A BIG issue

Background Bariatric patients are: • Patients weighing more than 120KG • Patients with a BMI greater than 35 • Patients who size and body shape do not fit standard size equipment and furniture. Increasing numbers of bariatric patients are presenting to SDMH. Optimal pieces of equipment are not always available for patients to be managed safely with dignity. Staff who manage these patients with insufficient equipment are at risk of injury. Unnecessary transfers to other sites for patients who we cannot manage due to their size and weight. The management of the bariatric patient doesn’t belong to one standard but is associated with a number of the 10 National Standards and lots of policies. E.G. NSW Occupation Health and Safety Act 2000 superseded by Work Health and Safety Act 2011 and NSW Dept. Health GL2005_70-Occupation Health and Safety Issues Associated with Management Bariatric (Severely Obese) Patients, September 2005 References Collopy, KT, Kivlehan, S & Snyder, SR 2012, ‘How obesity impacts patients health and EMS. EMS systems need to know how to handle the increase in bariatric patients’, PREMEDLINE and MEDLINE EMS World, vol. 41, no. 4, pp. 40-9. EBM Reviews – Health Technology Assessment Health Technology Assessment Database 2016, ‘Standard equipment for the usual care of bariatric patients: a review of the clinical evidence and guidelines (Structured abstract) CADTH’, no. 1. Logan, C 2008, ‘Substantial solutions. Creating safe and sensitive care pathways for bariatric patients’, PREMEDLINE and MEDLINE Rehab Management, vol. 21, no. 5, pp. 23-5. Or Manager 2004, ‘Selecting equipment for obese patients’, vol. 20, no. 5, pp. 15-6. PREMEDLINE and MEDLINE Healthcare Hazard Management Monitor 2008, ‘Equipping your facility for bariatric patients’, vol. 22, no. 2, pp. 1-6.

Diagnosis of the problem

Results (continued) Too early to ascertain if and when we have reached our stretch goal However, we have raised the profile of bariatric patients and their transfer and mobility needs in the Shoalhaven. We have ordered some equipment. We have created a wish list of additional bariatric equipment. Bariatric lifting equipment e.g. gantries are on planning list for future build. We did create a database for current equipment and a SWL for SDMH. We did label our equipment with the manufacture SWL. We did do a gap analysis of our Bariatric Patient Management Procedure ISLHD CLIN PROC48 and commence work on a training package. We did secure a location and wheelchair scales for patient weights. We did establish a process for alerting staff to bariatric patients via eMR. Outcome: Yet to be determined

Aim Statement Within 6 months 70% of bariatric patients at SDMH have appropriate transfer and mobility aids within 24 hours of admission and 100% within 12 months. (with stretch goal)

SDMH 2 week Demand Snapshot • 13 patients weighed more than 120KG • 2 patients weighed more than 160KG • Top patient weight was 174KG • 3 had size and shape issues (long and

lanky or short and round) • Equipment gaps identified • Process gaps identified

Ordered a gantry for ICU following successful trial (engineering specifications) Ordered new wheelchair scales, bariatric commode, wheelchairs, bedside chairs Commenced educating staff on creating bariatric eMR alerts Marked our equipment as agreed with our Infection control colleagues Changed the culture of ward/unit ownership of equipment Secured a commitment that bariatric will be included in future builds Secured more money for additional bariatric equipment Secured a 0.1FTE enhancement for a wards men to clean maintain the equipment and a “sweetener” to enable equipment to move around the hospital with the patient. Creation of a database of our bariatric equipment a system of tracking the equipment. List of equipment from the smaller sites that we transfer patients to.

Team members Guidance Team Dale Thomas (Director, Clinical services, SDMH) Anne Smith (ISLHD Physiotherapy Head of Discipline)

Project Team Natalie Wright (Registered Nurse, Whole of Health Project Lead) Michael Ruse (Medical Wards men and Medical Ward Manual Handling Champion) Paul Griffiths (Handyman) Rodney Juste (ICU Director) Rosemary Bodley (A/NUM Medical) Wendy Kellett (Hotel Services Manager) AnnMaree Wilson (Infection Control Coordinator) Melissa Bell (A/NUM Medical) Collette Early (Nurse Unit Manager {NUM} SDMH Intensive Care Unit {ICU}) Andrew Carroll (Carpenter) Ashley Overhill (Finance Business Partner Shoalhaven Hospitals Group) Barry Horton (Work Health Safety Consultant) Beverley Thomas (NUM Maternity) Casie Leigh Morrison (A/NUM Surgical) Chris Colmer (Physiotherapist) Emmakate Dewhurst (Occupational Therapy Unit Head - David Berry, Shoalhaven Memorial, Milton Ulladulla Hospitals) Lynn Hewitt (NUM Rehabilitation and Acute Stroke Unit) Shelley Jones (Registered Nurse) Wendy Fetchet (NUM ED) Wayne Farquhar (Facility Manager) Patricia Glasby (consumer and President of the Shoalhaven Hospital Auxiliary) Gaye Sykes ISLHD Quality and Accreditation Manager

Contact Details Helen Troy helen.troy@health.nsw.gov.au 02 44239560

Helen Troy

Plans to sustain change • Training package for what to do when a bariatric patient arrives

at SDMH. (including eMR alerts and accurate patient weights) • SIM training in the “bariatric suit”. • Now that we have our manual handling coordinator position

filled we need to revitalize the manual handling committee and to keep moving forwards with the work done to date and work on the areas that were out of scope in this initial project.

• Need to measure the impact of what we have achieved to date.

Results

A Clinical Practice Improvement Project

Plans to spread /share change ACI Innovation Exchange ISLHD Quality Awards 2018