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by Jeannie Akridge

Skytron 6701 Hercules table

The problem is universal, noted John H. Ambrose, BMET, CST, Skytron senior product manager for surgical tables and accessories. Not only are 33.3 percent of American men and about 35.3 percent of American women considered obese, "childhood and adolescent obesity is reaching epidemic levels today in the United States," he emphasized. "The latest statistics from the U.S. Surgeon General are quite sobering. They show that more than 12.5 million children and adolescents aged 2 to 19 are overweight. And these numbers are on the rise. As a result, growing numbers of children and teens are at increased risk for diseases traditionally seen only until now in adults, these include heart disease and Type 2 Diabetes."^{1, 2}

For evidence of how the population has grown in stature, Joe Przepiorka, vice president of marketing for Encompass Group LLC, need only look to the expanding size of patient gowns manufactured by Encompass.

"We have seen interest in bariatric patient apparel grow rapidly over the past few years as patient size has increased," he said. "Several years ago, for example, the average size patient gown had a 60-inch circumference, including overlap. Now the standard size gown that hospitals and laundries buy from us has moved up to 68 inches. This equates to a size XL.

"A decade ago, you started to see 10XL gowns come into the market with a sweep of 120 inches," Przepiorka added. "They have been commonplace over the last few years. And recently we’ve been asked for and are stocking for hospitals 15 XL gowns with a sweep of 130 inches. Size-wise they’ve really taken off."

Winco  Nocturnal Elite recliner distributed by TSK.

Pediatric gowns have also grown with the times, he said. Obesity issues aside, "even healthy kids today are taller and larger than kids in the same age range used to be. Add in the obese pediatric population, and you quickly realize that the ‘standard’ kids’ sizes don’t work well anymore. We’re in the process of upsizing all of our pediatric apparel items."

Bigger patient gowns are only the beginning. "Nearly everyone has added bariatric options to their portfolio of products," said Michael Klein, vice president for specialty distributor TSK Products. "Years ago, you had to search to find companies who had a bariatric line. Now to be a viable player, you have to supply that option. For example, I don’t know of any furniture manufacturer in healthcare that doesn’t offer bariatric seating products.

Many facilities are standardizing on higher weight capacity equipment facility-wide, he explained. For example, "in ambulatory surgery, you get patients of all weights and sizes. What used to happen, they would order [mostly] normal size recliners, now what they’re doing in some cases is ordering all the higher-end weighted recliner. A patient recliner is typically rated at 275 lbs. We have standard recliners that offer wider seat widths and can handle patient weights up to 500 lbs. We also offer a specialty bariatric recliner with a power lift assist that can handle up to 600 lbs. They’re saying, ‘let’s just order them all at the higher weight’."

"I think that it’s now part of the vocabulary and it’s starting to be a part of normal operations," observed TSK Vice President Eric Klein.

As a product utilization resource nurse clinician, Theresa Gibson, RN, applies her clinical and financial background to assist in the evaluation and purchase of surgical and clinical supplies used in the treatment of obese patients at 503-bed West Virginia University Hospitals, based in Morgantown, WV.

Featured at the new Upstate Golisano Children’s Hospital in Syracuse, NY, KI’s Arissa Collection of universal lobby and lounge seating – with a weight capacity of 750 lbs. and the ability to accommodate people of all sizes equally well – eliminates the need to specify a percentage of bariatric and standard seating.

WVU Center for Surgical Weight Loss performs gastric bypass banding, laparoscopic sleeve gastrectomy, and Roux-en-Y gastric bypass procedures, however Gibson indicated that "the patients we see for bariatric surgeries aren’t really the population that gives the hospital the most difficulty. It’s the patients who come in off the street who are bariatric patients that cause more anxiety in the hospital setting. Because at that point, they probably have a chronic illness and they have a higher chance of morbidity because of their obesity.

"Bariatric surgery is one thing," she explained. "They come in, they have their surgery, and generally they tend to go home fairly quickly. It’s the patients who are morbidly obese, who also have chronic conditions like diabetes, foot ulcers or heart disease, or any combination, who are coming in to the facility; and because they have multiple medical problems it’s difficult to manage their stay."

She estimated that the average weight for an obese patient visiting WVUH for bariatric weight loss surgery might be 300 pounds. "You don’t see a 500-lb. patient on a daily basis. If you do see those patients, they usually have other issues going on."

With a goal of ultimately achieving Bariatric Center of Excellence accreditation, WVUH houses a designated med-surg area for bariatric patients featuring larger rooms equipped with ceiling lifts, higher weight capacity commodes, heavy-duty beds, etc.

Even beyond that, "we have everything designed for bariatric that you can possibly think of," said Gibson. Among those essential products for obese patient care: "no-slip" fall-prevention socks and bariatric gowns, longer instrumentation for abdominal surgery, longer needles for performing spinal blocks on obese pregnant women, bariatric-capacity pressure-relief pads, transport gurneys, surgical tables and bariatric beds.

Encompass Group’s 15XL hospital gown

Bariatric bed pans from TSK Products are also used at WVUH. The Klein brothers noted that the oversized bed pans – which are made of a strong but pliable material that’s more comfortable for all patients, not just those that are obese, and are easier for nurses to use – exemplify how bariatric products and equipment are moving out towards other areas of the hospital. Starting in 2010, TSK will make the bedpans available as part of an obese patient kit that will include fall-prevention socks and an identification wristband.

Encompass manufactures and produces a variety of textile products that can accommodate obese and morbidly obese patients including its Dignified Comfort bariatric patient apparel line of adult and pediatric gowns, pajamas, robes, incontinence briefs and fall-prevention footwear; AlbaHealth DVT prevention products – anti-embolism stockings and compression sleeves; oversized bedding items such as sheets and blankets, towels, and incontinence underpads.

"Our Patient Care line of incontinence pads are designed with patient skin integrity in mind," said Przepiorka. "The specially-designed synthetic surfaces keep moisture away from the skin to help prevent skin breakdown, the risk of which is greater as the patient’s weight goes up and their health is compromised. The DermaCare pad has the thinnest profile of any reusable pad to prevent interfering with the pressure reduction therapy offered by specialty beds and surfaces." Encompass also recently formed a joint venture company with Hill-Rom to sell and distribute pressure reduction mattresses.

Obesity trends are affecting hospitals facility-wide and can lead to increased costs, labor and risks, noted Przepiorka. For one, "specialized product needs for bariatric patients are generally outside of the core items purchased by hospitals on a daily basis."

"Many times, the reimbursement to care for a bariatric patient does not cover the increased overall cost," he added. "From a labor standpoint – without proper protocol, equipment, and training – it may take more healthcare workers to care for and safely handle bariatric patients. The increased risks not only impact the general health of the patient, but the staff and the facility as well. There is an increased risk of staff injury and downtime if bariatric patient handling is not done properly with the proper equipment. You can’t move or ambulate a bariatric patient in the same manner that you can an average weight or even a slightly obese patient. If something happens to a bariatric patient during a handling episode, the facility will come under increased scrutiny for whether it has a proper safe patient handling program in place, for example."

Eric Klein noted that safe lifting policies and equipment are a prime example of lessons from the bariatric market being applied throughout healthcare. "Washington state passed HR1672 in 2005 which required all of the state’s hospitals to have [safe patient-handling] programs that eliminate patient lifting. Rhode Island, Texas and other states have either promulgated their own laws or have been trying to get legislation which works (California has passed legislation four times only to be vetoed by the governor each time)."

"You’re not going to lift a 120-lb. patient in the same way anymore," he said. "What we’re seeing now is a heightened awareness of not only staff back problems but also patient safety as far as transportation goes. And that includes a lateral transfer."

In the state of Washington, indicated Klein, products and equipment that eliminate the need for a patient lift by allowing for a safe lateral transfer – such as recliners with swing-out or drop arms, and air-assisted lateral transfer mattresses – are reimburseable safe handling purchases.

HoverTech's HoverJack Air Patient Lift accommodates up to 1,100 lbs.

The Liftaem Safe Patient Handling lateral transfer system available from Encompass uses a cushion of air to "levitate" the mat just above the surface allowing for effortless patient lateral transfers. (Visit www.smartmedtechnology.com for a demonstration video.) The single-patient-use Liftaem mats, available in extended widths of 39" and 45", are assigned to a patient for the duration of his/her stay and then disposed of, reducing the risk of cross-contamination due to improper cleaning. "The Liftaem Safe Patient Handling lateral transfer system can allow just two healthcare workers to very quickly transfer a patient weighing up to 1,000 lbs. from a bed to a stretcher, from that stretcher to an imaging table, OR table, cardiac chair, etc., without the slow process of using a mechanical lift," described Przepiorka. "Normally a move like this would require as many as eight to 10 HCWs to manually lift and transfer, and even with all those people, that move would not be safe for anyone."

Nurses at WVUH use HoverMatt lateral transfer devices to move patients from the bed to the gurney, and from gurney to bed. "The nurses use them on pretty much everybody," Gibson commented. "That was the single biggest turn around in the OR world, because people don’t wake up immediately and sit up from their surgery. It’s a very nice piece of equipment."

Besides ceiling lifts with a choice of cloth or disposable slings in the dedicated bariatric area, WVUH also provides its staff with portable bariatric and standard-size lifts with sling options ranging from full-body slings for transferring patients from a horizontal position, to seated slings, to those that allow for toileting. Gibson noted that buyers need to consider the amount of weight that a lift can pull from the ground up in case a patient falls and needs to be lifted from the floor.

"I don’t think that you should be lifting any patient," she stressed. "I think that you should be using a device or an assistance to lift the patient. You physically lifting a patient is putting yourself at risk, it’s putting the patient at risk in case you for some reason falter. It’s just not a smart, healthy thing to do."

Preventing back injuries should be a top priority for every hospital said Gibson, adding, "You have to be proactive, and you have to have education. That takes resources and it takes commitment."

From helping facilities prepare for Bariatric Surgery Center of Excellence certification to working with hospitals to accommodate unique equipment and space consideration needs, TSK Products offers facility assessment and audit services, relying on engineering skills to examine the effects of treating the obese population on patient throughput, equipment life, and incremental cost. TSK Products also works with equipment manufacturers to adapt products or implement changes manufacturers have made, for example, brainstorming alternative designs for equipment that is large enough to accommodate wider patient widths, yet still fits within the often confined spaces of the hospital setting.

Detecto 6550 portable wheelchair scale

Michael Klein noted that Winco’s 450-lb. capacity Transfer Cliner provides an attractive option for space, and cash, strapped emergency departments who are looking for a multi-purpose, infinite positioning transport chair with a smaller footprint and lower price tag for their Fast Track and Triage rooms.

"Dialysis clinics are purchasing bariatric recliners to accommodate nocturnal dialysis, another emerging market," noted Klein. "If they can maximize the efficiency of the center by utilizing those eight hours at night, then profit will improve. TSK Products carries models from Champion and Winco which feature wider widths, capable of carrying a heavier patient. Winco has produced a wide recliner that also lays completely flat thus enabling patients to turn on their sides during their eight hour treatments at night.

"If you can envision a typical recliner between the back and the seat, even when you recline, it maintains a ‘v’ shape in the lower back and it makes it very difficult to turn from side to side," explained Klein. "Winco’s recliner is the only one on the market that’s actually truly flat and can make it very easy for a patient to go from one side to the other." Designed for multiple hours of treatment, the chair features a patented cushion gel that’s designed to reduce capillary closure pressure and make it more comfortable for patients to sit in it long-term, he added.

Products to support the obese and bariatric population are not simply bigger versions of the standard, Przepiorka noted. "Designing and building the bariatric product properly is a must. It is not just ‘build it bigger.’ For instance, our anti-embolism stockings need to fit properly from the toe-end to the top, as they have as many as seven distinct points of specific vascular compression in between. Get this wrong, and you can compromise the health and comfort of a patient pretty quickly. In addition to the product itself, we feel our stocking-fit measuring system for the nursing staff is the best in the business. We supply color-coded measuring tapes and packaging to help the staff ensure they’ve done it correctly." 

Properly accommodating the obese patient can also go a long way towards maintaining a sense of comfort and dignity. "In general, having the product fit correctly is step number one to helping the patient feel more comfortable," said Przepiorka. "Secondly, many of our bariatric apparel items are color- and print-coordinated to our most popular apparel ensemble offerings, so the bariatric patient does not appear ‘different’ due to what they are wearing." 

Gibson offered this important piece of advice for caregivers and staff interacting with obese patients: "Just because they’re a larger size person, and they need a little bit more [assistance], you have to consider the person inside of that body, too. Sometimes I think that society forgets that just because you’re bariatric size, doesn’t mean that your feelings are bariatric size, too. You have to remember that the person already has sensitivity about their weight, probably more than you can imagine. You have to prepare your staff not only for the emotional aspects of having a bariatric patient, but the physical aspects of having a bariatric patient.

"Everybody’s aware that people are getting heavier," she continued. "And I think most hospitals are aware of how to take care of a bariatric patient to a degree. However, they may be strapped for finances and not be able to provide the equipment that they would like to have. In order to be able to justify the purchase of bariatric equipment and supplies, they need to look at their population and see what that population is doing. Is it costing them extra in reimbursement because the patients are staying longer because you can’t move them through fast enough? Obesity is not a problem that’s going to be changed overnight," Gibson emphasized.

References:

1. American Society for Metabolic and Bariatric Surgery

2. Michigan Bariatric Surgery Collaborative