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The BIG Issue: Manual Handling the Bariatric Patient

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Manual handling of the Bariatric Patient can be a daunting experience. This presentation explores some of the issues that people are experiencing. It presents the creative use of risk assessment as a framework for addressing some of these manual handling problems.

Published in: Health & Medicine
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The BIG Issue: Manual Handling the Bariatric Patient

  1. 1. Hoisted – beyond safetyBeyond Safety
  2. 2. Providing best care and outcomes for Bariatric Patients Aideen Gallagher – Risk Managed The “BIG” Issue 9 May 2016
  3. 3. OUTLINE MANUAL HANDLING DISCUSSION RISK MANAGEMENT EXPLORATION OF EQUIPMENT
  4. 4. MANUALHANDLING
  5. 5. Person Environment Occupation (PEO) Model (Law et al, 1996)
  6. 6. Person Environment Occupation (PEO) Model (Law et al, 1996)
  7. 7. What are the greatest manual handling challenges are you coming across in your practice with clients of size?
  8. 8. MANUALHANDLINGTASKS TRANSFERRING REPOSITIONING MOVING EQUIPMENT (Retasas & Piniahana, 2000) LIFTING LIMBS (Nelson et al, 2006; Muir & Archer, 2008) MOBILISING CLIENT (Rose et al, 2006) SHOWERING (Muir & Archer, 2008)
  9. 9. 1.8 TONS (Nelson et al, 2004; Tuhoy-Main, 1997) 8 hour shift – Nurse was lift cumulative weight of
  10. 10. TIME SKILL WORKERS EQUIPMENT INCREASED (Muir and Archer, 2008)
  11. 11. 35% BARIATRIC TRAINING (Hignett et al 2007) 58% 50% STAFFING CHANGE (Scott, Pokorny & Rose, 2010) 67% POLICY(Hignett et al 2007) EQUIPMENT(Hignett et al 2007) (Scott, Pokorny & Rose, 2010) THE ENVIRONMENT SOCIAL and ECONOMIC SYSTEMS N O
  12. 12. WHEN DID YOU LAST USE A HOIST? 42% LAST 30 DAYS; 40% NOT IN OVER A YEAR(Whipple, 2008) “NO LIFT” AMBULANCE (Crowley and Legette, 2008) EXIT PLAN COMMUNITY IN – HOSPITAL OUT THE ENVIRONMENT SOCIAL and ECONOMIC SYSTEMS
  13. 13. WEIGHT SHAPE SIZE (Crowley and Leggett, 2010) RECTANGULAR SQUARE (Crowley and Leggett, 2010) UNEQUAL WEIGHT (Hignett & Griffiths, 2009) STATIC DYNAMIC – double SWL (Crowley and Leggett, 2010) INDUSTRIAL APPEARANCE (Crowley and Leggett, 2010) THE ENVIRONMENT EQUIPMENT
  14. 14. CLIENT SHAPE Rush (2002) WEIGHT ? DISTRIBUTION (Hignett & Griffiths, 2009) REDUCED MOBILITY (Fife et al., 2007) ENDURANCE (Hignett & Griffiths, 2009) UNCOOPERATIVE (Nelson et al, 2006;Kneasfey, 2000) FEAR DIGNITY (Crowley and Leggett, 2010) THE PERSON
  15. 15. UNCONSCIOUS STIGMATISATION (Berger, 2007) OVERWHELMING (Coates, 2010) EQUIPMENT ACCEPTANCE (Crowley and Legette, 2008) CLIENT COOPERATION (Crowley and Legette, 2008) BARIATRIC JOURNEY (ASCC, 2009) MORE WORKERS = SAFER? (Kayess et al, 2013) THE ENVIRONMENT SOCIAL
  16. 16. OHS Card
  17. 17. SOC!AL Physical Handling Manual
  18. 18. RISKASSESSMENT
  19. 19. RISK MANAGEMENT
  20. 20. RISKASSESSMENT Severity Likelihood
  21. 21. RISK Danger Loss Injury Harm Therapeutic Risk Taking Benefits Opportunity DignityofRisk
  22. 22. SAFETY Efficiency
  23. 23. FEAR
  24. 24. HARMFUL Non therapeutic OPPORTUNITY Therapeutic Positive Negative RISK TAKING
  25. 25. Enabling Occupation
  26. 26. A B C D H O I S T O N O F F O N O F F C H A I R O N O F F O F F O N When positioning in the chair from a hoist what brakes go on where?
  27. 27. RULES Handling Manual
  28. 28. Three minute rule
  29. 29. “making the same mistakes with increasing confidence over an impressive number of years” ….experience means…. O’Donnell,1997
  30. 30. “Creativity is allowing yourself to make mistakes. Art is knowing which ones to keep” Scott Adams
  31. 31. RISK MANAGEMENT CREATIVE RISK MANAGEMENT
  32. 32. Positive implications • What problem might be solved if this action was put in place? • Are there any further opportunities or actions that could be made easier because of this? • What is the likelihood of there being positive consequences? Negative implications • Is there a likelihood of any injury if this action was put in place? How might that occur? • What’s the severity of the injury if an incident did take place? • How can I enhance the positive/helpful actions and control the negative/unhelpful actions? OPTIONS?
  33. 33. RISKCONTROL HIERARCHY Eliminate Substitution IsolationEngineering Controls Administration Controls
  34. 34. RESIDUAL RISK
  35. 35. NEXTBESTALTERNATIVE
  36. 36. PRACTICAL PROBLEM SOLVING  1. BED MOBILITY STATION  Lying to sitting – sitting to lying transfer  Sit to stand and stand to sit from the bed  2. HOIST STATION  Test scenario of brakes on wheelchair and hoist  Compare standard yoke with four pronged hoist  3. FLOOR TRANSFERS IN SITTING STATION How many of your manual handling problems could this solve and how?  4. LYING TRANSFERS – HOVER MAT How many of your manual handling problems could this solve and how?
  37. 37. A B C D H O I S T O N O F F O N O F F C H A I R O N O F F O F F O N When positioning in the chair from a hoist what brakes go on where?
  38. 38. BARIATRICRESOURCES
  39. 39. ALGORITHMS (DrAudreyNelson) BEDCHAIRS(Baptiste, 2007) FRICTIONREDUCTIONDEVICES (Nelson & Baptiste, 2007). HOISTS (McGinley&Burke,2008) MOVEMENTPATTERNS (Christine Colavitti, QLD) HOVERMATS (Coates, 2012) RESOURCES
  40. 40. Muir, M. & Archer, G. (2008). Safe Patient Handling of the Bariatric Patient: Sharing of Experiences and Practical Tips When Using Bariatric Algorithms. Bariatric Nursing and Surgical Patient Care, 3(2), 147-158 A practical resources examining common manual handling scenarios in bariatric care and possible solutions. Coates, E. (2012). A path following approach to bariatric patient transfers. Safety Institute of Australia Conference Sydney, 2012 https://www.sia.org.au/downloads/Conferences/NSW/2012-sydney-safety- conference/speaker-presentations/elissa-coates.pdf An excellent presentation by Elissa Coates providing practical tips and algorithms for problem solving patient care as well as equipment options Kay, K., Glass, N. & Evans, A. (2012). Its not about the hoist: A narrative literature review of manual handling in healthcare. Journal of Research in Nursing 19(3), 226-245 An engaging and informative discussion on the origins of manual handling interventions and their effectiveness USEFUL RESOURCES
  41. 41. Safe Bariatric Patient Handling Toolkit- http://www.visn8.va.gov/patientsafetycenter/safePtHandling/BariatricsToolkit.pdf A publication by Dr Audrey Nelson outlining how to manage the Bariatric client Safe Bariatric Patient Handling Toolkit. BARIATRIC NURSING AND SURGICAL PATIENT CARE Volume 2, Number 1, 2007, 17-45 A practical resource to problem solve the management of the bariatric client Cowley SP, Leggett S. (2010). Manual handling risks associated with the care, treatment and transportation of bariatric patients and clients in Australia. International Journal of Nursing Practice 2010; 16: 262–267 Bariatric care in Australia USEFUL RESOURCES
  42. 42. MEDIA Warren MacDonald - photography reproduced with permission Three minute rule - Lars Ploughmann - Creative commons licence - Flickr Beach scene - Ricardo Liberato - Creative commons licence – Flickr Sheep - Amanda Slater Creative commons licence - Flickr Stairs - Creative commons licence - Flickr Law M, Cooper B, Strong S, Stewart D, Rigby P, Letts L (1996) The Person-Environment-Occupation Model: a transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63(1), 9-23. - Diagram reproduced with permission from CAOT REFERENCES/RESOURCES
  43. 43. Nelson A, Matz M, Chen F, Siddharthan K, Lloyd J, Fragala F. Development and evaluation of a multifaceted ergonomics program to pre- vent injuries associated with patient handling tasks. Int J Nurs Studies 2006;43:717–733. Kneafsey R. The effect of occupational social- ization on nurses’ patient handling practices. J Clin Nurs 2000;9:585–593. Nelson A, Matz M, Chen F, Siddharthan K, Lloyd J, Fragala F. (2006) Development and evaluation of a multifaceted ergonomics program to pre- vent injuries associated with patient handling tasks. Int J Nurs Studies 2006;43:717–733. Nelson A, Baptiste A. Evidence-based practices for safe patient handling and movement. Online J Issues Nurs 2004;9:4. Available at www.nurs- ingworld.org/ojin/topic25/tpc25_3.htm. Accessed 8 January 2007. McGinley, L.D. & Burke, J. (2008). Best Practices for Safe Handling of the Morbidly Obese Patient. BARIATRIC NURSING AND SURGICAL PATIENT CARE Volume 3, Number 4, 2008, 255-260. Gallagher, A. (2014). Risk Assessment: An enabler or barrier? British Journal of Occupational Therapy. Coates, E. (2012). A path following approach to bariatric patient transfers. Safety Institute of Australia Conference Sydney, 2012 https://www.sia.org.au/downloads/Conferences/NSW/2012-sydney-safety-conference/speaker-presentations/elissa-coates.pdf Rose M. Nurse staffing requirements for care of morbidly obese patients in the acute care setting. Bariatr Nurs Surg Patient Care 2006;1:115–120. Kay, K., Glass, N. & Evans, A. (2012). Its not about the hoist: A narrative literature review of manual handling in healthcare. Journal of Research in Nursing 19(3), 226-245 Rose M. Nurse staffing requirements for care of morbidly obese patients in the acute care setting. Bariatr Nurs Surg Patient Care 2006;1:115–120. Berger E. Emergency departments shoulder challenges of providing care, preserving dignity for the super obese. Annals of Emergency Medicine 2007; 50: 443–445. “Card “ by Fredrik Rubensson is licenced under CC by 2.0 addition of caption OHS card REFERENCES/RESOURCES
  44. 44. Muir, M., & Archer-Heese, G. (2009). Essentials of a bariatric patient handling program. Online Journal of Issues in Nursing, 14(1), 1. Muir, M., & Gerlach, S. (2003). Reducing the risks in bariatric patient handling. The Canadian Nurse, 99(8), 29–33 Muir, M., & Heese, G. A. (2008). Safe patient handling of the bariatric patient: Sharing of experiences and practical tips when using bariatric algorithms. Bariatric Nursing and Surgical Patient Care, 3(2), 147–158. Cowley SP, Leggett S. (2010). Manual handling risks associated with the care, treatment and transportation of bariatric patients and clients in Australia. International Journal of Nursing Practice 2010; 16: 262–267 Hignett, S., Griffiths, P., Chipchase, S., Tetley, A. (2007). Risk Assessment and Process Planning for Bariatric Patient Handling Pathways. www.hse.gov.uk/research/rrhtm/rr573.htm Scott, E. S., Pokorny, M. E., Rose, M. A., & Watkins, F. (2010). Safe ‘‘handoffs’’ for the morbidly obese. Bariatric Nursing and Surgical Patient Care, 5(1), 71– 74. Whipple, K. L. (2008). Maximizing healthcare provider safety while rehabilitating the bariatric patient. Bariatric Nursing and Surgical Patient Care, 3(1), 41–45. Australian Safety and Compensation Council (2009). MANUAL HANDLING RISKS ASSOCIATED WITH THE CARE, TREATMENT AND TRANSPORTATION OF BARIATRIC (SEVERELY OBESE) PATIENTS IN AUSTRALIA. Commonwealth of Australia Retsas, A., & Pinikahana, J. (2000). Manual handling activities and injuries among nurses: an Australian hospital study. Journal of Advanced Nursing, 31(4), 875-883. Rush, A. (2002). Overview of Bariatric Management. Disabled Living Foundation.: http://www.dlf.org.uk/news/archive/anitarush.html Fife C, Benavides S, Otto G. Morbid obesity and lymphedema management. Lymph Link Newsletter 2007; 19: 1–3. Nelson A, Baptiste A. Evidence-based practices for safe patient handling and movement. Online J Issues Nurs 2004;9:4. McGinley, L.D. & Burke, J. (2008). Best Practices for Safe Handling of the Morbidly Obese Patient. BARIATRIC NURSING AND SURGICAL PATIENT CARE Volume 3, Number 4, 2008, 255-260. Kayess, R., Valentine, K., Thompson, D., Meltzer, A. & Fisher, K. (2013) Research on the need for two care workers in a community setting. For Ageing, Disability and Home Care, Department of Family and Community Services NSW Social Policy Research Centre https://www.flickr.com/photos/comedynose/6939206771/in/photolist-bzcfq4-aoFsF9-dXwQCS-dXrafv-kKPAVS-graNZj-bg8dcr-gjvLc5-944LFa-a9PZ48-dyLUhH-mKiLC8- qjWAQB-r5kDHb-fLFr49-9FBMBF-61baGa-bjmKX4-e82EJ8-boJ5jC-aCWhkm-9pF9Sh-pPyvhx-dCVoK9-dXwPKu-iynY4g-8SJq5F-ax2vp6-4JzJrH-fQdypu-qo7GcF- graRRD-dXra7n-bi4E42-o2KeAL-e2fPV2-dySp2L-dySp5w-dXwPjC-aeq5Ud-nW2bqy-o4MAmr-pxahVf-ovQMkL-voF4oG-dXram8-dXr8HV-4EYnCE-o4Faad-o4MCjz Nelson A, Baptiste AS. Evidence based practices for safe patient handling and movement. Online Journal of Issues in Nursing 2004;9(3). Tuohy-Main K. Why manual handling should be eliminated for residents and career safety. Geriaction 1997;15:10-14. REFERENCES/RESOURCES
  45. 45. CONTACT  aideengallagher@risk.managed.com.au  www.riskmanaged.com.au

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