Optimizing Care of the Bariatric Patient
- Participants will be able to identify two potential adverse outcomes for the bariatric obstetric patient.
- Participants will be able to identify two safety measures the nurse can implement when caring for the bariatric obstetric patient.
- Participants will be able to identify two pieces of equipment to assist in caring for the bariatric obstetric patient.
Obesity, defined as BMI equal to or greater than 30, is a rising concern in all fields of healthcare. The pregnant obese population presents unique challenges. These women are at increased risk of hypertension, preeclampsia, diabetes, deep vein thrombosis, labor dystocia, shoulder dystocia, stillbirth, and postoperative complications from cesarean delivery. As the nurse cares for both the mother and the fetus, she must also be mindful of her own safety. Lifting, turning, and repositioning heavier patients can predispose nurses to injury which could result in long term implications for their own health.
Proposed change:
We had two goals: facilitate care for the bariatric maternal-fetal dyad, and protect the nurses caring for them. Consideration was taken to length of assignment, because even with the use of assistive devices nurses can become physically exhausted. Continuous fetal monitoring can become a challenge leading to frustration to both the patient and nurse.
Implementation, outcomes and evaluation:
To meet the challenges as described above, we have select labor rooms with overhead ceiling lifts built in for moving patients and portable leg supports for pushing, as well as an operating room with bariatric capacity (tables,lifts, and support). The labor beds and operating room tables have both stirrups, calf supports, and a large air mattress. Ceiling lifts are available for moving patients. All staff have been inserviced on safe use of leg supports and ceiling lifts. The use of these devices protect both the patient and the nurse form injury. A supply cart is available in all areas containing extra large patient gowns, monitor belts, and blood pressure cuffs. When a woman's weight exceeds 300 pounds, a specialty bed or stretcher can be provided for safe transport. The patient is placed in team care or as a shorter assignment. With both options, no one nurse spends eight hours or more continuously trying to adjust the fetal monitor. Staff are encouraged to utilize regularly scheduled safety rounds as an opportunity to consult with the charge nurse and covering physician/APN when difficulties arise with monitoring to discuss appropriate monitoring alternatives.
Implications for nursing practice:
Future goals to improve care include development and use of specialty bariatric fetal monitor equipment to protect both patients and nurses and research regarding comorbidities, interventions, and outcomes. Additionally, nursing staff need to evaluate their own attitudes for this patient population; as well as discover optimum methods to communicate in a sensitve manner.
Keywords:
bariatric, obesity, safety
