Hospitals and geriatric care facilities increasingly have to care for very heavy and severely overweight people – a task with multiple challenges for both occupational health and safety and humane nursing and medical care. The decisive factor here is good preparation of the facilities before a shooting situation occurs.
Hardly any hospital is prepared for the emergency care of heavy patients. The first hurdles are already encountered in the emergency room: there is often a lack of resilient patient stretchers and chairs, blood pressure monitors and nursing materials in the appropriate sizes. The functional units for diagnostics, such as radiology, the cardiac catheter measuring station and sonography, are often not designed for heavy people with their corresponding body dimensions. If an operation is necessary, there may be. only operating tables are available which do not meet the requirements for safe working loads and also have a much too narrow lying surface. But even transferring patients to the operating table is a challenge, as the sluice tables are often only designed for patients weighing up to 160 kg.
Overweight and obesity in numbers
- Whether someone is overweight is usually determined on the basis of the body mass index (BMI). This is calculated according to the following formula: BMI = weight / height 2 . The weight in kilograms and the size in meters are taken into account here.
- According to the World Health Organization’s classification, overweight begins at a BMI of 25, and at a BMI of 30 or more, it is called severe overweight or obesity.
- According to a study by the Robert Koch Institute, 53.0 percent of women and 67.1 percent of men in Germany are currently overweight. The proportion of obese people has increased in recent years. It is currently 23.9 percent of women and 23.3 percent of men.
- However, the extent to which a person’s weight poses special challenges for nursing and medical care does not depend on BMI alone.
- Example 1: A non-ambulatory patient is 1.60 meters tall and weighs 80 kilograms. She has a BMI of 31.2 and is therefore severely overweight. The round body shape makes it difficult to move this patient, but the regular aids and other equipment of the hospital are perfectly sufficient in this case.
- Example 2: A patient who is also unable to walk measures 2.05 meters and weighs 115 kilograms. He has a BMI of 27.4 and is therefore not yet considered obese. Nevertheless, due to his weight, he can only be moved with aids. At the same time, pay attention to the load-bearing capacity of equipment and materials here.
Stresses on the musculoskeletal system of employees
Even caring for "normal-weight" people (80 kg) places (too) great a demand on the musculoskeletal system, as shown by laboratory studies conducted by the BGW together with the Leibniz Institute for Occupational Research at the Technical University of Dortmund. Many transfer, positioning and mobilization situations here are far above the recommended values.
As a follow-up study with heavy test subjects (90, 110, 130 and 150 kg) has shown, this strain on the spine generally increases significantly when caring for heavyweight people. However, the patient’s body shape, fitness and current condition also play a role. of the patient play a role. Very rounded body shapes, for example, are particularly difficult to grasp and thus increase the physical strain on caregivers. On the other hand, it is easier for the caregivers if the patient or caregiver is able to walk. the patient can actively participate in movement processes.
Preparation for the emergency "admission of a heavy patient"
To avoid being faced with various unresolved issues and problems in an emergency situation, hospitals can systematically prepare for the care of heavy patients. Three topics in particular need to be considered:
- Structural and technical aspects
- Equipment of the facility with aids
- Organizational issues
In terms of construction, the following questions, among others, need to be addressed:
- In old buildings in particular, structural issues must be clarified: Up to what point weight can the ceilings be loaded?? The bed usually has four or five support points (castors) on which the entire weight of the bed including the patient rests. Special beds weigh over 350 kg. Added to this is the patient weight, for example 250 kg plus equipment on or in the bed, total weights of 700 to 900 kg (. ) are then quickly reached.
- Do thresholds, gratings or other uneven floors impede the admission of heavyweight patients to the emergency department and their onward transport to other hospital departments/areas?
- If the floor coverings are designed for appropriately heavy care beds and aids?
- Are the spatial dimensions and load-bearing capacity of the elevators sufficient to transport the patients – if necessary in heavy special beds together with aids, medical equipment and accompanying persons – to other floors??
Does the facility have traffic routes with slopes that can be used with the patient?. the patient must be able to drive on the wheelchair, for example, to reach a functional department?
Are the door widths and curve radii in the building sufficient to safely move extra-wide special beds?
Do patient rooms and wet cells offer sufficient space for movement, positioning and storage??
Are the existing railings and handrails stable enough to provide secure support for ambulatory heavy patients??
What load weight can the toilets, which are usually wall-mounted, withstand?? Here, the question of mounting or dowelling and the type of masonry must be taken into account.
Up to what support load can washbasins and wall-mounted grab rails/support folding handles withstand without breaking out of the wall??
For the care of heavy patients, all relevant furnishings, equipment and aids must be checked with regard to their safe working load (maximum load capacity). The determined weight should be clearly noted on the items. This means that every member of staff can decide immediately whether they want to use or not. he can use the aid.
With regard to compliance with safe working loads, it is not only the weight of the patient or the patient’s. of the patient must be taken into account, but also, for example, in the case of beds, the weight of the mattress and of add-on parts such as the bed frame. B. Side rails, infusion stands, anti-decubitus mattress with motor.
Technical aids are indispensable when caring for non-ambulatory heavyweight patients in the hospital.
Lifts help, for example, to safely transfer patients or to pick them up from the floor if they have fallen. Mobile lifts can be used flexibly here. However, permanently installed overhead lift systems are preferable, as they do not require floor space and the difficult maneuvering of the lift with the patient is eliminated.
Mobile stand-up aids support the transfer of patients from the edge of the bed to a wheelchair or commode chair. They also make it easier to put on clothing.
Sliding aids for beds, so-called movers, are special floor conveyors. The beds are moved by motor power instead of muscle power.
In addition, small aids support the movement of patients.
- Sliding mats/sliding sheets/sliding tunnels reduce frictional resistance when positioning patients in bed, for example when raising them up. This reduces the strain on employees and patients.
- Rolling boards help to safely transfer patients horizontally from a stretcher to a bed, for example.
- Anti-slip mats offer patients support when they push off with their heels on the mattress in order to slide toward the head end.
Hospitals are recommended to prepare at least one nursing room – preferably on the first floor – as a preventive measure for the care of heavy patients. A particularly powerful ceiling lift should be installed there, as well as an adequately sized nursing bed and other suitable aids. Wheelchairs and rollators are also available in foldable versions, even in oversized models. In this way, they can be stowed in cabinets together with the relevant small aids if there is a shortage of space.
Contact should also be made with suppliers of medical devices for the heavyweight. If there is a lack of equipment in an acute case, the necessary material can be purchased or rented at short notice. After all, it may happen that a medical device has to be procured within hours in order not to risk any hazards to the patient or the employees due to unsuitable medical devices. This is also legally relevant: For example, when a nurse lifts a patient or. places a patient in a wheelchair with too low a safe working load, she is using this medical device contrary to its intended purpose. Does the wheelchair buckle under the weight and injure the patient or. the patient, this can have civil and criminal consequences.
In addition to the workload, other factors often play a role in the selection of aids. In the case of beds for the care of heavy patients, for example, the lying surface should be 120 to 150 cm wide, so that the patient or caregiver can lie on it. giving the patient enough room to turn onto his or her side. The electric adjustability, which is already important in regular nursing beds, is indispensable here. An integrated weighing device can also be useful in helping the patient or. To spare the patient and the employees in the daily care routine the transfer to the scales.
The possible uses and safe working loads of small and large assistive devices can be looked up in the "Assistive Device Database".
Other arrangements should be made at the organizational level:
- Labeling of aids and furnishings
- Maintaining an inventory list that also indicates the safe workload of the various assistive devices
- Creation of an action instruction/guideline for the admission of heavyweight patients
- Regular instruction of employees in the use of available aids as well as in suitable movement and transfer concepts, such as z. B. Kinesthetics
- Clarify whether there is a suitable mobile lifter that is capable of lifting a heavy patient or patient with a heavy weight. Pick up a heavy patient who has fallen from the floor
- Evacuation of the severely ill patient or. of the heavyweight patient in a fire situation:
On what floor is the patient’s room located? Since elevators cannot usually be used, "manual" evacuation via a stairwell must be considered. If necessary, can the fire department. reach the room from the outside with a turntable ladder, and if so, up to what weight is laddering out possible?
- When admitting a heavyweight patient or. of a heavy patient, the duty schedule and work processes must be adapted to the requirements. There must be sufficient personnel available at all times to assist the patient or. to care for the patient safely. It should also be taken into account that examinations, treatments and care activities usually take longer for severely obese people.
Especially in case of missing or insufficient equipment the care of obese patients can also lead to psychological stress due to the extraordinary care situation. In addition to the technical and organizational precautions already mentioned, targeted training on the subject of obesity can also help to prevent it.
Recommendation on the procedure for dealing with the topic
The systematic preparation of a hospital for heavyweight patients best begins with a systematic analysis of the situation on site. The criteria listed above can be used to determine up to how many kilograms of body weight patients can currently be adequately cared for.
From this, we can infer the necessary measures that must be implemented to care for higher-weight patients when needed.
There should also be a contingency plan in place in case a patient becomes obese. a patient is brought in who cannot be cared for safely with the existing equipment.
It is advisable to include in this process the external cooperating partners such as fire department, ambulance service, ambulance services and external diagnostic facilities.