Bariatric patients and the use of mobile hoists: user experiences from three hospitals

in South Australia

*Health and Rehabilitation Research Institute /Centre of Occupational Health and Safety Research

AUT University, New Zealand

**Ergolab, Mawson Institute, University of South Australia, Mawson Lakes SA 5095, Australia

Mark Boocock*Gunther Paul**

Introduction - rationale

Nursing personnel - one of the occupational groups most at risk of work-related musculoskeletal disorders

Hazards and risks associated with moving and handling of bariatric patients is multi-factorial weight atypical body mass distribution mobility co-morbidity of symptoms patient co-operation

Equipment design for bariatric patient care is often lacking

Introduction - rationale

Video clip available on YouTube athttp://www.youtube.com/watch?v=yO7sMFi1W2E

Undertake a literature review of patient handling to identify hazards and risks associated with the care and

rehabilitation of bariatric patients identify relevant design criteria for mobile hoists

Identify end-user experiences of bariatric patient handling equipment

Develop end-user acceptance criteria appropriate to design

Aims and objectives

Methods: literature search

Six electronic databases EBSCO Host Medline via Ovid Scopus Web of Science AMED ProQuest Central

Search terms and MESH headings were relating to patients handling devices

Supplemented with a search of relevant national and international website (e.g. ISO, CEN, Standards Australia and Standards New Zealand, Health and Safety Executive (UK), WorkCover)

Methods: interviews and observations

Structured interviews - 6 experienced injury management staff from the Manual Task Services department of 3 Adelaide hospitals

Open-ended questions were structured around five main themes: 1. patient factors2. building/vehicle space and design3. equipment and furniture4. communication5. organisational Hignett and Griffiths (2009)

Focus - the use of mobile hoists for lifting and transferring bariatric patients

Walk-through of the hospital to view the types of mobile hoists, and the location and storage

Results – literature search

Considerable variation in classification of bariatric patient BMI (>30 and >40) body weight (>45 kg ideal weight) waist-to-hip ratio waist circumference anyone who has limitations in health due to physical size, health,

mobility and environment access (Baptiste, 2007)

6 bariatric body shapes and identified concerns affecting lifting of these patients (Grundy and Abate, 2003; Murphy, 2003)

Apple PearApple Pear

Results – literature search

Design standards: AS/NZS ISO 10535:2011 ‘Hoists for the transfer of disabled persons – Requirements and test methods’

Barriers to the use of moving and handling equipment – 3 categories:

Equipment design, e.g. weight limitations, instability, difficult operations, storage problems, incompatibility with other equipment

Care provider, e.g. lack of training, cumbersome/inconvenient, inability to locate, time constraints, levels of motivation, governance

Patient, e.g. aversion to equipment, loss of sense of control, insecurity, discomfort, dignity, privacy

Results: interviews - patient factors

Bariatric classification considerable variation and ambiguity ≥120 kg, although general hospital policy ≥100 kg BMI sometimes used move to considering a range of factors, e.g. body anthropometry and

health status

Bariatric patient numbers – each of the hospitals 10 per month ≥170 kg, 3 per year ≥250 kg 5 per month ≥150 kg, 2 per month ≥180 kg 4 patients per day considered bariatric (≥120 kg)

Results: interviews – building and space design

Equipment storage major problem identified at the 3 hospitals some had a central storage often disused wards, vacant store rooms, corridors

Space restrictions size and layout of room important for bariatric patients storage of equipment close to bariatric patient sufficient space in and around patient to allow safe

access accommodate visitors modifications made to wards, e.g. reduce from 6 to 2

or 3 bed wards

Results: interviews – equipment and furniture

Tasks performed - mobile floor hoists transferring and not transporting short transfer tasks, e.g. bed-to-chair, wheel chair

Poor design features – mobile floor hoists manoeuvring – view as most high risk tasks due to pushing and

pulling combined with trunk rotation handle positions – designed for moving in linear direction not rotation height of the wheelbase – in and around adjustable beds relatively unstable (‘tippy’) with heavy patients In restricted/confined space – becoming trapped between hoist and

wall patient ‘swinging’ into the main support arm floor lifts collision type injuries

Results: interviews – equipment and furniture

Desirable design features – mobile floor hoists power assistance when manoeuvring hoists user-friendly controls – essential combined functions, e.g. assisted walking storage preference for 4 pt spreader bar and loop attachments scales built into hoist device for monitoring frequency of use height adjustability detachable, rechargeable battery/warning indicators

Mobile floor hoists vs ceiling/overhead hoists overhead hoists were considered to offer significant

advantages H-track designs offer greater flexibility

Results: interviews – communication/organisational

Communication – factors considered poor communication between wards often wards given responsibilities for equipment purchase – no central

equipment database

Organisational – factors considered poor no systems that keep track of equipment - slings getting lost often no systems for regular maintenance of equipment no designated central storage space for specialised equipment

Design requirements: end-user acceptance criteria

Compactness – suitable for use in confined spaces (e.g. bathrooms and toilet areas) and when moving along narrow corridors

Compatibility – comply with appropriate standards and suitable for use with other equipment (e.g. stretchers, wheelchairs)

Durability – low maintenance, high strength requirements (at least 300 kg)

Functionality - powered assisted for manoeuvring and patient re-positioning

Adapted from Conrad et al., 2008

Mobile floor hoists

Design requirements: end-user acceptance criteria (cont.)

Storability - easily stowed, foldable or collapsible for storage purposes

Operability – quick, easy and intuitive to operate, and assemble and disassemble

Clean-ability – easy to clean and disinfect

Stability – stable during patient transfers and when moving on different floor surfaces (e.g. slopes and inclines, carpeted floor)

Adapted from Conrad et al., 2008

Mobile floor hoists

ConclusionsConclusions

Limitations associated with mobile floor hoists for use with bariatric patients

Significant improvements in design requires designer to consider user and patient requirements

improved appreciation of hazards user and patient involvement in design

A co-ordinated and collaborative approach for moving and handling of bariatric patients is needed across the range of care providers

Is there a need for bariatric classification?

Is the mobile floor hoist a necessary piece of handling equipment?