Lift smarter, not harder: avoid injuries when mobilizing your bariatric residents.

Has your facility ever turned away a potential bariatric resident because of a lack of equipment? With an increasing number of obese people entering nursing homes, many facilities are forced to deny their admission because the facilities can't meet their needs.

"Twenty years ago we didn't buy equipment for the morbidly obese," says Melissa Yetter, MHA, NHA, CRCFA, president of Health Care Experts and Consultants, Inc., in Simpsonville, SC. Now, facilities need to have such equipment.

As the number of bariatric residents in nursing homes increases, so do the number of ways staff can sustain injury caring for them. That's why, in this age of care, it's crucial to educate staff about the proper way to lift and mobilize bariatric residents, as well as how to use equipment to its best advantage.

Before a facility accepts a bariatric resident, it needs to perform a thorough assessment of its ability to handle the resident's needs, explains Carolyn Brown, BS, MEd, RN, ARM, FCCWS, national director of clinical services for Sten+Barr Medical, Inc., in Tampa, FL.

Plan ahead so you know where to find the appropriate equipment to transport the resident to your facility, and then assess your facility's architecture, supplies, and equipment. Brown suggests considering the following:

* Can the doorways accommodate wide equipment?

* Do the bathrooms allow enough room for the resident to move?

* Are the toilets and sinks floor-mounted so they will not come out of the wall if weight is applied to them?

* Are grab-bars securely attached to the wall?

* Do you stock incontinence products of an appropriate size and capacity?

* Do you have correctly proportioned tape measures, needles, gowns, slippers, etc.?

It's all in the lifts

When nursing homes admit obese residents, they need to ensure that they have the proper equipment, whether it's a bariatric bed, shower chair, gurney, wheelchair, or mechanical lift, explains Yetter.

Training staff on proper equipment use and educating them on the different types of equipment are the first steps to staff safety, says Debbie Smith, RN, director of nursing at Andover (OH) Retirement Village Community. Smith's 20-bed facility specializes in bariatric care and assists residents who weigh anywhere from 300 lbs to 900 lbs.

"We are a low-lift facility, so the residents do as much for themselves as they can," explains Smith.

At Andover, bariatric residents are on a similar bathing schedule to the rest of the residents, but the process of getting them to the bath is more complex, says Carrie Peska, LPN, Andover's assistant director of nursing. Tasks such as bathing and keeping a bariatric resident mobile are practically impossible without specialized equipment, she adds.

Staff by the numbers

Although mechanical lifts such as ceiling or floor lifts help, staff should work in teams to transfer residents. Depending on the residents' weight and mobility, two staff members should generally be present to safely transfer each bariatric resident from the bed to a shower gurney or wheelchair, says Peska.

While only two or three staff members may need to assist in transferring a 300-lb resident, four or five staff typically help transfer a 500-lb-700-lb resident. One of the most challenging aspects is making sure there are enough staff to turn and position residents into a lift's sling, says Peska.

"The most involved step is placing the sling under an obese resident," agrees Stacy Lemmer, director of marketing at Medcare Products in Burnsville, MN. This is true whether staff perform a log-roll type action when a resident is lying down or shift the weight of a resident forward when he or she is in a seated position.

For most residents, the number of staff needed during a transfer is determined during the initial assessment. But you'll always need at least one caregiver to handle the equipment while the others mobilize the resident, advises Lemmer.

Equipment breakdown

When using mechanical lifts and equipment, it's important that staff follow your facility's procedures and the equipment manual's instructions. The following are some of the types of equipment staff can use when assisting a bariatric resident:

* A mechanical lift requires two or more staff to be present when assisting an obese resident out of a bed or gurney.

* A sit-to-stand lift allows a weight-bearing resident to move into a sitting position and stand up without staff needing to lift his or her entire body.

* A ceiling lift, when installed in the bath area, raises a resident into the tub. It is helpful to have either a tub that allows the residents' legs to swing over the top of it when they're in the lift or one with a side door.

* A trapeze allows the resident to reposition in bed with minimal to no assistance.

"Properly using equipment and practicing safe handling methods, like applying slings correctly, will prevent injuries. If slings are applied correctly and equipment is used properly, injuries should not occur," says Lemmer.

"Some slings are breathable and may be left underneath the resident while [he or she is] in bed or in a chair," she adds. "This decreases the number of log-rolls required or shifting of the resident in a chair where some lifting and twisting may occur," during which staff could sustain injury.

Back injuries are the most common staff malady. To minimize their occurrence, train staff to always call for assistance and never lift a resident alone, Smith recommends.

RELATED ARTICLE: New residents mean new policies.

To protect both caregivers and residents, each long-term care facility should develop its own guidelines for lifting and equipment use--especially regarding the care of bariatric residents, says Stacy Lemmer, director of marketing at Medcare Products in Burnsville, MN.

For lifting safety and equipment use, train all staff upon hire and then regularly conduct refresher courses, says Carolyn Brown, BS, MEd, RN, ARM, FCCWS, national director of clinical services for Sten+Barr Medical, Inc., in Tampa, FL. Also, give an orientation about facility standards, policies, and procedures when it comes to caring for bariatric residents.

Managers should monitor that staff lift, transfer, turn, and position residents correctly, says Brown. It's the management team's responsibility to identify those who don't and give additional training as needed. Also, provide training any time the facility receives new equipment or admits a bariatric resident, suggests Brown.

When admitting bariatric patient, discuss his or her routine and how he or she got around before entering the facility. Brown suggests asking the following:

* How did you prevent injury?

* What type of routine did you have to get around?

* Did you have the bed at a particular height?

Your purchase of special bariatric equipment should include an inservice on the best way to train staff in the proper technique of safe handling, Lemmer says. Work with your vendors to ensure that you receive the right equipment. Vendors can direct you to the appropriate sling, bed, trapeze, etc., for your residents' needs, says Brown. It is no longer appropriate to order equipment according to weight accommodation; you must order the right type to suit your residents' particular needs.

When using a mechanical lift, Debbie Smith, RN, director of nursing at Andover (OH) Retirement Village Community, advises her staff to do the following:

* Move what's easiest first. When a 500-lb resident is up in a lift, the easiest thing to move is the empty chair he or she just came out of.

* Position the gurney under the resident.

* When entering or leaving a room with a lift, make it a straight shot and minimize turns.

In the past, facilities didn't have to develop policies for the morbidly obese, but now it's a must, says Melissa Yetter, MHA, NHA, CRCFA, president of Health Care Experts and Consultants, Inc., in Simpsonville, SC. Adjust your facility's expectations about how staff care for bariatric residents with clearly written policies and procedures for safe equipment use and lifting.--Adrienne Trivers

BY ADRIENNE TRIVERS, ASSOC. EDITOR