From The Ergoweb® Learning Center

Ergonomics and the Bariatric Patient

Have patients become larger? Ask any caregiver and most will respond in the affirmative. For those same care providers, this increased prevalence of obesity in our society creates a number of unique challenges.

The topic of obesity is everywhere, from books and movies to watching the latest celebrity undergoing gastric bypass surgery and sharing his or her story on TV or in a magazine.  In 2001, the Secretary of Health and Human Services, Tommy Thompson, said, “Overweight and obesity are among the most pressing new healthcare challenges we face today. Our modern environment has allowed these conditions to increase at alarming rates and become a growing health problem for our nation.”

For the healthcare provider, handling average size patients can be difficult enough, but when dealing with Bariatric patients the problems are only compounded.  More and more hospitals are adding Bariatric programs to their list of services to address the needs of the communities they serve; however, many facilities fail to take the time to adequately address all of the ergonomic issues of handing a patient who may weigh 400- to 500-pounds or more.  In fact, patients weighing in excess of 600- to 800-pounds are becoming more and more common. 

Not only do hospitals need to consider larger beds, but all aspects of patient care need to be modified to accommodate the Bariatric patient.  Items such as room sizes, door widths, toilets and other bathroom fixtures, handrails, showers, and flooring are just a few of the environmental issues that are often overlooked as facilities plan for larger patients.

A bed that is half again as wide as a regular bed may not fit through many of the doors in the hospital. Wall mounted or other smaller toilets often do not have the capacity to handle a person weighing in excess of 350 pounds.  A bed or transfer device that is fairly easy to maneuver while empty, often becomes a major challenge for caregivers when loaded with a 600-pound-plus patient.  Now add carpet on the floors, ramps in hallways, elevator thresholds or other obstacles that must be navigated and it becomes clear that moving a Bariatric patient can quickly become an ergonomic nightmare, if not handled appropriately.

For these reasons, as well as many others, it is important that hospitals consider powered assist beds and transfer devices.  Providing motors to move the patient, rather than relying on the backs and legs of the caregiver, keeps everyone safer.  Plus, it can also increase the quality of care to the patient.

All departments that interact with the Bariatric patient must be evaluated and modified to meet the patient’s needs.  The time to evaluate an exam or x-ray table is not when the Bariatric patient arrives for the first procedure.  It is important that these departments also have the proper equipment necessary to accommodate and handle these larger patients.  In most cases, Bariatric patients are highly dependant and will require assistance to be moved from one location to another or from one piece of furniture to the next.

This only examines the tip of the proverbial iceberg on this subject.  There are multiple issues that need to be addressed to protect the safety of the caregiver and provide the quality of care most patients, regardless of size, have come to expect when dealing with leading healthcare facilities.

There is also one last point that must be mentioned here: relying on “proper body mechanics” as the main approach to patient handling doesn’t work, yet many hospitals use this as their first, and sometimes only, solution to the problem.  They will say things like, “If the nurse only used proper body mechanics when she lifted the patient she would not have been hurt.”  There is no safe way to manually handle a 150-pound patient, let alone a patient who weighs four- or five-times that amount.  Getting more people to assist with the transfer only places more people at risk.

Proper body mechanics training cannot overcome an inherently unsafe task like lifting a Bariatric patient.  No amount of “lifting with the legs” or “keeping the back straight” can protect the caregiver while moving these amounts of weight.  An ergonomist would never consider telling a worker in an industrial setting to use good body mechanics while repeatedly lifting a 350-pound load or even a 150-pound load.  When loads become that large, ergonomists recommend lifting devices to assist the workers in accomplishing their task safely and efficiently.  Healthcare workers deserve at least the same considerations for their work environments. 

This article originally appeared in The Ergonomics Report™ on 2004-09-14.