Bariatric Times

SEP 2017

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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10 Review and Case Study Bariatric Times • September 2017 INTRODUCTION Facilities that offer weight loss surgery have comprehensive policies, procedures, training, and tools that serve as a framework for managing anticipated and unanticipated patient care needs. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBASQIP) promotes national accreditation standards for bariatric surgery centers. MBSAQIP and other groups require patient care support to be in place in order for healthcare facilities to receive accreditation status. 1,2 Programs that have achieved accreditation status in performing weight loss surgery have seen dramatic improvement in clinical outcomes. 3 However, the nonsurgical individual with morbid obesity admitted to a facility without this accreditation might not have the benefits associated with this level of excellence. In the United States and globally, patients who have morbid obesity historically have had increases in their length of stay, costs of care, and adverse events, such as pressure injury, fall-related injury, infection, pneumonia, and embolic conditions. Many of these events are associated with the hazards of immobility. 4 Authors have identified both economic and clinical implications in caring for the person living with morbid obesity. 5 ,6 Experts are seeking ways to ensure early and ongoing mobility as a way to combat the economic and clinical hazards of immobility. 7 Bariatric readiness by way of criteria-based protocols might be one such strategy to address the consequences associated with immobility. A case study is featured herein that explores the economic and clinical impact associated with bariatric readiness. Specific clinical complexities of bariatric care are examined. Leading and lagging outcome indicators associated with bariatric care are described as well as the way factors such as dignity, safety, and satisfaction influence care. An interdisciplinary approach to patient care is presented as an important step to developing and supporting a pre-planning tool that can be part of the process for bariatric readiness. DIGNITY Dignity is at the heart of sound bariatric care; however, many patients report experiencing weight bias. 8 Weight bias is a term that refers to devaluing a person solely based on excess body weight or weight maldistribution. Experts suggest that weight bias is considered one of the most complicated social phenomena, whether in the general population or in the healthcare setting. 9 As early as 1995, Fox referred to this as the last safe domain of discrimination and prejudice in the United States. 10 Puhl and Brownell explain that there is consistent evidence that individuals living with obesity experience discrimination in family, social, education, and employment settings. Further, studies suggest that healthcare professionals, including physicians, medical students, nurses, dietitians, and behavioral health professionals, share the same attitudes of obesity, weight bias, and discrimination as the general public. 11,12 These studies reveal that some healthcare professionals hold beliefs that patients with obesity lack self- control, are lazy, and have character flaws causing them to be nonadherent when making attempts to lose weight. 13 Researchers have examined strategies to overcome these beliefs. Respect, dignity, and compassion toward the person who has morbid obesity requires execution of a well thought-out plan of care based on trust. This plan best serves all stakeholders when size-appropriate care and treatment, compassionate communication, and supportive language are in practice. Sensitivity education and training are good first steps in overcoming bias and changing attitudes. 14 Criteria-based pre-planning tools that include size- appropriate technology and equipment are also needed. For instance, access to size appropriate furnishings, physical space, equipment, supplies, and instruments create reasonable accommodation. Having the right equipment at the right place and at the right time promotes efficiencies. In addition, the development of a team of experts who serve to support caregivers when questions of equipment, mobility, physical assessment, and care arise is essential to success. Kaminisky and Gadelenta 15 explained that employees hesitate to interact with individuals whose size interferes with the caregiver's by GEORGINA TEMPLE, BSC (Hons), PT, NZRP; SUSAN GALLAGHER, PhD, MA, MSN, RN, CBN, CSPHP; JENNIFER DOMS, NZRCompN, CNS; MICHELLE TONKS, BSC (Hons), PT, NZRP; DARNELL MERCER, B.OT, NZROT; DEBBIE FORD, B.HSc (OT), NZROT Bariatric Times. 2017;14(8):10–16. BARIATRIC READINESS: Economic and Clinical Implications ABSTRACT Care for hospitalized individuals living with morbid obesity is considered more complex for a number of reasons. Authors suggest that adults with morbid obesity have more significant comorbid conditions as compared with their non-obese counterparts. F urther, dignity, safety, and satisfaction are often threatened because of ill-thought-out care plans. In healthcare settings, these challenges often lead to increased humanistic, clinical, and economic costs. A case-study approach is used herein to explore the economic and clinical considerations of bariatric readiness, which includes preplanning and outcome measures. KEYWORDS Bariatric, obesity, economic outcomes, immobility, readiness Figure 1. The bariatric care team at Waikato Hospital in Hamilton, New Zealand. Pictured left to right: Darnell Mercer, Georgina Temple, Jennifer Doms, Michelle Tonks, Debbie Ford Figure 2. Economic and Clinical Analysis Comparing Admission 1 and Admission 2

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