Safe Patient Handling: Big Patients, Big Complications. Pamela Moseley RN, MN, CNS, MBA Cherie Lowre, MD, Hospitalist
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1 Safe Patient Handling: Big Patients, Big Complications Pamela Moseley RN, MN, CNS, MBA Cherie Lowre, MD, Hospitalist
2 Pregnancy vs. Obesity
3 Obesity Epidemic 28% of Pregnancies with Obesity 8% with Category 3 Obesity (>40 BMI) Incidence is Greater in African- American population (49%) and Hispanics (39%) compared with Caucasians (31%)
4 The Patient Experience The last acceptable prejudice Right-sized equipment, gowns Room safety Weight limits Equipment availability
5 High BMI & Pregnancy Category 1= (30% of our patients) Category 2= Category 3= > 40 Normal BMI= Overweight=
6 Risks Hemorrhage & Thrombosis Stillbirth- 2-3x greater rate Shoulder Dystocia Difficult Epidural Placement Difficulty moving patient Difficult Airway Sleep Apnea Risk to Staff- Workplace Injuries $$$
7 Labor and Delivery C-section Cat 33.8% Cat 50% VBAC Success 13% if > 300 lbs. Failure 30% if overweight, 39% for Cat 3
8 Bariatric & Pregnant: Are You Ready? Need Leadership Support & Engagement Meet Often : Bi-Weekly Co-Chairs OB Providers & Nursing Equipment on hand? Go for Easy Changes to Gain Momentum Review Recommendations Form Subgroups to work on more complex recommendations Multidisciplinary Bariatric Task Force OB MDs & CNMs Bariatric Specialist Workplace Safety Expert Nursing Admin & Managers Anesthesia Surgical Tech Front-Line RNs
9 Bariatric & Pregnant: Are You Ready? Develop Specific Targets & Timelines Assess Your Unit Develop an Equipment List Train Unit on Equipment/Supply Location Train Unit on Moving/Buddies C-Section Safety Checklist Discuss Plan at Multidisciplinary Rounds Develop Inpatient Bariatric Protocol to Include: Antenatal Care Intrapartum Preparedness Surgical Care Postpartum Care
10 The Anesthesia Perspective Implications for a Crash C/S Always get a second anesthesia provider Consider SPINAL Anatomic changes make endotracheal intubation difficult Ramp head, do not tape pannus Physiologic changes: desaturation in 1 minute!
11 Anesthesia Perspective Little time for emergency maneuvers Laryngeal mask airway (LMA) to rescue If able to ventilate, section depressed fetus only Surgical airway if unable to ventilate If morbidly obese with a clearly difficult airway: Do NOT proceed with a "crash" general anesthetic
12 Post-Op Infection Prevention Antibiotics - 3 grams Kefzol if BMI > 40 Running or interrupted closure of subcutaneous space if > 2 cm Use Chlorhexidine wipes-abdominal Prep; CHG Bath, 24HRS before Surgery
13 LDR KP Panorama City
14 L&D Room Equipment & Supplies Amniocentesis: long needle and highresolution sonograph guidance Bariatric bed with frame and trapeze Bariatric chairs CPAP equipment Extra-large B/P Cuffs Extra-large gowns Extra-large panties
15 L&D Room Equipment & Supplies Extra-large SCDs (bariatric calf vs thigh-high) Extra-wide wheelchairs Graduated compression stockings HoverMatts Inflatable mattress Long instruments OR straps Sliders Toilet to exceed 500 lb. capacity
16 Bariatric Wheelchair
17 Hill-Rom Affinity 4 Birthing Bed: Ergonomic- Stow and Go
18 Hill-Rom Affinity 4 Birthing Bed
19 Bariatric Bed with Trapeze: Antepartum & Postpartum
20 Anesthesia Equipment Difficult Airway Cart Emergency Cricothyroidotomy kit Glide Scope LMAs Video Guided Laryngoscopes
21 Support Devices: Anesthesia
22 Troop Elevation Pillow: Airway Aid for Bariatric Patients
23 OR Equipment Adhesive straps/elastoplast tape for pannus management Atraumatic self-retaining retractor(alexis) Bariatric OR Table and Extenders (1000lbs) Bariatric/Long Instrument C-Section Tray Disposable covers or disposable mats, DVT Prophylaxis Epidural Support Device
24 OR Equipment Extra-large SCDs Extra-long surgical instruments Hovermatt for lateral patient transfer Large belts/straps for OR table Positioners, wedges Vacuum or forceps
25 Lateral Transfer Patient Device: HoverMatt
26 C-Section Tray- Bariatric/Long
27 C-Section Tray+ Step Stools
28 Surgical Instruments
29 Surgical Equipment
30 Stryker Zoom Motorized Gurney
31 Teamwork + Communication =
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