Bariatric Times - September 2008 - (Page 30)

30 Consultant’s Corner Bariatric Times • September 2008 Consultant’s Corner Understanding Bariatric Risk—A Legal, Clinical, and Customer Service Focus by James W. Saxton, JD; Maggie M. Finkelstein, JD; and Susan Gallagher Camden, RN, MSN, PhD All from Stevens & Lee, Lawyers and Consultants We recently had a patient who spent seven days in critical care. On the general medicalsurgical unit, we had trouble lifting or transferring him from his bed to the wheelchair or gurney. The ergonomist brought in a mechanical lift and sling, but as a medical-surgical nurse, I think this whole process is simply too time consuming and, as a unit, we would like to simply do our best to move him ourselves. What are the trends across the country? Experts: This is a common reaction to the safe patient handling and movement effort that is sweeping the country. However, keep in mind that patient lifting, transferring, and repositioning tasks are the leading cause of back, neck, and shoulder injuries for employees in the healthcare industry. Back injuries result in the most lost work days.1 In 2005, healthcare workers sustained 37,980 musculoskeletal disorder (MSD) injuries requiring days away from work, which totals 10 percent of all MSD injuries in the labor force.2 This estimate is low, as many injuries go unreported.3 Data from more than 80 studies show that every year, 40 to 50 percent of nurses experience a back injury. At any point in time, 17 percent of nurses are injured.4 Assuming there are 2,852,000 direct care nurses, at any point in time approximately 484,840 direct care nurses are suffering from a back injury.5 The concern is that an estimated 47 percent of hospital nurses report that they have considered leaving patient care because of their jobs’ physical demands. Therefore, it is not surprising that a number of states have enacted minimal or zero-preventable lift legislation, and the trend is to continue this effort until a federally mandated policy is in place. Interestingly, it is the clinicians who are closest to the bedside who are often most resistant to these efforts. The proper use of lifting and transferring products is a learned skill and, as true with all learned skills, time is required to develop enough confidence to use the equipment in a safe and efficient manner. As such, it is absolutely essential that the facility obtain equipment from a company that understands the product and supports your facility with an adequate amount of training and education to ensure you and your colleagues are confident using the equipment. Further, we encourage you to become involved in the decision-making process in acquiring specialty equipment. In evaluating equipment, look for ease of use, maintenance, training, and delivery times. Safe and effective equipment, for both patient and caregiver, is a good risk management practice. With continued use and support, products that help to ensure the patient’s safety and your own will become second nature. This is the goal of a comprehensive safe patient handling program.6 How is it possible to hold patients to a higher level of accountability? Experts: The issue of accountability transcends practice settings. Sixty-six percent of patients take prescribed medications incorrectly or not at all! Cigarette smoking is the leading cause of death in the United States. We know there are issues of accountability not only among patients of size, but all patients. The concern among patients having weight loss surgery (WLS) is that patient participation is likely the most important factor in long-term success. Additionally, from a risk management perspective, patient behavior can contribute to unfortunate outcomes, and when something goes wrong, patients or family members often blame the healthcare provider. It makes good sense to encourage patients to become partners in their own care and therefore more accountable for their own health.7 A truly patientcentered approach transfers power and authority away from healthcare clinicians and toward patients. The aim of healthcare clinicians is to learn how healthcare treatment and recommendations affect the patients’ lives and not simply their health.8 By more fully understanding power and authority and the role they play in accountability, we are better able to understand ways to adapt our practices to promote accountability among ourselves and our patients. Clinicians should send the message that says, “I have certain responsibilities and obligations to you that I must live up to; however, so do you. If we both accept our respective rights and responsibilities and take care of your health together, we’ll fare better.” To truly develop a partnership with the patient, there has to be cultural change within the organization. Statements such as, “You are an important part of your healthcare team,” should be displayed. This message should be integrated into marketing materials, brochures, contracts, and patient education information. Every staff member must agree that patient involvement is an essential part of the collective goal. Admittedly, a cultural shift is tough to accomplish. It requires commitment by all members of the WLS team. It means reviewing the way patients communicate with staff members and the way patients receive instructions and education.9 There are certain clinician behaviors that promote intrapersonal relationships and communication, such as addressing the patient with an attitude of openness, acceptance, and lack of judgment or prejudice. This can be particularly challenging for the office team when patients regain weight, are angry or indifferent, or fail to meet certain objectives. It is human nature to judge others, but in WLS practice it is imperative to recognize this tendency and make every attempt to overcome it. Other behaviors that enhance relationships are honesty, reliability, and respect. Successful clinicians are able to balance confidence and humility. The concern among patients having weight loss surgery (WLS) is that patient participation is likely the MOST IMPORTANT FACTOR IN LONG-TERM SUCCESS.

Table of Contents Feed for the Digital Edition of Bariatric Times - September 2008

Bariatric Times - September 2008 Emerging Technologies Case Report Sleeve Gastrectomy after a Jejunoileal Bypass Reversal Editorial Message Contents Editorial Board Walk from Obesity The Latest on Nutrition and Hair Loss in the Bariatric Patient Consultant’s Corner Journal Watch Calendar of Events Advertiser Index

Bariatric Times - September 2008

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