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Bariatric patients and the use of mobile hoists: user experiences from three hospitals in South Australia
 

Bariatric patients and the use of mobile hoists: user experiences from three hospitals in South Australia

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Mark G. Boocock

Mark G. Boocock
Health and Rehabilitation Research Institute,
Auckland University of Technology
(P46, Thursday, NZI 5 Room, 4.30-5)

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  • The Accident Compensation Corporation (ACC) is the NZ government body which provides comprehensive, no-fault personal injury cover for all New Zealand residents and visitors to New Zealand. Approximately 42% claims accepted

Bariatric patients and the use of mobile hoists: user experiences from three hospitals in South AustraliaBariatric patients and the use of mobile hoists: user experiences from three hospitals in South Australia Presentation Transcript

  • Bariatric patients and the use of mobilehoists: user experiences from three hospitals in South Australia Mark Boocock* Gunther Paul** *Health and Rehabilitation Research Institute / Centre of Occupational Health and Safety Research AUT University, New Zealand **Ergolab, Mawson Institute, University of South Australia, Mawson Lakes SA 5095, Australia
  • Introduction - rationaleNursing personnel - one of the occupational groups most at risk ofwork-related musculoskeletal disordersHazards and risks associated with moving and handling ofbariatric patients is multi-factorial  weight  atypical body mass distribution  mobility  co-morbidity of symptoms  patient co-operationEquipment design for bariatricpatient care is often lacking
  • Introduction - rationaleVideo clip available on YouTube athttp://www.youtube.com/watch?v=yO7sMFi1W2E
  • Aims and objectivesUndertake a literature review of patient handling  to identify hazards and risks associated with the care and rehabilitation of bariatric patients  identify relevant design criteria for mobile hoistsIdentify end-user experiences of bariatric patient handlingequipmentDevelop end-user acceptance criteria appropriate to design
  • Methods: literature search Six electronic databases  EBSCO Host  Medline via Ovid  Scopus  Web of Science  AMED  ProQuest Central• Search terms and MESH headings were relating to patients handling devices• Supplemented with a search of relevant national and international website (e.g. ISO, CEN, Standards Australia and Standards New Zealand, Health and Safety Executive (UK), WorkCover)
  • Methods: interviews and observations Structured interviews - 6 experienced injury management staff from the Manual Task Services department of 3 Adelaide hospitals Open-ended questions were structured around five main themes: • patient factors • building/vehicle space and design • equipment and furniture • communication • organisational Hignett and Griffiths (2009)• Focus - the use of mobile hoists for lifting and transferring bariatric patients• Walk-through of the hospital to view the types of mobile hoists, and the location and storage
  • Results – literature searchConsiderable variation in classification of bariatric patient  BMI (>30 and >40)  body weight (>45 kg ideal weight)  waist-to-hip ratio  waist circumference  anyone who has limitations in health due to physical size, health, mobility and environment access (Baptiste, 2007)6 bariatric body shapes and identified concerns affecting liftingof these patients (Grundy and Abate, 2003; Murphy, 2003) Apple Apple Pear Pear
  • Results – literature search• Design standards: AS/NZS ISO 10535:2011 ‘Hoists for the transfer of disabled persons – Requirements and test methods’• Barriers to the use of moving and handling equipment – 3 categories:  Equipment design, e.g. weight limitations, instability, difficult operations, storage problems, incompatibility with other equipment  Care provider, e.g. lack of training, cumbersome/inconvenient, inability to locate, time constraints, levels of motivation, governance  Patient, e.g. aversion to equipment, loss of sense of control, insecurity, discomfort, dignity, privacy
  • Results: interviews - patient factorsBariatric classification  considerable variation and ambiguity  ≥120 kg, although general hospital policy ≥100 kg  BMI sometimes used  move to considering a range of factors, e.g. body anthropometry and health statusBariatric patient numbers – each of the hospitals  10 per month ≥170 kg, 3 per year ≥250 kg  5 per month ≥150 kg, 2 per month ≥180 kg  4 patients per day considered bariatric (≥120 kg)
  • Results: interviews – building and space designEquipment storage  major problem identified at the 3 hospitals  some had a central storage  often disused wards, vacant store rooms, corridorsSpace restrictions  size and layout of room important for bariatric patients  storage of equipment close to bariatric patient  sufficient space in and around patient to allow safe access  accommodate visitors  modifications made to wards, e.g. reduce from 6 to 2 or 3 bed wards
  • Results: interviews – equipment and furnitureTasks performed - mobile floor hoists  transferring and not transporting  short transfer tasks, e.g. bed-to-chair, wheel chairPoor design features – mobile floor hoists  manoeuvring – view as most high risk tasks due to pushing and pulling combined with trunk rotation  handle positions – designed for moving in linear direction not rotation  height of the wheelbase – in and around adjustable beds  relatively unstable (‘tippy’) with heavy patients  In restricted/confined space – becoming trapped between hoist and wall  patient ‘swinging’ into the main support arm  floor lifts  collision type injuries
  • Results: interviews – equipment and furnitureDesirable design features – mobile floor hoists  power assistance when manoeuvring hoists  user-friendly controls – essential  combined functions, e.g. assisted walking  storage  preference for 4 pt spreader bar and loop attachments  scales built into hoist  device for monitoring frequency of use  height adjustability  detachable, rechargeable battery/warning indicatorsMobile floor hoists vs ceiling/overhead hoists  overhead hoists were considered to offer significant advantages  H-track designs offer greater flexibility
  • Results: interviews – communication/organisationalCommunication – factors considered poor communication between wards often wards given responsibilities for equipment purchase – no central equipment databaseOrganisational – factors considered poor no systems that keep track of equipment - slings getting lost often no systems for regular maintenance of equipment no designated central storage space for specialised equipment
  • Design requirements: end-user acceptance criteriaMobile floor hoists Compactness – suitable for use in confined spaces (e.g. bathrooms and toilet areas) and when moving along narrow corridors Compatibility – comply with appropriate standards and suitable for use with other equipment (e.g. stretchers, wheelchairs) Durability – low maintenance, high strength requirements (at least 300 kg) Functionality - powered assisted for manoeuvring and patient re- positioning Adapted from Conrad et al., 2008
  • Design requirements: end-user acceptance criteria (cont.)Mobile floor hoists Storability - easily stowed, foldable or collapsible for storage purposes Operability – quick, easy and intuitive to operate, and assemble and disassemble Clean-ability – easy to clean and disinfect Stability – stable during patient transfers and when moving on different floor surfaces (e.g. slopes and inclines, carpeted floor) Adapted from Conrad et al., 2008
  • ConclusionsLimitations associated with mobile floor hoists for use with bariatricpatientsSignificant improvements in design requires designer to consideruser and patient requirements  improved appreciation of hazards  user and patient involvement in designA co-ordinated and collaborative approach for moving andhandling of bariatric patients is needed across the range of careprovidersIs there a need for bariatric classification?Is the mobile floor hoist a necessary piece of handling equipment?