking harnesses can help improve functional independence through challenging rehabilitation activities.64,65


Discharge


A planned discharge date and time reduces length of stay, emergency readmissions and pressure on hospital beds.66


Planning for discharge must begin prior to a planned admission, or as early as possible after an emergency admission, as it can take longer to organise equipment and care packages and modify the care environment. Best practice indicates that a discharge to assess model67


considers


roles and responsibilities; multidisciplinary collaboration; early identification of patients at risk; transitional planning; medication management; patient and family involvement and information transfer.68


Ambulance transport


If the patient requires an ambulance for discharge, the service provider should receive advance notice of the patient’s discharge. Effective communication and planning, supported by a risk assessment of the patient and the discharge environment, will identify any equipment provision and safety measures to be implemented.


Inpatient areas will need to have appropriate equipment, facilities and handling procedures in place so that the deceased are transferred safely while maintaining dignity. Following the death of the patient, the ward should advise the porters and mortuary staff of the patient’s weight, height and body shape. When a patient dies in the community, the funeral director should undertake a risk assessment to identify and implement a safe system of work to transfer the deceased.


Burial and cremation


Obesity does have an impact on how the individual is laid to rest, as they may have to be buried. Local crematoriums may not be able to accommodate the morbidly obese person. Councils are starting to design and equip their crematoriums to manage the plus size person including larger coffins, furnaces, lifting equipment and funeral transportation. Funeral services may have to be adapted as the weight of the coffin may be too heavy for the traditional pallbearers to carry.


Summary In conclusion, whether the episode of care is planned or an emergency, person centred care should be provided throughout the patient journey from admission to discharge. The management of plus size patients’ needs is complex and multifactorial, demanding a multidisciplinary approach that empowers individuals and their families to work in collaboration to achieve positive outcomes. CSJ


References for this article are available upon request.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92