1. Belinda Thomson Manual Handling Adviser Head of Manual Handling Service Risk Management Department NHS Forth Valley Scotland belinda.thomson@fvah.scot.nhs.uk

2. 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

3. 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

4. Forth Valley - Scotland Population: Stirling 88,190 Clackmannan 49,900 Falkirk 150,720 -------- 288,810 Geographical area: 2,643 square km or 1,021 square miles

5. ClassificationBMI (kg/m 2 )Risk of Co-morbidities Underweight< 18.5Low (but increased risk of other clinical problems) Healthy Weight18.6 - 24.9Average Overweight (pre-obese)25.0 - 29.9Increased Obese (Grade I)30.0 - 34.9Moderate 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)

6. 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.

7. 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

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

9. Case Study 1 From LIKO - Gantry Hoist

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

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

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

13. 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

14. Emergency Ambulance with Bariatric capability

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

16. Case Study 2

17. Ferno Megasus (SWL 300 kg)

18. 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.

19. In-house Equipment

20. 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!!!

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

22. 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

23. APPENDIX A Bariatric Patient Flowchart Pathway

24. 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

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