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SizeWise Rentals, a Kansas City, MO. company that provides bariatric rehabilitation equipment rentals nationwide, meet facilities' needs for beds, lifts and wheelchairs that can handle weight capacities of up to 1,000 pounds.

Jill Arzouman, MSN, RN, has helped develop hospital protocols for handling severely obese patients, but she no longer assists in moving people who weigh more than 300 pounds.

"I have a bad back, not from moving any one patient, but from doing it over a number of years," said Arzouman, an advanced practice clinical nurse specialist at the University Medical Center in Tucson, Ariz. "I just can't help lift heavy patients."

Arzouman is not alone. When it comes to risk for back injuries, nurses aides and assistants rank the highest-above construction workers-and RNs, LPNs and VPNs, health aides and physical therapists are high on the list, according to the Bureau of Labor Statistics.

The problem is that the nation's population is getting heavier, and the number of people considered morbidly obese-100 pounds or more overweight-is soaring. The added weight puts a strain on hospital systems that must install special beds, lifts, scales, wheelchairs and other equipment to accommodate the needs of the obese.

Some diagnostic facilities are not able to serve the morbidly obese, which results in a lack of preventive and imaging services available to a portion of the bariatric population-patients with a body mass index of 35 or greater.

A growing need

When more overweight patients began to show up at University Medical Center and strain staff resources, a multidisciplinary team was formed to come up with solutions. Co-chaired by Arzouman and Jane Lacovara, MSN, RN, who also share clinical duties, the panel developed a set of protocols for handling a range of issues that involve obese patients.

"Overweight patients can put employees at risk of being hurt," Lacovara said, "so it's very important when a bariatric patient is admitted that the hospital gets the proper equipment for handling them. We want to protect employees from back injuries and strains."

Lacovara said staff at the 355-bed hospital could quickly customize a "bari room," where everything is larger than normal. The room would have an oversized bed, chair, toilet and access to an overhead mechanical lift. If extra equipment is needed, the hospital contracts with an outside vendor to supply it on short notice.

The protocol includes a set of preprinted orders that can be easily followed by the hospital's 713 nurses. For example, if a patient's abdominal girth is a certain size, or if a patient has pulmonary problems, then special equipment must be obtained. "Everything is laid out for them so they don't have to memorize the procedures," Lacovara said.

In most cases, a clinical nurse specialist coordinates the patient's needs through consultations with a nutritionist, pharmacist and social services. Case management for the patient's discharge needs is set up at the time of admittance.

Heavy duty

At Kaiser Permanente, special two-person "lift teams" have been trained to handle the increase of heavy patients at the managed care organization's hospitals throughout California.

Dale Thompson, a workplace safety expert with Kaiser Permanente's Southern California region, said the teams are on duty from 5 a.m. until about 8 p.m. in order to help with weigh-ins in the morning and to make sure patients are secure for the night. The teams often handle between 30 and 35 lifts a day, using special equipment.

"If the use of lift teams can prevent two or three staff injuries, this can save a significant amount of money," Thompson said. "The equipment is expensive, but it lasts for years."

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