Belinda Thomson Manual Handling Adviser Head of Manual Handling Service Risk Management Department NHS Forth Valley Scotland

Structure of Manual Handling Service Level 1Core Team Induction Training Level 2 MH Unit Trainers Onsite refresher Level 3MH Key Workers local resource LEVEL 1 CORE TEAM LEVEL 2 MH UNIT TRAINERS LEVEL 3 MH KEY WORKERS

NHS Forth Valley Staff Population Acute Service:Surgical Medical, Emergency Care and Rehabilitation Women & Children/Clinical Services Facilities Corporate/Finance/HR Staff population =~ 4,900 Community Services:Community Health Partnerships - CHP’s Stirling Clackmannan Falkirk ~ 2,100 Staff population = 7000 staff members

Forth Valley - Scotland Population: Stirling 88,190 Clackmannan 49,900 Falkirk 150, ,810 Geographical area: 2,643 square km or 1,021 square miles

ClassificationBMI (kg/m 2 )Risk of Co-morbidities Underweight< 18.5Low (but increased risk of other clinical problems) Healthy Weight Average Overweight (pre-obese) Increased Obese (Grade I) Moderate Obese (Grade II)35.0 – 39.9Severe Obese (Grade III) > 40.0Very Severe Body Fat Mass 10 – 20% fat20 – 25% fat25 – 30% fat30 – 40% fat> 40% fat Healthy WeightOverweightModerately Obese Severely ObeseMorbidly Obese Source:Campbell I.W (2004)

NHS Forth Valley Bariatric Definition ‘Very heavy’20 st/127 kg and > greater. Patient unsuitable for a range of routine hospital patient equipment e.g. toileting commodes, scanners. ‘Bariatric’ Patients28 st/178 kg and > greater or due to body morphology. The patient unsuitable for routine patient equipment e.g. Kings Fund bed, x-ray tables. ‘Extreme Bariatric’ Patients Greater than > 35 st/222 kg and above.

Case Study 1 Year 2004/2005 Female patient aged 43 years Weight recorded at 52 stone/330 kg Decreasing mobility over a 2 month period prior to admission to hospital. Non ambulant at time of admission Was known to Social Services Patient medically stable at time of admission

Case Study 1 Hired in ALL equipment that was used during the patients hospital stay. LIKO Gantry Ultra Twin Hoist KC1 Bari-Air bed

Case Study 1 From LIKO - Gantry Hoist

Case Study 1 From Benmor Medical (UK) Ltd. Riser/Recliner chair SWL 50 stone/320 kg

Case Study 1 From LIKO UK Mobile Viking Hoist used with Lift Pants

Case Study 1 From Benmor Medical (UK) Ltd. Bariatric Rollator SWL 50 stone/320 kg

Case Study 2 Admitted February 2008 Male patient aged 39 years Weight recorded at 48 stone/ 306kg Decreasing mobility over a 2 month period prior to admission to hospital All independent ADL decreased over a 2 week period prior to admission Non ambulant at time of admission Known to Social Services Patient medically stable at time of admission

Emergency Ambulance with Bariatric capability

Case Study 2 Non Emergency: Patient Transport Ambulance with Bariatric capability

Case Study 2

Ferno Megasus (SWL 300 kg)

Evacuation Sheet Case Study 2 From Stryker Transfer-Flat a rugged and versatile evacuation sheet offers 12 rigid handles, polyester reinforced construction SWL 114 stone/700 kg capacity. Portable and compact, it rolls to stow-away size.

In-house Equipment

Case Study 2 OUTCOME Discharged home May 2008 Weight on discharge 29 stone/185 kg Only requiring assistance with ADL e.g. for hygiene care Carers reduced from 4 to 1 /day by end of August 2008 Independently mobile with quad sticks within and outwith home Independently buying cakes at shops!!!

Bariatric Patient Pathway Aim of project - identify a strategy for the most effective and efficient pathway to deliver necessary healthcare needs to bariatric patient……

Bariatric Patient Pathway Bariatric Patient Flowchart PathwayAppendix A ‘Step by step’ action pathways Admission to A&E/CAU for Diagnostic Investigation Pathway Appendix B Acute Hospital Admission PathwayAppendix C Community Hospital Admission via Acute Service PathwayAppendix D ‘Home Location’ for Rehabilitation/Care Pathway Appendix E Community Hospital for Rehabilitation/Care PathwayAppendix F ‘Home location’ NO Hospital admission PathwayAppendix G

APPENDIX A Bariatric Patient Flowchart Pathway

Bariatric Patient Pathway Bariatric Patient Flowchart PathwayAppendix A ‘Step by step’ action pathways Admission to A&E/CAU for Diagnostic Investigation Pathway Appendix B Acute Hospital Admission PathwayAppendix C Community Hospital Admission via Acute Service PathwayAppendix D ‘Home Location’ for Rehabilitation/Care Pathway Appendix E Community Hospital for Rehabilitation/Care PathwayAppendix F ‘Home location’ NO Hospital admission PathwayAppendix G

APPENDIX B Bariatric Patient Pathway A&E / CAU Diagnostic Investigations