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RCS survey

UK hospitals underprepared for bariatric surgery

Many hospitals did not have access to equipment, like beds and wheelchairs, suitable for bariatric patients. Photo: Flickr / daveynin
Hospitals understocked with bariatric equipment and lack policies for bariatric patients
Staff and patients put at harm, says Royal College of Surgeons survey

Many UK hospitals are inadequately equipped and underprepared for dealing with morbidly obese patients, putting their dignity at risk as well as the health and safety of staff, according to a study by the Royal College of Surgeons.

Ms Sally Norton, consultant bariatric surgeon and upper GI surgeon, and lead author of the report, said: “The current challenges in managing the increasing population of morbidly obese patients must be addressed. Failure to provide adequate equipment and appropriate management of obese patients could result in their safety being compromised and injury to both patients and staff”.

Surveying 18 NHS hospitals in the south west of England, the Royal College of Surgeons failed to find a single hospital that owned all of the equipment commonly deemed suitable for patients weighing over 350lb (159kg). Even where equipment was available, nurses were not always aware of its existence: only 39% of surgical ward sisters reported that they were aware of extra-large dignity gowns for morbidly obese patients that they had access to.

A lack of equipment designed for obese patients like wheelchairs and beds with suitable weight limits can also lead to dangers for staff and patients. The National Patient Safety Agency reported 25 incidents between 2009-2010 where delays or limited access to appropriate equipment had the potential to cause harm to bariatric patients. More than half of the nursing staff in the survey felt that patients were being put at risk due to a lack of safe equipment.

The manual handling of bariatric patients also puts staff at risk: 10% of claims to the NHS Litigation Authority were related to injuries sustained while caring for anaesthetised obese patients.

Obesity policy

In 2007, the Health and Safety Executive released a report recommending that every trust should have a policy for the care and manual handling of bariatric patients.

However, just 39% of theatre departments reported having a policy for the care of bariatric patients. Only 50% of theatre managers in the study were made aware of a patient weighing over 350lb when they are listed for surgery; 11% said they only discovered that their patient is morbidly obese on the day of surgery.

Only 17% of radiology departments reported that they had CT and MRI scanners suitable for patients weighing over 490lb, potentially delaying the diagnosis of conditions in morbidly obese patients.

In the past, a lack of scanning resources has led to patients attempting to have their scans performed at zoos, in MRI machines designed for animals.

Recommendations

The paper recommends that the following areas should be addressed “as a matter of urgency”:

  • recognition by every acute hospital trust of the obesity epidemic, and the clinical and medicolegal risks that may ensue;
  • provision and implementation of a policy for the care of bariatric patients as recommended by the HSE in 2007;
  • appropriate planning of infrastructure in new hospital builds/upgrading of existing facilities to allow safe management of morbidly obese patients in an appropriate, safe and adequately equipped environment;
  • formal and routine identification of any risk factors associated with obesity at initial presentation of any patient, and appropriate action taken to ensure appropriate management and communication to all involved in care;
  • appropriate manual handling training and easy access to safe lifting equipment at all times;
  • provision of appropriate imaging equipment; and
  • adequate and accessible general equipment and clothing for the morbidly obese patient in outpatient, ward and theatre settings.

“Our survey suggests that hospitals in the South West remain potentially inadequately prepared and equipped to provide optimal management of morbidly obese patients in their care,” says the article. “This is likely to affect clinical outcome adversely and may result in avoidable injuries to staff involved in their management.”

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