Moving and handling of bariatric patients can present as a risk for both caregivers and client. Therefore, it is important to use the proper aids to avoid injury and improve work health and safety. Get the occupational therapist's best advice for the safe transfer of bariatric patients.
By Occupational Therapist Pia Beck
When you, as a healthcare professional, need to transfer a bariatric client, you may be concerned about your health and safety and afraid of getting injures. And you are not alone. The bariatric client may also be concerned about how the transfer will proceed and might be afraid of injuring you or of falling on the floor.
Through my 15 years of experience with this group of patients, I have gained extensive knowledge of how to deal with this situation. In this article, I, therefore, present some of my best advice for moving and handling bariatric patients.
When a bariatric client needs to be transferred, there are several things to consider, and as in all other patient transfer situations, thorough preparation is essential. According to a discussion paper from the European Agency for Safety and Health at Work, a risk assessment should always precede any patient handling and transfer, “as these are the riskiest work tasks for healthcare workers” (source). However, many times a lack of time and resources means that risk assessments are overlooked.
But according to a study by The Danish Work Health and Safety Agency, a lack of risk assessment is one of the main causes of acute physical overload of caregivers during patient transfers (source). Therefore, it is always a good idea to start patient transfers here, not least when it comes to moving and handling of bariatric patients.
As with other patients, the risk assessment should include an assessment of the type of patient (physical and cognitive function), the available aids and equipment, and the number of helpers (and their training), possible unexpected loads, and consideration of the room, environment and space.
However, with the bariatric patient, some other factors are important to consider. Below I will review the three factors, especially relevant when it comes to the transfer of bariatric patients.
Before you start moving and handling a bariatric patient, the first thing you need to do is to clarify what physical and cognitive resources the client has. Some health professionals who have no, or very limited, experience with bariatric patients may mistakenly assume that the client has more restrictions than they actually do, and therefore do not make use of the client's abilities.
Many bariatric clients develop new ways of moving and may be able to do many things independently, such as put on shoes themselves, even if you would not think so from looking at them. This is why it is crucial to involve the bariatric client in the planning process and to ask the client how they usually do certain things and what they are comfortable with.
However, it is also important to be aware that although the client can walk around on their own, it can be difficult for them to move around when lying in a bed. This is because of the shifts in weight distribution that occur when we lie down, which can limit the bariatric client’s movements.
The second thing to take into account when moving and handling bariatric patients is the way the client’s fatty tissue is deposited and whether it is soft or firm. This is to avoid the tissue moving unexpectedly, when turning the client.
As a rule, it is always recommended to work with good support and positioning of the client's tissue, to avoid a painful and uncomfortable experience for the client. This is particularly relevant if the client's tissue is very soft and risks suddenly moving during the transfer. Using support cushions will help keep the tissue ‘in place’ when turning the client.
In this case, it is important to place support cushions before starting the transfer, e.g. if the client is to be turned from supine to side-lying position. Support cushions will help support the stomach and chest tissue while ensuring that it is not carers, who must ‘catch’ or move the tissue during the transfer.
For clients, where the tissue is primarily located around the stomach area and is very firm (often the fatty tissue is placed on the inside of the abdominal muscles), the tissue will not drift (move) during transfer. Instead, it can be advantageous to ensure stability around the pelvis, by working with a pillow under the knee/lower leg either in front of or behind the client.
Another important focal point when it comes to the client's tissue is attention to the client's respiration. During the transfer, the tissue may challenge their respiratory function, for example when the client is lying on the back. To avoid this issue, slightly elevate the head end of the bed while turning.
Studies have shown that in-bed transfers of patients within the normal-weight range or patients using manual aids " [...] are high-risk tasks where a very large proportion of the transfers will exceed the safe working load limit values." (Scotte and Fallentin), even when the transfers are carried out by experienced caregivers. Thus, the probability that a transfer of a bariatric client also exceeds these limits when manual aids are used is very high. Therefore, the third thing that needs to be taken into consideration is, what kind of care tasks that needs to be done, and what aids are available.
For example, in many care situations, there is a need to move or lift a client’s legs. In this case, it is important to be aware that one leg represents about 16 % of a person's total body weight. Transferring a bariatric client's leg can thus exceed what is safe for you to transfer.
If you need help with patient transfers such as higher up in bed, turning to side or prone position, moving of legs in and out of bed or placing slings, then bariatric clients or patients must always have a powered turning aid combined with a ceiling hoist to ensure the working environment of staff and the safety of the client.
The VENDLET system can also help make the bariatric patient more comfortable being turned in bed because the speed can be adjusted. If the tissue is very soft, the low speed allows the staff to place cushions to support the tissue while turning the client.
Further, it is also important to be aware of the safe working load of both bed, hoist and other equipment. Make sure you do not have any unnecessary items in the bed, that all add up to exceeding the safe working load of the bed, and can result in the brakes on the bed failing. This can make the work situation risky for both clients and staff.
As with all clients, it is not least important to communicate well with the bariatric client and assure him/her that you are in control of the situation.
It is always a good idea to share with the client the considerations you have made about the transfer and why you are doing what you are doing. This can help prevent the client from doing something unexpected that may prevent you from doing your job.
If the bariatric patient is uncomfortable, it is even more important to have an open dialogue and together agree on what is going to happen.