Safety

With safety in mind, Facility Guidelines Institute tweaks terminology for ’patients of size’

Hospital Safety Insider, July 26, 2018

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The American Society for Metabolic and Bariatric Surgery notes that bariatric surgeries have steadily increased in recent years, climbing 10% from 2015 to 2016 alone to 216,000 total surgeries. Yet bariatric patients aren’t the only group that may present challenges with movement and transfer throughout the healthcare setting.

That is one reason the Facility Guidelines Institute (FGI) made a terminology change in the 2018 edition of the FGI Guidelines. The Guidelines now focus on safe handling for “patients of size,” a switch in terminology away from bariatrics that’s meant to account for not only a patient’s weight, but also height and distribution of weight throughout the body.

Douglas Erickson, CEO of FGI, explains that the shift “has to do with accommodating any type of patient that presents themselves as unusual as far as size is concerned. ... It’s not just about body mass.” For example, an 8-foot-tall patient—or visitor or staff person, Erickson points out—may have as much of a challenge in movement and comfortable accommodations as someone who has a body mass index over 40.

Safely accommodating these patients improves not only patient care, but care for the healthcare worker as well.

In its Determination of Minimum Design Standards for Safe Patient Handling and Transportation, FGI highlights that back injuries affect up to 38% of nurses. “Musculoskeletal injuries are responsible for more lost work time and permanent disability than any other reported injury in healthcare,” the report adds. So it’s important to understand the risks staff face in lifting, managing, and mobilizing patients of size.

The first step in understanding what changes may need to be made in your healthcare facilities is to take a deep dive into the demographics of your patient population: Some regions will find a more pressing case for an upgrade. As the State of Obesity organization highlights, adult obesity rates now exceed 35% in five states, 30% in 25 states, and 25% in 46 states. West Virginia has the highest adult obesity rate at 37.7%, and Colorado has the lowest at 22.3%. But a demographics assessment should also include an analysis of historical data on the types of patients the organization has treated who have had accommodation challenges, as well as information on visitors and staff of size.

The next step, Erickson advises, is to conduct a safety risk assessment. FGI’s assessment has seven elements, one of which is a patient handling and movement assessment (PHAMA). He notes that the PHAMA has been around for about two code change cycles, but it now reflects the recently updated bariatrics criteria.

The PHAMA should include consideration of how to accommodate patients of size, including the main parking lot, the main entrance, and transportation throughout the building.

As Erickson puts it, “What happens when a 700- to 1,200-pound patient is brought into the emergency department, and how they are going to accommodate them from that point on? Do you have the exam room necessary? If you have to take them into imaging, is imaging able to accommodate them? If you have to go up a floor, how do you get the patient up there through the corridor and elevator? All of those transportation elements have to be considered.”

This also includes an examination of furniture, equipment, door sizes, and corridor sizes. “Maybe the standard corridor of 4 feet wide is not going to be sufficient to handle that patient of size along with staff,” Erickson adds.

You can download FGI’s PHAMA at www.fgiguidelines.org. The 150-page document describes the different decisions that should be made when it comes to patient handling: from the number and percentage of rooms that may need to be set up for accommodations to the transportation routes into various areas of a healthcare facility.

Erickson calls this assessment the “number one thing” healthcare facilities should be doing to understand their need for changes to accommodate patients of size. “And if they can’t [make changes], where are they going to send this patient of size when they present themselves?” Erickson adds.

Editor's note: A version of this article first appeared in Patient Safety & Quality Healthcare, an H3.Group publication.



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