Bariatric Safe Patient Handling And Mobility Guidebook: A .

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Research Laboratory Safety uidebook Volume 1:Managing Chemical SafetyBariatric Safe Patient Handling and MobilityGuidebook: A Resource Guide for Care ofPersons of SizePublished byVHA Center for Engineering & OccupationalSafety and Health (CEOSH)St. Louis, Missourivaww.ceosh.med.va.govJuly 2015

Table of ContentsPREFACEDisclaimers . ivExecutive Summary . vAcknowledgements . viHow to Use This Guidebook . ixUpdate Listing . xAcronyms and Abbreviations . xiPART I1 Introduction . 11.1. Overview . 11.2. Enclosure . 22 Assessing the Organizational Capacity for Bariatric Care . 32.1. Bariatric Equipment, Space, and Design . 42.1.1. Planning for the Future . 42.1.2. Technology. 52.1.3. Bedframe and Support Surface . 52.1.4. Bedside Chairs . 62.1.5. Commodes or Shower Chairs . 62.1.6. Portable Floor-Based Lifts . 72.1.7. Gantry Lifts . 72.1.8. Wheelchairs . 72.1.9. Walkers . 82.1.10. Scales . 82.1.11. Stretchers and Stretcher Chairs. 82.1.12. Space and Design Considerations . 82.1.13. Public Areas . 92.1.14. Design for Patient Rooms . 102.1.15. Bariatric Room Dimensions . 112.1.16. Storage. 132.1.17. Doors . 142.1.18. Flooring . 14i

2.1.19. Bathrooms . 142.1.20. Public Showers and Bathrooms . 152.1.21. Toilets . 152.1.22. Ceiling or Wall-Mounted Lifts . 162.2. Bariatric Safe Patient Handling and Mobility (SPHM) Policy. 172.3. Addressing SPHM Needs During Emergencies . 182.4. Enclosures . 213 Planning for Bariatric Patients . 233.1. Developing a Bariatric Clinical Pathway . 233.2. Admission and Room Preparation . 243.3. Technology Needs for Patient Safety . 253.4. Enclosures . 284 Implementing Bariatric Patient Care . 294.1. Assessment Criteria, Care Planning, and Use of Safe Patient Handlingand Mobility (SPHM)/Algorithms. 294.2. Co-morbid Conditions . 344.2.1. Cardiovascular System . 354.2.2. Respiratory System . 354.2.3. Genitourinary (GU) System . 364.2.4. Gastrointestinal (GI) System . 364.2.5. Medication Absorption . 374.2.6. Endocrine System . 374.2.7. Integumentary System . 374.2.8. Lymphatic System . 384.2.9. Hygiene . 384.2.10. Musculoskeletal System . 384.2.11. Surgical Complications . 394.2.12. Body Shape. 394.3. Critical Aspects of Communication . 394.3.1. Communication Tools . 404.4. Safe Patient Handling and Mobility (SPHM): The Key to Better PatientOutcomes and Fall Prevention . 414.5. Planning for Discharge . 434.6. Bariatric Community Care . 45ii

4.6.1. General Patient Handling Recommendations for Community CareSettings . 464.6.2. Outpatient/Primary Care Clinics. 464.6.3. Specialty Outpatient Areas . 474.6.4. Physical Therapy Clinics . 474.6.5. Nursing Home/Long-Term Care. 474.7. Steps in the Bariatric Discharge Process . 474.8. Long Term Care (LTC) or Community Living Center (CLC) Considerations . 484.9. Enclosures . 485 Education and Competency Training . 515.1. Sensitivity. 515.2. Staff Education and Training . 535.3. Patient and Family Education . 555.4. Enclosures . 576 Monitoring and Evaluating Patient and Program Outcomes . 596.1. Enclosures . 607 Conclusions and Final Thoughts . 618 Definitions and Glossary of Terms . 639 References and Bibliography . 779.1. Helpful Links . 979.2. Links to SPHM and/or Bariatric Guidebooks . 98Enclosures . 99iii

DisclaimersEndorsementReference herein to any specific commercial product, process, or service by tradename, trademark, manufacturer, or otherwise, does not necessarily constitute orimply its endorsement, recommendation, or favoring by the U.S. Government.The views and opinions of authors expressed herein do not necessarily state orreflect those of the U.S. Government and shall not be used for advertising orproduct endorsement purposes.HyperlinksThe appearance of external hyperlinks does not constitute endorsement by theDepartment of Veterans Affairs (VA) of the linked Web sites or the information,products, or services contained therein. For other than authorized VA activities,the Department does not exercise any editorial control over the information youmay find at these locations. All links are provided with the intent of meeting themission of the Department and the VA Web site. Please let us know aboutexisting external links that you believe are inappropriate and about specificadditional external links that you believe should be included.LiabilityWith respect to documents available from this server, neither the U.S.Government nor any of its employees makes any warranty, expressed or implied,including the warranties of merchantability and fitness for a particular purpose, orassumes any legal liability or responsibility for the accuracy, completeness, orusefulness of any information, apparatus, product, or process disclosed, orrepresents that its use would not infringe privately-owned rights.Reference from this Web site or from any of the information services sponsoredby VA to any non-governmental entity, product, service, or information does notconstitute an endorsement or recommendation by VA or any of its employees.We are not responsible for the content of any “off-site” Web sites referenced fromthe Veterans Health Administration (VHA) Center for Engineering & OccupationalSafety and Health (CEOSH) Web site, electronic media, or printed media.GuidanceVHA CEOSH guidebooks are “BEST PRACTICE” resources designed to assisthealth care facilities implement and enhance programs and more effectivelycomply with current VA/VHA policy and external regulatory standards. CEOSHguidebooks are NOT OFFICIAL POLICY. In accordance with VHA Directive6330, Directives Management System, official policy documents include: (1)Directives, which carry the authority to mandate Department- or Administrationwide policies, and (2) Handbooks, which carry the authority to mandateprocedures or operational requirements implementing policies contained indirectives.iv

Executive SummaryEstablishing a culture of safety pertaining to patient care is challenging in anysetting; however, special challenges arise in the presence of obesity becauseexcess weight and weight distribution often interfere with the caregiver’s ability toprovide the most basic care. This is especially true when considering patienthandling and mobility. The risks associated with bariatric patient handling andmobility are complex, and each patient must be considered individually.The purpose of this Bariatric Safe Patient Handling and Mobility (SPHM)Guidebook is to provide best practice guidance to address the needs of bariatricpatients, their families, and those who care for them. It presents emergingscience, practical information, and a collection of tools and information that enablemembers of the greater health care community to: assess their currentorganizational capacity; plan and implement safe care of bariatric patientsthroughout the continuum of health care; and evaluate both patient and programoutcomes. It includes space and design recommendations, guidance for selectionof appropriately-sized technology (equipment and devices), communication tools,and other essential information; along with a comprehensive list of references andlinks.This guidebook is designed as a first step to safely accommodate the physical,emotional, and spiritual needs of our patients of size; however, it is not aprescription for care. Readers are encouraged to seek new and emergingscience as a way to continue the journey toward further improving patient careand promoting caregiver safety, irrespective of patient size.v

AcknowledgementsThis guidebook was possible because of the devoted attention of the personneland management of the Center for Engineering & Occupational Safety and Health(CEOSH), St. Louis, Missouri.A special thank you is extended to the Bariatric Safe Patient Handling andMobility Guidebook Professional Advisory Group (PAG) who developed thisguidebook and to management at their respective Veterans Integrated ServiceNetworks (VISNs) and medical centers for their support.Peggy Bone, MSN, RN, CSPHP, CIC, Safe Patient Handling and MobilityCoordinator, Birmingham VA Medical Center, Birmingham, ALTim Buchanan, RN-BC, MSN, Safe Patient Handling and Mobility FacilityCoordinator, VA St Louis Health Care System, St. Louis, MOJudee Gozzard, RN, MSN, CSPHP, Former Safe Patient HandlingCoordinator, C.W. Bill Young VA Medical Center, Bay Pines, FLTony Hilton, DrPH, MSN, FNP, CRRN, RN, Safe Patient Handling Coordinator,VA Loma Linda Healthcare System, Loma Linda, CAValerie Kelleher, Visual Information Specialist, VISN 8 Patient Safety Center ofInquiry, Tampa, FLNancy Kirchner, MA, RN, Safe Patient Handling Coordinator/VISN 23Safe Patient Handling Point of Contact, Minneapolis VA Health CareSystem, Minneapolis, MN*Charlotte Lynch, MS, CNS, CSPHP, Safe Patient Handling Coordinator,Dayton VA Medical Center, Dayton, OHMarie Martin, Ph.D., Acting National Program Manager, Patient Care Ergonomics(10P3D) and Industrial Hygienist/Safe Patient Handling Facility Coordinator, VANorth Texas Health Care System, Dallas, TXMary W. Matz, MSPH, CPE, CSPHP, former VHA Safe Patient Handling NationalProgram Manager, James A. Haley Veterans’ Hospital, Tampa, FLLisa Milstead, RN, MSN-ED, MHA, CHPN, Nurse Manager SpecialPrograms/Medical Specialty, Huntington VA Medical Center, Huntington, WVMary Lou Muir, RN, COHN, Former Bariatric Patient Handling Consultant,Winnipeg, MBLynne Olson, ARNP, Bariatric Coordinator/Bariatric Nurse Practitioner,Bay Pines Health Care System, Bay Pines, FLvi

Val Posa, MSN, RN, Special Projects Clinical Coordinator, VA PittsburghHealthcare Center, Pittsburgh PAFrank Rossi, Physical Therapist, C.W. Bill Young VA Medical Center, BayPines, FLA special thanks is extended to the following individuals for their contributions tothis guidebook and to management at their respective VISNs and VA/VHAfacilities for their support.Sylvia Baack, PhD, RN, Chief, Nursing Education, VA North Texas Health CareSystem, Dallas, TXLois Barkman-Soloman, RN, Fargo VA Health Care System, Fargo, NDRoberta Capewell, PhD, RN, Quality Assurance & Program IntegrityDept., Visiting Nurse Association of Greater Philadelphia, Philadelphia, PALena Deter, RN, MPH, CSPHP, DELHEC, LLC. Educational Services &Consulting, Hermitage, TNMichelle Franklin, RN, BSN, Safe Patient Handling Coordinator, CaptainJames A. Lovell Federal Health Care Center, Chicago, ILTraci Galinsky, Ph.D., Captain, U.S. Public Health Service, ResearchPsychologist, NIOSH, Cincinnati, OHSusan Gallagher, PhD, MSN, MA, RN, CBN, CSPHP, Founder, CelebrationInstitute, Inc., Sierra Madre, CAKimberly A. Hudson, MSN, RN, CCRN, SPHM-Fall Prevention Coordinator,Marion VA Medical Center, Marion, ILChristina McCullough, R.T.(R)(M)(CT), Radiology Technologist, C.W. Bill YoungVA Medical Center, Bay Pines, FLRoberta Oeser, RN, Former Safe Patient Handling Coordinator, Jack C.Montgomery VA Medical Center, Muskogee, OKLynn Salazar, MSN, RN, Safe Patient Handling/Falls Prevention Coordinator,South Texas Veterans Health Care System, San Antonio, TXSusan Wyatt, BSN, RN, Safe Patient Handling Coordinator, Phoenix VA HealthCare System, Phoenix, AZvii

CEOSH Publishing StaffTina Beckner, Lead Technical Information Specialist, St. Louis, MOLesley Luscri, Technical Information Specialist, St. Louis, MOMelody Watts, Technical Information Specialist, St. Louis, MOConnie Young, Chief, Publishing Services, St. Louis, MOCopyright AcknowledgementsCopyrighted documents used in this guidebook were reproduced with permissionfor VA use only.Alpha Modalities, LLC3110 Judson Street, Suite 149Gig Harbor, WA 98335http://alphamodalities.com/HumanFit, LLC15401 S. Len AvenueOregon City, OR 97045Hignett, et al.Loughborough UniversityLiftSeat Corporation, Inc.2001 Midwest RoadSuite 204Oak Brook, IL 60523http://www.liftseat.com/MedCare Products151 East Cliff RoadBurnsville, MN 55337www.medcarelifts.comPatran/Jamar Health Products, Inc.http://www.patran.net/index.htmlStryker Medical3800 East Centre Ave.Portage, Michigan 49002http://www.stryker.com/en-us/index.htmviii

How to Use This GuidebookVeterans Health Administration (VHA) Center for Engineering & OccupationalSafety and Health (CEOSH) guidebooks are “BEST PRACTICE” resourcesdesigned to assist health care facilities with the implementation and enhancementof programs and to more effectively comply with current Department of VeteransAffairs (VA)/VHA policy and external regulatory standards.Each guidebook has three sections: Preface: Disclaimers, Executive Summary (summary of how this booksupports each program), Acknowledgements, How to Use ThisGuidebook, Update Listing (list of any online updates made to theguidebook prior to a new publication), and Acronyms and Abbreviations,(list of acronyms and abbreviations used in the guidebook). Chapter Contents: Each chapter contains a general discussion thatprovides VA-specific guidance on the topic. Additional Reference Materials: Enclosures and Appendices.(Enclosures are provided in a generic format, to be edited and used byindividual facilities. Examples include templates, forms, samples, tools,and checklists.)This guidebook is available in two formats:Online Version: The online version toolbar includes the following features: Previous and Back Buttons – These buttons allow the user to pagethrough the chapter contents. Contents – A hyperlinked table of contents that helps the user navigatethe guidebook quickly. Click this icon to return to the full table of contentsfrom the Search or Favorites tools discussed below. Search – This feature allows the user to type a specific word(s) to befound. Once the search is complete, a hyperlinked list of locations of theword(s

Safe Patient Handling Point of Contact, Minneapolis VA Health Care System, Minneapolis, MN *Charlotte Lynch, MS, CNS, CSPHP, Safe Patient Handling Coordinator, Dayton VA Medical Center, Dayton, OH Marie Martin, Ph.D., Acting National Program Manager, Patient Care Ergonomics (10P3D) and Industrial Hygienist/Safe Patient Handling Facility .

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