From The Ergoweb® Learning Center

Another Side to Obesity — Increasing Patient Size Impacts Hospital Worker

The “Health” section of any newspaper will confirm it: Americans are getting larger.  Regardless of the culprit or the means necessary to fix this fact, the increased size of people poses unique problems for ergonomists, particularly in the realm of health care.

It’s not just a few extra pounds that are causing the problems.  The concern, particularly for health care practitioners, comes when patients exceed the weight limits on traditional medical equipment or when the patient’s body weight makes a manual move even riskier for anyone involved.  And with today’s weight statistics, that’s becoming all too common.

In a 2003 survey by Novation, a hospital supply services company, 80 percent of responding hospitals said they had seen more severely obese patients in the previous year than ever before.  Additionally, 41 percent of hospitals said they had made patient procedural changes to accommodate the growing number of growing patients.

For the health care worker, the increase in larger patients can be even more taxing.  In the March 2004 issue of Health Facilities Management Magazine, authors and architects James W. Harrell, FAIA, FACHA, and Bill Miller, AIA, ACHA, note that Bariatric patients, patients who encompass “a very wide weight range–from roughly 250-300 pounds to over 1,200 pounds,” can impact hospitals and workers in a number of ways.  “Moving a Bariatric patient requires special training and equipment. The most basic tasks can be very difficult for the Bariatric patient. Sitting up, standing, walking, going to the bathroom, taking a shower and moving from the bed to the chair are all tasks that often require assistance. . . . Obese people require more health care than average people, and there are increased physical problems for staff and attendants in administering that care,” Miller and Harrell wrote.

Miriam Wedermeyer, MS OTR/L BCN, Ergonomics Program Manager for Long Beach Memorial Hospital, agrees that the providing care for the Bariatric patient can greatly impact the hospital worker.  “Worker ergonomic issues could be the predicament most often overlooked by facilities–as well as the people who work in them,” Wedermeyer told The Ergonomics Report. “An informal survey revealed that weight loss surgery program planners and managers tend to believe that worker safety is not a problem because, to qualify for surgery, patients must be active and independently mobile, and they need to get up and moving as soon as possible after the surgery.  This optimism fails to address the risks of surgery of any kind for obese persons.  They easily develop serious complications that require transfer out to a higher level of care.  It takes a lot of strength for an obese person to move anyway. In a weakened state, they may need help just to turn over in bed; if able to walk to the bathroom, they need assistance to safely sit, rise from the toilet and complete their hygiene.”  And that assistance, says Wedermeyer, falls into the hands of the hospital staff.



Machines Don’t Provide All the Answers

With an increasing number of Bariatric patients requiring treatment of some sort, facilities can be faced with the tough, and expensive, goal of determining how to provide for the patient.  A bed, a bathroom, and even the layout of a room for a 700-pound patient can be drastically different than traditional models.  So, too, can the lift equipment.

Having the right lift equipment is key to the task of moving a patient for a health care provider.  But even while the number of Bariatric patients hospitals see continues to rise, keeping the equipment on hand may or may not be in the budget for a facility.  More often, facilities rely on rental equipment.

“Most facilities do some renting,” says Lynn LaSalle, MOTR/L, Ergonomics Specialist for MultiCare Health System in Tacoma, Washington.  “But it’s not necessarily a smooth process if you’re not prepared,” LaSalle says.  If a hospital that relies on renting lifts and beds knows in advance that a Bariatric patient is arriving, then there is sufficient time to get the right equipment in place and ensure workers are trained to use the equipment, but the nature of health care is that patients show up when they need medical attention, not after they’ve had time to give the hospital warning.  Plus, says LaSalle, “Even if you have the right equipment, you can still have limitations.”

For example, while Wedermeyer’s Long Beach Memorial Hospital has implemented a successful Zero Manual Patient Lift (ZMPL) policy (see The Ergonomics Report, August, 2003) and usually has the equipment to back it up, Wedermeyer still indicates that working with Bariatric patients can be tricky.  First, just getting the patient onto a lift device can pose risks like awkward postures and force.  For example, the worker may need to put the strap of a lift sling under a 100-pound leg or remove the sling from a patient’s leg, and even once the patient is on the lift, workers may still have to push the lift device. Second, says Wedermeyer, even with the right lift, more staff are often required to help spin the Bariatric patient into the desire position.

Plus there can be other problems.  “Even at our hospital, with ZMPL and abundant mechanical equipment, staff run into problems,” says Wedermeyer. “One weekend night a 600-pound patient somehow slid to the floor and couldn’t get up. The staff knew to not use their 450-pound-capacity lift device but they didn’t know to get the 700-pound-capacity device upstairs.  Instead, they called the fire department to get the poor man back to bed.”  Fortunately, Wedermeyer says, the patient had a very good sense of humor about the incident.

“Every setting is somewhat different,” says LaSalle, who notes that facilities themselves may be unprepared for Bariatric patients.  Larger patients sometimes require a double room in order to fit the rented equipment as well as the increased number of staff required to operate the equipment, and there’s always the potential problem of the patient being uncomfortable with being hauled around by an impersonal lift.  Still, says LaSalle, hospitals need to make the commitment to keeping workers healthy.  “There should never be a manual lift,” she says, regardless of the patient’s size, and regardless of anyone’s resistance to change previous procedures.


How to Make the Hospital Accommodating

The first step in making the task of moving Bariatric patients more agreeable for everyone

This article originally appeared in The Ergonomics Report™ on 2004-09-15.