Bariatric Transfers Meeting The Challenge

Overview

More than 8 million people in Britain, representing nearly a quarter of the adult population, are classified as clinically obese. Obesity has grown by almost 400% in the last 25 years and on present trends will soon surpass smoking as the greatest cause of premature loss of life (House of Commons Health Committee).

With childhood obesity levels rising, the needs of heavier patients and the staff caring for them must be addressed. One of the main challenges facing the hospitals today is getting these patients into and out of hospital in order to receive treatment.

Bariatric patients will often require the use of specialised equipment such as specialist ambulances, lifting devices and stretchers and these are in short supply. At NSL Care Services we regularly transport bariatric patients receiving treatment at hospital for a variety of reasons including regular outpatient care, inpatient care, mental health problems and diagnostic testing. We found that our current fleet of ambulances, even when fitted with specialist megasus stretchers, were unable to cope with the largest patients.

The NHS spends over £7bn every year on obesity- or bariatric-related disorders. People are classified as obese when their body mass index (BMI) goes over 30. Nearly a quarter of British adults are now overweight, which has created huge problems for hospitals, PCT's and emergency services.

In a well documented case in Suffolk a patient weighing nearly 65 stone was left stranded as no ambulance was available. It took more than 30 people, as well as members of the Fire Brigade, to get him to hospital. NSL Care Services are determined to be able to provide on demand and contract bariatric ambulance provision.

The Challenge

The new challenge NSL Care Services has is to deliver safe, dignified care, as well as systems and procedures that work for all bariatric patients, and to ensure that our team have the proper training when transporting this group of patients. There is a need for joined up thinking across hospitals, PCT’s, the rescue services and other professionals in order to preserve the dignity and care of individuals, and provide an industry leading bariatric ambulance service.

Obese patients have an increased risk of pressure ulcers and maintaining skin integrity is one of the challenges that the transport staff will encounter. Lack of training, poor staffing and unsafe handling techniques can also contribute to the increased risk of tissue damage within this patient group.

Poor safer people moving techniques can also not just cause injury to the patient but also the staff member and their colleague. Holistic training by appropriately trained staff should be provided.

Moving and transporting bariatric patients around is a challenging task and will often take up to three or more people. Bariatric transfers can be haphazard in their organisation, with a trust giving insufficient planning to the transfer, or indeed only making decisions on arrival for the transportation of bariatric patients, which is unacceptable.

The correct equipment needs to be organised in advance to meet this type of patient transfer, and co-ordination of medical professionals and patient transfer both at the originating and final destination, often overlooked, need to be in place.

The Solution

NSL Care Services understands the critical role it plays in ensuring that the bariatric patient pathway is successfully completed. We have drawn up stringent guidelines for bariatric patient transport and in August 2010 formalised this with a Bariatric Transfer Policy. This gives clear guidance including roles and responsibilities to managers and staff alike.

Due to the specialist equipment and treatment that is required at the hospital, organising and planning treatment can be complicated. Often it involves a vast multi disciplinary team of healthcare professionals to ensure that all aspects of their care is considered prior to treatment, and includes ensuring the necessary patient bed or trolley, theatre table, diagnostic testing equipment, and ancillary equipment are available.

To mitigate any risk NSL Care Services undertakes a risk assessment prior to starting the journey. This risk assessment will ensure that all the circumstances are considered before the patient is moved. Risks not only relate to the patient but also our staff, and this assessment will ensure that both are kept safe during the move. We consider the patient’s home and any access difficulties, the equipment that may need to be transported, the patient’s medical condition and mobility, and equipment we might need to provide to assist the patient move from their home to the vehicle.

To provide a service for all patients we have in invested in the latest bariatric vehicles, capable of carrying patients up to a weight of 75 stone. We have eliminated moving and handling activities, where there is a risk of injury, through the use of specialist bariatric equipment such as carry chairs, stretchers and wheelchairs all designed specifically for the patient’s needs.

We have also developed extensive relationships with the fire services to respond to issues where there may be involved, and provide staff with additional training to ensure patients are given some control over their situation. Their aim is always to give dignity back to the patient, acknowledging the confidence, embarrassment and self-consciousness issues, depression and added medical problems.

The Result

NSL Care Services have taken the lead in providing the highest possible quality of bariatric ambulance service, to specified standards, and always with the patient at the centre of this complex pathway. Our procedures ensure sufficient time is given for each bariatric transfer and will include:

• Identifying and using the correct vehicle for the job, within the scope of our bariatric transfer policy
• Providing sufficient planning time to complete a risk assessment, gathering the correct equipment, and sourcing trained personnel.
• Spending time with the patient, providing reassurance and explaining the process that is to take place, who will be involved and what will happen. Ensuring any patients’ concerns are listened to and where necessary acted upon.
• Ensuring driving staff have sufficient time to undertake the task safely, do not feel rushed and are able to act calmly to the situations as they occur.
• Keeping patient’s dignity as the main priority and ensuring the actions of our driving staff consider this at every opportunity.
• Completing a detailed handover with the clinical staff and ensuring a seamless service is delivered to the patient.

Bariatric Ambulance Service - equipment

Ricon inboard fully automatic heavy duty tail lift (500kgs)
Sumed Fortuna bariatric folding wheelchair (50 stone capacity)
Bariatric stair-pro carry chair
Ferno Megasus Stretcher
Premier mobile bariatric hoist (47 stone capacity)
Tinted privacy glass and cassette window blinds
Air conditioning
Lomax Folding wheelchair
Ferno cmpact 2 carry chair
Piped oxygen system
Roll-a-ramp access system for easy off site access (10 foot reach)
Recessed Unwin tracking for wheelchair/ stretcher locks
Blue light capability
Hand gel dispensers