Patients admitted to a facility deserve proper care and respect regardless of their complaint or any comorbidities. Increasingly, obesity is a common comorbidity. Viewed as a chronic health condition, patients with obesity pose patient safety issues. The challenge is being prepared to accommodate obese patients and care for them with dignity while keeping both patient and staff safe. Consider the following as you treat obese patients.
Being in the hospital puts patients in a vulnerable position. Comments or facial expressions that signify degrading or offensive feelings about a patient’s obesity can negatively influence care. For example, patients who are treated with antipathy might not be as forthcoming about medical concerns or complaints of pain. Treatment should focus on the person, not the person’s obesity.
The most common cause of obstructive sleep apnea (OSA) in adults is excess weight or obesity. It is associated with airway obstruction when soft tissue of the mouth and neck relax during sleep. One predictor of OSA in obese men and women is an increased neck circumference, as it places them 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. Heavy sedation also puts these patients at risk.
For patients undergoing procedures or surgeries, screening for OSA during the preoperative evaluation is essential. It is estimated that more than 80 percent of adults with OSA remain undiagnosed. Take appropriate precautions during and after the procedure. Patients should not be discharged from the recovery area (i.e., to home or an unmonitored hospital bed) until they are no longer at risk for postoperative respiratory depression. This is especially true for obese OSA patients who require postoperative opioids. Patients who exhibited signs of OSA during the procedure should be directed to follow up with their primary care physician. Thorough patient education about pain medications and documentation of such teaching are also important patient safety considerations.
Childhood obesity is a complicated health issue. Obese children and adolescents are at risk for developing the same comorbidities as adults. They are more likely to have risk factors for cardiovascular disease, prediabetes, bone and joint problems, sleep apnea, and social and psychological problems. Often, they become obese adults. Like adults, physical assessment, airway management, drug dosing, and equipment and infrastructure pose unique challenges for this population. Preplanning and care guidelines to address these challenges will help to optimize care and enhance patient safety.
Obese patients are often immobile because of their body weight and are, therefore, at 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, perform a thorough skin assessment upon admission, and document any ulcers with accurate descriptions, measurements, and pictures. Regularly repositioning an obese patient, along with a suitable bed with a pressure-reducing mattress, may help to reduce this risk.
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.
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.
The Centers for Disease Control and Prevention (CDC) indicates that overexertion injuries in healthcare workers is the most common risk factor associated with manual patient handling (moving, lifting, or repositioning). Obese patients present further challenges to staff when they assist with manual patient handling and 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.
Wolfe R, Pomerantz J, Miller D, Weiss-Coleman R, Solominides T. Obstructive sleep apnea: preoperative screening and postoperative care. J Am Board Fam Med. www.jabfm.org/content/29/2/263.full. Accessed December 9, 2016.
Prevalence of obstructive sleep apnea in surgical population. STOPBang Website. www.stopbang.ca/surgery/prevalence.php. Accessed December 9, 2016.
Childhood obesity causes and consequences. Centers for Disease Control and Prevention Website. Available at www.cdc.gov/obesity/childhood/causes.html. Accessed December 9, 2016.
Porter RM, Thrasher J, Krebs N. Implementing a pediatric obesity care guideline in a freestanding children’s hospital to improve child safety and hospital preparedness. J Pediatr Nurs. 2012;27(6):707-714. www.pediatricnursing.org/article/S0882-5963(11)00665-8/abstract. Accessed December 9, 2016.
Safe patient handling and movement (SPHM). The National Institute for Occupational Safety and Health. Centers for Disease Control and Prevention Website. Available at www.cdc.gov/niosh/topics/safepatient/. Accessed December 9, 2016.
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 healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.