The Complexities of Plus Size Management Anita Rush THE ... · The Complexities of Plus Size...

1 www.yorkshirecareequipment.com

© Yorkshire Care Equipment 2015

www.yorkshirecareequipment.com

The Complexities of Plus Size Management

Anita Rush

© Anita Rush 2015

THE COMPLEXITIES OF PLUS SIZE MANAGEMENT

Anita Rush MSc (Health Ergonomics) Dip Health Care Studies RGN

Clinical Nurse Specialist - Equipment email: [email protected]



Anita Rush

© Anita Rush 2015

Introduction Plus Size refers to:- Mediatric

Bariatric

Guiding principles:-

Managing the foreseeable risk

Reduce the potential exposure hazards

Safety and harm free care

Integrated person centred approach

Education and communication





Anita Rush

© Anita Rush 2015

Definition An organisational policy may define a bariatric person differently e.g.

• A person whose weight and dimensions are over the safe working load of routine equipment

• A person whose weight and size restricts their ability to access health and social care, due to:-

Limitations on movement and the ability to travel to local or specialist centres

Difficulty with access and egress to buildings

Inability to gain an accurate diagnosis

A reluctance to seek advice from health and social care professionals



Anita Rush

© Anita Rush 2015

Prevalence within the local, UK and World Population

Estimated Number of Obese Men 2003 and 2010, by Region





Anita Rush

© Anita Rush 2015

Human Consequences

Reduced mobility and functioning

Discrimination

Increased morbidity and mortality

Reduced body image



Anita Rush

© Anita Rush 2015

NHS costs

£10 billion

2050





Anita Rush

© Anita Rush 2015

Economic cost

£49.9 billion



Anita Rush

© Anita Rush 2015

Body Shape - Somatotypes

Apple shaped:

Android

Pear shaped:

Gynoid

Proportional Bulbous Gluteal

Reproduced with the kind permission of National Back Exchange





Anita Rush

© Anita Rush 2015

Organs affected

Source Peate. I 2005

Daily Mail 7 December 2010





Anita Rush

© Anita Rush 2015

Balanced Decision Making

Health and Safety at Work Act 1974 miscellaneous regulations 2002 (HSE,1974)

Management of Health and Safety at Work Regulations 1999

Lifting Operations and Lifting Equipment Regulations 1998a

Provision and Use of Work Equipment Regulations 1998b

Manual Handling Operations Regulations 1992 3rd Edition (HSE 2004)

Human Rights Act 1998

Equality Act 2010 The Occupiers Liability Act 1957

Regulatory Reform (Fire Safety) 2005



Anita Rush

© Anita Rush 2015

Manual Handling Operations Regulations 1992, as amended 2004

Requirements of Employers:

Avoid hazardous manual handling, so far as is reasonably practicable

Assess the risk, for tasks which can not be avoided

Reduce the risk, so far as is reasonably practicable

Review the risk assessment, in the light of any changes

Provide information on the weight of the load e.g. the person





Anita Rush

© Anita Rush 2015

Numerical Guidelines for Lifting and Lowering (MHOR 1992) as amended 2004



Anita Rush

© Anita Rush 2015

Human Rights Act 1998

Article 2 - Everyone’s right to life shall be protected by law

Article 3 - No one shall be subjected to torture or to inhumane or degrading treatment or punishment

Article 5 - Everyone has the right to liberty and security of person

Article 8 - Everyone has the right to respect for his private and family life, his home and his correspondence



Effective inter-agency communication and working practices with all key stakeholders

A clear definition of a bariatric person and the necessary referral procedures

Clear responsibilities for Directors, Heads of Service, Care Managers and Advisors e.g. Tissue Viability, Back Care

An effective policy - approved, supported and financed by the organisation

Involvement of the patent and family at all stages of health or social care intervention

Provision of necessary equipment and staffing, in a timely manner

A holistic package of care, focusing on the physical, psychological and rehabilitation or treatment aims of the person

Review of the effectiveness of the care or treatment plan

A Person Centred Approach

Systems Approach



Anita Rush

© Anita Rush 2015

Risk Assessment

The following are required to be assessed:

Task

Individual Capabilities of the handler(s)

Load i.e. Patient

Environment





Anita Rush

© Anita Rush 2015

Risk assessment

Mobility assessment

Handling activities

Equipment provision



Anita Rush

© Anita Rush 2015

Task • Increased exertion / force in moving and handling tasks

• Frequent and prolonged physical effort

• Excessive pushing or pulling forces e.g. Moving heavy duty equipment, turning in bed, lateral transfers

• Holding/manipulating limbs at a distance from the trunk e.g. Holding a leg during turning/leg ulcer dressings, holding abdomen to allow access for catheterisation

• Reaching forward e.g. for rolling, turning or lateral transfers; providing personal care on a wider bed





Anita Rush

© Anita Rush 2015

Twisting or rotation of the lumbar spine – assisting to stand from a wider chair, catheterisation, personal care in bed, wound dressings

Risk of sudden movements – the weight of a distended abdomen suddenly moving during turning; sudden movements to stand / get in or out of bed

Exceptional circumstances – emergency evacuation during a fire, resuscitation, management of the falling or fallen client

Task



Anita Rush

© Anita Rush 2015

Individual Capabilities

Experience and skill in moving plus size people

Knowledge and training in specialist equipment

Attitude to obesity

Ability to communicate effectively and work as a team

Height, reach and physical strength

Underlying health problems or pregnancy

Clothing and footwear, including protective equipment e.g. Gloves, lead aprons





Anita Rush

© Anita Rush 2015

Load (Patient) • Accurate or estimated weight? (Research demonstrates a

20% variation)

• Shape, size and distribution of weight

• Presence of lymphoedema

• Neck circumference (Increased neck circumference is linked to metabolic syndrome and a predisposing factor to sleep apnoea (> 37cm for men and > 34cm for women)

• Ability to tolerate lying flat

• Ability to assist with movements and restrictions on movement due to distribution of weight / medical condition



Anita Rush

© Anita Rush 2015

Load (Patient) Medical diagnosis

Skin integrity and classification of pressure ulcers

Site and level of pain

Patient and family expectations and previous experience of being moved

Treatment and rehabilitation goals

Clothing

Mental capacity and psychological needs



Equipment Concerns

Equipment design

183kg no restrictions –

270kg with restrictions





Anita Rush

© Anita Rush 2015

Patient Specific Constraints Linens Patient gown Abdominal binders BP Cuffs Pharmaceutical Dressings Ventilation Continence Catheters for Venous access Environments



Bed Design

Bed width



Expanding Bed

Chair beds





Anita Rush

© Anita Rush 2015

Bed assessment (consider width)





Anita Rush

© Anita Rush 2015

Head neck position in bed

Posterior scapula adipose deposits around the neck

Ramping improves the laryngeal view, arrange either a medium pillow, flat pad and/or neck roll under the patient’s head until an imaginary horizontal line can be drawn between the external ear and sternal notch space. This provides a supportive surface that ensures safe alignment of the head and neck

Hyperextension is an important position for airway management

Ramping Ear level with sternum. Reduces risk of difficult laryngoscopy, improves ventilation.





Anita Rush

© Anita Rush 2015

Ramping with pillows



Anita Rush

© Anita Rush 2015

Concluding: when evaluating beds and mattresses consider:-

Height and width of the bed Safe working load of the bed, to include mattress

weight and health staff caring for the patient Suitability of the bed design Width of the bed enables patient to be turned from

side to side Sustaining Tissue Viability pressure reducing,

reduction Working environment Length of the bed Weight Capacity of side rail support Bed Positioning

Otherwise unsafe practice can occur



Anita Rush ©

Seating



Anita Rush

© Anita Rush 2015

Why Prescribe Riser Recliner Chairs? Plus Size persons sleeping surface 24 x7

Independent function

Aid Rehabilitation

Heavy Lymphatic legs

Decreases exertion

Cardiac management

To facilitate postural management

Tissue viability



Consequences of inappropriate seating

non healing leg wounds

Wound exudate





Anita Rush

© Anita Rush 2015

Seating Assessment Seat width

Seat depth

Weight capacity - is it:

static

moving

Foam should be high density to prevent compression

Ease of use stable and well balanced

Check arms are in reach

Surface texture facilitate the insertion of slide sheets or slings

Consider BS EN 1022:2005 and BS EN 12520:2010 (strength and stability)



Anita Rush

© Anita Rush 2015

Consider the Following Approximately 75% of the body weight is taken through

the seated area

Weight of each leg may account for up to 15.7% of persons total body weight

(ref Chaffin D.B, Anderson GBJ, Martin BJ (1999) Occupational Biomechanics 3rd ed New York: J Wiley and Sons)

Knees and hips should be level

Majority of the weight should be over the Ischial tuberosities and buttocks.

Upper half of the posterior thighs with head in midline and balanced over the body





Anita Rush

© Anita Rush 2015

Potential Challenges Feet dangling in plantar flexion when sat in the chair in an upright

position (can’t bend knees)

Gluteal shelf

Low seat height required

Depth of chair (no head support)

Pannus putting pressure on groin area (non-healing tissue damage)

Cardiac management

Combat fatigue

Prescriber knowledge base

Chairs fit for purpose



Plus Size Seating Assessment

Look at the body dynamics of the patient

Functional spatial requirements for the person

Where the chair is being used

Environmental constraints

Independent adjustments: (1,2,3,4 motor options)

Configurability of the chair, (i.e. can it be adjusted to meet the varying needs of the person)

Safe working load of all the functional movements

Height width and depth of chair

Arm rest width/height (comprising seat width/safe transfers)

Purpose it is being used for

Tissue Viability Properties i.e. seating leg elevation, tilt in space function

Weight of leg elevation if pannus and legs combined

Recyclability

Otherwise you can disable rather than enable

Hoist and Slings Design and Safety: Impact Weight

Accommodate the weight of a falling patient

As a rule of thumb, a falling patient is double their weight

Designing for Plus Size persons anything designed needs to consider the persons impact weight i.e. 25stone impact weight 50stone.





Anita Rush

© Anita Rush 2015

Increased Footprint

Storage

Width of room

Width of equipment

Corridors/opening/doors/transport

Home environment

Delivery transportation



Anita Rush

© Anita Rush 2015

Circulation

Width can it go through doorways

Map route

Where are you going

Manoeuvrability

Number of staff required to move

Stability



Hoist Design

Slings Types





Anita Rush

© Anita Rush 2015

Re-positioning/lifting Limbs

It has been identified that the weight of a person’s leg will be 15.7% of the total body weight and an arm 5.1%

(Chaffin et al 1999, Pheasant 1992)

e.g. For a person weighing 190kg, the leg weight would be 190 x 0.157 = 29.83kg

This does not take into account additional weight from conditions, such as lymphoedema

Leg Dressings



Anita Rush ©

Hoist and slings in evacuation



Consider the following when using hoists and slings:

• Positioning of the sling • Safe working load of the hoist / sling • Width of the sling bar • Size of the sling: patients dynamics not only height and

weight but shape • Will the position of the patient enable safe transfer on and

off the bed • Does the patient have any ability to assist • Sustaining tissue viability with the use of slide sheets • Attachments • Working Environment. E.g. safe working load of the floor



Anita Rush

© Anita Rush 2015

Cost Analysis Case study

Patient 216kgs discharge from hospital following a stroke. No potential for rehab and bedbound Care visits: 4 carers 4 times a day Equipment in place:

Overhead hoist Turning bed

Patients family unhappy with the different carers visiting and the intrusion into their family life Trialled motorised repositioning device worked well. Purchased device at a cost of £7,300 Outcome:

• One Carer visit twice a day • Annual saving to Social Services £116,800 • Family well being improved



Repositioning Equipment



Wendylett





Anita Rush

© Anita Rush 2015

Pushing and Pulling of Loads

Slopes and rough surfaces increase the amount of force required to push/pull a load

Risks increase over longer distances and when frequency does not provide sufficient rest/recovery time

Obstacles can create risks by trying to avoid collision

Large amounts of effort increase risks

Repetitive pushing and pulling increases risk

Position of the hands are best placed between the waist and shoulder height





Anita Rush

© Anita Rush 2015

Pushing Pulling Forces Guideline figure for starting or stopping

a load is a force of about 20kgs

Guideline figure for keeping a load in motion is a force of about 10kg

Guidance exists in relation to gradients (Manual Handling Operations

Regulations amended 2004)



Anita Rush

© Anita Rush 2015

Equipment Provision

All equipment designed for Plus Size person is not alike – one size does not fit all

Use the appropriate equipment for your patients body dynamics

Are you competent to prescribe (if not ask the manufacturer/supplier (i.e. joint visit/training)

Remember majority of Plus Size person will require Specialist equipment

Access and Egress



Factors to consider

Individual Factors Health and safety Space & Design

Equipment / Furniture





Anita Rush

© Anita Rush 2015

Client

Family

Clinical

Hygiene

Community Environment



Anita Rush

© Anita Rush 2015

Environmental Hazards

Constraints

Access and Egress

Safe working load of the floor

Stair lifts

Carpets

Furniture

Door openings

Corridors





Anita Rush

© Anita Rush 2015

Associated Environmental Risk

When prescribing equipment for the home environment ensure that the following is considered

Floor weight limits

Weight of the equipment being used

Weight of the spouse/carer if they sit on the bed or kneel to undertake handling tasks

Weight of the mattress

Lift weight

Corridors

All need to be added to the weight limit calculation.



Anita Rush

© Anita Rush 2015

General rule of thumb a ground floor

can take 2000kgs based on a 3 metre

square room

Upstairs will be less

Equation has to take into account the

joists, type of floor and size of room





Anita Rush

© Anita Rush 2015

6 inches x 6 inches

Max: point load 1 square foot

Point load 375kgs most building are built to that as a minimum

400 kg person should not stand on one leg

99% of ground floor buildings are adequate

1st floor and above you should always seek advice

Consider the combined weight of the bariatric person, staff and equipment / furniture, for example: -

Weight of person 200kg

Weight of bed 285kg (bariatric bed 1080)

Weight of mattress 24kg

Weight of hoist +/-100kg (gantry)

Combined weight of 2 carers 200kg

Weight of armchair 100kg (Riser/Recliner)

Additional furniture +/-100kg

Total 1009kg

Weight Limit of Floors



Bathroom Dimensions

Bathrooms Apart from inpatient bariatric bathroom facilities, bariatric patient-accessible bathrooms should also be

located in outpatient facilities and signposted with universal signage that is respectful and functional. The toilet design should also not have features that can lead to stigmatization.

Heavy-duty benches for bariatric patients to sit down during shower but with heavy-

duty grab bars in case /patient slips. Sinks located away from toilet and

Heavy-duty grab bars that look trendy and are functional



Anita Rush ©





Anita Rush

© Anita Rush 2015

Key Messages Moving and handling bariatric people is complex and multi-factorial

Treat the person as an individual and with dignity and respect

Accurate assessment is essential

Obtain an accurate weight, wherever possible

Identify equipment which will maximise the ability of the person to assist

Reduce the risk of injury to all, to the lowest level reasonably practicable

Ensure there is a detailed handling plan

Seek specialist advice as required



Anita Rush

© Anita Rush 2015

Emerging Bariatric Themes

Risk Management

Patient Led intervention

Appropriate Resources

Appropriate Equipment

Appropriate Environments

Education



In Essence The right equipment can facilitate

Patient function

Increase independence

Eliminate some high-risk nursing tasks

Inappropriate equipment causes over-exertion injuries to staff

Regular heavy patient handling increases the risk of cumulative damage

(Pheasant 1997)



Anita Rush

© Anita Rush 2015

Concluding

Bariatric Management is complex and multi-factorial.

Requires a Whole Systems Approach

Bariatric patients should be enabled not disabled





Anita Rush

© Anita Rush 2015

THANK YOU

Anita Rush SRN Dip MSc Clinical Nurse Specialist Equipment

Email: [email protected]

Electronic copies of presentation are available upon request

mailto:[email protected]

The Complexities of Plus Size Management Anita Rush THE ... · The Complexities of Plus Size...

Documents

Transcript of The Complexities of Plus Size Management Anita Rush THE ... · The Complexities of Plus Size...