Caring for the Hospitalized Obese Patient
As the first medical malpractice insurer to establish a patient safety department, The Doctors Company remains the leader in developing innovative tools that can help you reduce risk and keep your patients safe.
Patients admitted to your facility deserve proper care and respect regardless of their complaint or any comorbidities. Increasingly, a common comorbidity is obesity. These patients pose exacerbated patient safety issues. The challenge is being prepared to accommodate obese patients and to care for them with dignity while keeping both patient and staff safe. Consider the following as you treat obese patients.
Increase Patient Satisfaction
Being in the hospital already puts a patient in a vulnerable position, and making comments or facial expressions that signify degrading or offensive feelings about a patient’s obesity can negatively influence care. For example, patients treated with antipathy might not be as forthcoming about medical concerns or complaints of pain.
Be Aware of Obstructive Sleep Apnea
Known or undiagnosed obstructive sleep apnea (OSA), particularly with an increased neck circumference, places the obese patient at higher risk for respiratory difficulties. A claims review by The Doctors Company revealed a pattern of severe postoperative respiratory depression in obese patients with OSA. In addition, heavy sedation in these patients puts them at risk. When caring for an obese patient with OSA, pay close attention to the airway, and consider additional monitoring of his or her respiratory status.
Reduce the Risk of Pressure Ulcers
Obese patients are at an increased risk of developing pressure ulcers. Poor circulation of oxygen to fatty tissue is a factor that can make the patient more vulnerable to pressure ulcers. Because pressure ulcers are potentially a hospital-acquired condition, make sure you perform a thorough skin assessment upon admission, and document any ulcers with accurate descriptions, measurements, and pictures. Regular repositioning of an obese patient, along with a suitable bed with a pressure-reducing mattress, may help to reduce this risk.
Take Fall Precautions
Due to possible limited mobility, illness, medications, and/or other conditions, obese patients can be at an increased risk for falls. Conduct the appropriate fall assessment in use at your facility, making sure to note obesity as a risk factor. Clearly advise the patient to call for help when moving from a bed, chair, or bathroom or when making any other transfer. Institute other fall precautions as indicated.
Ensure Properly Sized Equipment
Patient care areas need equipment designed for obese patients. This includes, but is not limited to, blood pressure cuffs, bandages, gowns, extra-long needles, and adequate weight-bearing beds, toilets, chairs, and wheelchairs.
For example, most wall-mounted toilets are designed to support up to 350 pounds. Floor-mounted toilets typically support much more weight. There are also small supports specifically made to be placed under wall-mounted toilets that will help increase the support for heavier patients.
It is best to design and equip designated patient rooms to accommodate morbidly obese patients. Guidelines are available for bariatric patient rooms when upgrading rooms in your facility. Properly sized MRI, CT, and other diagnostic equipment must be available at the facility, or transfer agreements need to be in place. Safe care of the obese patient requires the appropriate equipment.
Focus on Staff Safety
The obese patient presents further challenges to staff when assisting with ambulation. Always make certain that adequate staff is available to help move a patient or to assist a patient getting in or out of bed. In patient rooms, a ceiling-mounted or portable lift can help reduce the risk of injury to staff.
Several states have enacted safe patient handling legislation to encourage the use of lifting devices and incorporate lift teams that result in better coordination of a patient transfer. Check hospital policies and procedures for additional requirements. Regularly review and practice proper lifting techniques to avoid pulled muscles or back injuries.
By Paul Nagle, ARM, CPHRM, Director of Physician Patient Safety.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.