Bundle Approach to Management of Bariatric Patient from Admission to Discharge

In an acute care facility the challenges faced by a bariatric patient raise awareness of the need to develop a protocol ensuring quality care that begins on admission and continues to discharge. The gaps needing to be addressed included providing interdisciplinary resources related to mobility, skin issues, stigma/bias an respiratory care.

An evidence based practice initiative was implemented to improve bariatric care in an acute care facility. PICO question was developed: For the bariatric patient in acute care setting, would implementation of a bundled care approach, as compared to current standard, effect complications: skin integrity, clinician injury, patient safety, negative stigma. A literature search was done using databases PubMed, CINAHL, Joanna Briggs, and Cochrane was conducted to identify relevant sources of evidence. 144 articles were originally obtained, after eliminating duplications, screening titles, abstracts and assessing full text for eligibility there remained 22 relevant sources of evidence. Level of evidence were determined: level six (4) and level seven (18). Relevant sources were appraised for quality and strength using the CASP and GRADE tools. Synthesis of evidence showed that quality bariatric care focuses fundamentally on five clinical practices including safe patient handling, skin/tissue integrity, sensitivity training, sleep apnea management and creating interdisciplinary support. There was a lack of nursing research in bariatric management and most evidence was from descriptive study or expert opinion. GRADE was used to determine the quality of evidence that was low/weak. After reviewing the evidence, the benefit of implementing the five focuses of clinical care outweighed the risk. Based on the evidence, "The 5 S's for Management of Bariatric Care Bundle" was developed and implemented. The 5 S's Bundle includes specific interventions for each clinical practice areas: Safe patient handling, Skin assessment, Sleep apnea, Stigma and Support personal. Algorithms, staff education and resource availability were developed and implemented. For monitoring outcomes a data collection tool was developed in REDCap. Monitoring is done with monthly prevalence's.

After pre and post data analysis there has been shown an improvement in use of safe patient handling (reduction of staff injury), availability and selection of appropriate equipment and prevention of impairment in skin integrity (IAD/MASD/pressure injuries). The measures for quality care are initiated earlier from the time of admission than prior to the study implementation.

Implementation of the 5 S Bundle brought awareness to clinical staff to initiate quality care including prevention and implementation from admission (ED) to discharge. Complications secondary to immobility were decreased. Post sensitivity training nurses were aware of addressing the total care of the bariatric patient. Due to the low level of evidence identifying quality bariatric care, nursing research needs to be placed as a high priority.

Trademarked Items (if applicable):

References (if applicable): Abir, F., & Bell, R. (2004). Assessment and management of the obese patient. Critically Care Medicine, 87-91.
Sturman-Floyd, M. (2013). Moving and handling: supporting bariatric residents. NRC, 432-437
Williams, B. (2007). Nursing Obese Patients is a Pain in the Back. Nursing Standard, 33.