Growth in obesity among the population has a materially higher proportionate effect on the healthcare sector because of the propensity for heavier people to need healthcare services. This creates a need to review policy and procedures for the management of this class of patient covering obese and bariatric patients. In 2007 a paper written by Loughborough University was published by the HSE addressing ‘Risk Assessment and Process Planning for Bariatric Patient Handling Pathways’. This paper identified issues to be addressed and provided useful research, some of which is mentioned here.
Since 1993 there has been a 50% increase in patient numbers with a BMI over 30 and a 100% increase in BMI over 35-40.This suggests a 26% proportionate increase of people classified as obese by 2010 against the 1993 base. The least successfully managed area of difficulty from NHS trusts’ point of view is space and design for managing the care of obese patients. Technical assessment suggests that an area of 3.93m wide and 4.23m long is required as a minimum for care of obese patients, which is more than current NHS estate guidelines.
Some trusts have now progressed the recommendations of the HSE paper and have introduced policies and directives for moving bariatric patients.
These policies suggest that existing equipment may not be appropriate to support bariatric patients. It is important to notice here that the classification of obese and bariatric is the clinical definition by reference to the patient rather than a health and safety classification from a moving and handling point of view. There may be a disconnect between a clinical view of the patient for treatment and the procedure to classify the correct approach from a moving and handling point of view. In some guidelines there is a need to identify the correct equipment to be used and where necessary procedures are set out for hiring the equipment. The risk factors to be considered are, among others:
- Safe loading of floor
- Safe working load of the hoist
- Weight of equipment
- Weight of carers and attendees
This process ought to result in the preparation of the appropriate bed, hoist, sling, chair, commode and slidesheets. The space provision is a key feature of comfort for the patient and safety for the carer when moving a patient.
Some guidelines give a specific directive that: ‘Once admitted, the manual movement of equipment loaded with the patient must be reduced as far as reasonable. In particular only equipment designed for use with the weight involved should be used. Where possible electric equipment must be used as a minimum standard.’
In January 2009 a further paper was published by Rice/Wolley/Waters, ‘Comparison of required operating forces between floor-based and overhead-mounted patient lifting devices’.
This was based on research into the effort required by a male of 1.8m weighing 84.1kg wearing rubber soled shoes to move patients in a floor-based hoist and overhead system. The research identified a compelling difference in push/pull and rotational forces required in floor-based equipment for patients in the upper range of those involved in the study (21st-23st). The forces identified are: push – 15.80kg, pull – 17.30kg.
These forces were measured where the equipment is in pristine condition and floor coverings are optimal. The report confirms the view that rotational movement of floor-based hoists may require materially greater effort to initiate and maintain movement in comparison to push pull because of the tangential forces associated with moving mass in a circular motion.
The HSE-published guidance on moving and handling, ‘Getting to Grips with Moving and Handling’, provides various recommendations in relation to human effort in moving and handling. The guidance from the HSE is:
- Force to start/stop load – men 20kg, women 15kg
- Force to keep load in motion – men 10kg, women 7kg
These recommended figures may be reduced for biomechanical effect, reduced space and uneven floors.
These papers suggest there is an imminent need to review the type of equipment used and made available for heavy, obese and bariatric patients across the UK, and a comprehensive solution designed to each patient’s needs should be considered to avoid the risks identified.
ERGOS bariatric solutions address the need for slings of the right size, smooth, comfortable movement for patients and a risk-free method of moving heavy patients. This is the solution needed to address the needs of the new protocols being introduced and to protect staff against the risks identified in the papers referred to.