Bariatric Equipment Injuries Expert Article

According to data from the Centers for Disease Control and Prevention (CDC), adult obesity affects over 40% of the US population. For healthcare providers, the prevalence of obesity requires that facilities are ready and equipped to care for larger and heavier patients.

In this article, Doctor of Occupational Therapy & Health Care Administration Expert, Dr. Joseph Muniak provides an overview of the standard of care and best practices surrounding bariatric equipment.

Bariatric Patient Care Requirements

Patient size may be relevant when investigating liability in a personal injury claim. The patient’s physical dimensions and/or BMI may affect the standard of care, potentially requiring specialized equipment to safely meet the needs of the patient. Beyond the equipment itself, it may be relevant to review training that staff received to care for larger patients, equipment inspection protocols, and modifications to discharge/admissions procedures.

What is a Bariatric Patient?

A person is considered to have obesity and is referred to as a bariatric patient when their body mass index (BMI) is equal to or greater than 30. BMI is calculated using a person’s weight in relation to their height. There are various classes of obesity that are determined by the range a person’s BMI falls into. For example, morbid obesity is defined as a BMI of 40 or more.

Specialty equipment is required to care for these individuals. Broadly put, bariatric equipment refers to equipment or supplies that are designed for larger or obese patients.  In addition to BMI consideration, individuals needing bariatric equipment can be defined as those overweight by more than 100-200 pounds or an overall body weight greater than 300 pounds. 

Bariatric equipment also includes devices designed for persons requiring wider widths, in addition to increased weight capacities. To meet bariatric patient needs safely and properly, there are greater durability and functionality requirements for these medical devices.

The industry standard of care places the responsibility on facility administration to ensure that the overall needs of the individual are met, which includes equipment needs. Within the individual facility, occupational and physical therapists are often responsible for the selection and management of positioning and mobility equipment.

Types of Bariatric Equipment

As defined above, the obese/bariatric population makes up a significant percentage of healthcare patients. This percentage of the population is growing, as are the types and styles of bariatric equipment available to meet patient care and functional needs.

Common types of bariatric equipment include:

• Overhead / ceiling lifts
• Portable / hydraulic lifts
• Lift and repositioning slings
• Hospital beds
• Stretchers
• Exam / treatment tables and mats
• Positioning wedges and bolsters
• Transfer / convertible and bedside chairs
• Commodes
• Portable and built-in shower chairs and benches
• Step / foot stools
• Stair and curb trainers
• Manual and power wheelchairs
• Walkers, rollators, canes, and crutches
• Toileting hygiene and feeding equipment

Bariatric Equipment Failures

Weight Requirements

All equipment that serves the purpose of supporting a patient’s weight, either static or through mobility, has an associated weight limit. This includes all the above listed bariatric equipment examples. There is no universal weight limit supported by ‘bariatric’ equipment, it varies by make, model, and manufacturer.

The same is true for equipment that is designated ‘wide’ or ‘tall.’ This equipment will also have varying weight limits dependent on the intended use, manufacturer specifications, and ancillary components.

Some types of healthcare equipment that appear to be single products, are made up of a series of components that each have a separate weight capacity.  For example, a ceiling lift system has at least three components with potentially different weight ratings. 

1. The polyester, cotton, or rayon sling that is used to cradle the patient will have one weight capacity associated with it. 
2. The sling bar or carry bar that holds the sling with the patient in it has a weight capacity. 
3. The lift motor or hoist will have a weight capacity. 

All three of these components need to be checked when lifting a patient. If any one of these three components do not properly support the patient, a severe or deadly patient fall and/or injury can occur.

Identification/Delineation of Weight Capacity

A key component to the appropriate utilization of bariatric equipment is the ability of staff to easily identify what the weight limit is before using. This requires making the weight capacity clear and visible to staff. This is often achieved through highlighting existing weight indicators, adding additional tags, or the weight capacity being displayed in various locations on the equipment. Color coding systems are also used in many healthcare organizations to provide standardized and visible identification of bariatric equipment or weight limits.

It is especially important that these delineators be checked regularly to ensure they have not been removed or worn off. Even manufacturer’s labels indicating the weight capacity can fade or wear over time. The weight capacity will need to be reidentified and checked against the instructions for use (IFU) and manufacturer’s recommendations before reapplication. A specific problem area for maintaining labeling that is visible to staff is for equipment that encounters water or is cleaned often, such as shower chairs/benches and commodes.

Staff Training

Staff training specifically targeting the appropriate use of bariatric equipment is essential to its safe implementation with patients. This training should be provided to staff on a routine or scheduled basis, and records of education maintained.

Bariatric equipment is often rented by facilities on an as-needed basis. When this occurs, staff should be educated on its safe and appropriate use before implementing patient care.

A few examples of staff education with bariatric equipment are:

• Importance and reasoning behind checking weight limit
• How and where to check the weight capacity
• Identification of visible wear or obvious device malfunction
• Consideration for the individualized needs of the patient
• Reporting and removal procedures for broken or malfunctioning equipment

Maintenance & Inspection

Routine and regularly scheduled inspection of bariatric equipment must occur, including testing of the weight capacities. Bariatric equipment often features mechanical components, which necessitates the involvement of the facility’s engineering services department. This is especially true for ceiling and portable lift systems.

Some bariatric equipment may need to be sent away to the manufacturer or third-party service for inspection or maintenance. In those circumstances, the equipment’s IFUs and/or manufacturer’s guidelines should be followed.

Discharge & Admission Procedures

Planning for the admission and discharge of a bariatric patient is more involved than the planning for a non-bariatric patient, in-part due to the need for specialized equipment. Patient’s individualized needs and safety must always be at the forefront of planning, and this often starts with having the appropriate equipment. 

Communication between the sending and receiving facilities should ensure that all equipment is ready before the patient changes levels of care, which may sometimes require delaying an admission or discharge until these needs are met. 

For emergency rooms, maternity centers, or other care environments that may suddenly receive a bariatric patient, equipment used to safely care for the individual needs to be available. In addition to the appropriate equipment being available, the appropriate number of staff needed to safety utilize this equipment for patient care should be present.

Meeting these preparatory standards for safe patient discharge and/or admission of patients with bariatric equipment requirements is the job of the multidisciplinary team, which typically includes case managers, administrators, therapists, and physicians. 

Bariatric Equipment Expert Witness Investigations

Ultimately, assessment of individualized needs must occur when identifying, implementing, and evaluating interventions. For bariatric equipment, those needs include, but are not limited to: weight, width, height, skin, cognition, balance, and functional mobility. Additionally, in keeping with the standard of care, constant reevaluation of these interventions should occur and appropriate changes made as needed.

An investigation of the bariatric equipment, care records, and witness reports can help determine the cause of an incident. The health care experts at Robson Forensic can analyze the causation behind medical equipment mishaps and address the relevant standards of care.

For more information, submit an inquiry or contact the author of this article.

Featured Expert

Joseph Muniak, MS, OTD, OTR/L

Doctor of Occupational Therapy & Health Care Administration Expert

Dr. Muniak is a board-certified Occupational Therapist (OTR) and hospital administrator with expertise in the continuum of care provided to patients in the acute hospital, inpatient rehabilitation,… read more.