From waiting-room chairs and floor-mounted toilets to blood pressure cuffs and gowns, treating overweight patients presents unique challenges with respect to outfitting your facility. Here's how seemingly small touches will make your facility a safe and comfortable haven for these patients.

Weighting in comfort
Start at the beginning of the patient's experience when making your facility overweight-friendly. Jan Carlo, RN BSN, bariatric program manager at Sacred Heart Hospital in Pensacola, Fla., designated five parking spaces 10 feet outside her front door for exclusive use by obese patients. That might seem like a small gesture, but it goes a long way in setting the tone for accommodating the special needs of the overweight patient population.

Keep in mind that the daily challenges to self-esteem, physical comfort and wellness of obese patients are huge, says Nancy Burden, MS, RN, CPAN, CAPA, director of ambulatory surgery at BayCare Health Systems in Tampa, Fla. She was morbidly obese before gastric bypass surgery transformed her life. "The difficulty of completing everyday activities is something that the obese person tries to hide at all costs," she says. "Not being able to tie your shoes, walk up a flight of stairs, fit a seat belt around you, squeeze into a movie theater seat or scratch your own back are incomprehensible to normal-weight people, but a daily struggle if you are obese."

In the waiting room, include bariatric furniture that's typically built to hold up to 750 pounds. At upwards of 30 inches wide, bariatric chairs are also built wider than standard furniture. Placing oversized chairs alongside standard furniture is key to tastefully accommodating overweight patients. Furniture regulated to a "special" section of your waiting area will only embarrass the patients who you're working to welcome. Obese patients will find the chairs appropriate for them, and they'll appreciate not being singled out.

Try to match the fabric of the bariatric furniture to the rest of the chairs in the waiting room. The good news: manufacturers are aware of the growing demand for bariatric-grade furniture so you'll have plenty of options in choosing the right look for your facility. In many cases, manufacturers of standard furniture provide matching bariatric models, letting you coordinate the design of the entire waiting room. Take advantage of the opportunity. Matching furniture will look nice, but it's also another way to make overweight patients comfortable without making them feel different from the other patients at your facility.

Be sure to include oversized seating options in all areas visited by patients, including physician offices, conference rooms, private rooms used for physician-patient consultations and secondary waiting areas next to procedure rooms or labs. The chairs in Ms. Carlo's conference room, for example, are 24 inches wide, have no armrests and are rated to 600 pounds.

One final advice about outfitting the non-clinical areas of your facility for the overweight patient: Wall-mounted toilets present a potential safety hazard for the obese. Add floor-mounted toilets in the public bathrooms, and include safety bars mounted to the walls around the toilet.

Clinical upgrades
As health professionals, Ms. Burden says you can do a lot to bring more humanity and comfort to the obese person's care. She notes that seemingly small touches like having the right size gown and blood pressure cuff ready so that a patient doesn't have to be embarrassed by asking for a larger size can make a huge difference in comfort. In addition to making sure waiting room chairs are of adequate size so larger people can sit down, ensure beforehand that your stretchers and OR beds can handle an obese patient's weight during surgery.

Ms. Carlo keeps a supply of oversized gowns — up to 10X — to adequately cover anyone of size. Consider keeping a couple oversized blood pressure cuffs on hand to accommodate the larger arms of obese patients. Ms. Carlo has two oversized cuffs that are longer and wider than a standard cuff. She also purchased a bariatric scale rated to 1,000 pounds. The scale is kept in a separate room for the weighing of obese patients, who are understandably sensitive to weight issues and often appreciate private weigh-ins.

In the OR, verify the weight limit of your OR tables, suggests Jennifer Griffin, BSN, vice president of perioperative services at Sacred Heart Hospital. She says OR beds historically accommodated patients up to 450 pounds. Those weight capacities increased over time as patient populations grew in size. A few years ago tables could hold 500-pound patients. Today, those limits continue to increase, eclipsing 800-pound capacities, says Ms. Griffin. The width of OR tables is just as important to consider as the weight capacity. Attachments can extend the width as much as six inches, a key aspect of the comfort and safety of the obese patient.

Dee Willey, RN, clinical manager of the Surgery Center of Richardson in Richardson, Texas, has a three-ring binder on her desk containing the manufacturer's weight limits for every piece of equipment used in her facility, including stretchers, OR beds and PACU recliners. "If there's ever a question about an equipment's weight capacity, or if a problem arises, we can pull the book to make sure the equipment is safe for use with obese patients."

Also consider adding longer instrumentation to your standard laparoscopic sets for working in the deeper abdomens of obese patients. Ms. Willey has 45cm instruments alongside the 33cm standard tools in her facility's nine instrument sets because of the high volume of obese patients presenting for surgery.

Maintaining the airway is a major concern when operating on obese patients because of the large circumference of their neck. In addition to using a limited number of anesthesia providers who are comfortable with the precision needed to treat the obese patient population, Ms. Griffin makes sure emergency airway equipment is always on hand and easily accessible, including laryngoscope blades, laryngeal mask airways, endotracheal tubes and fiber optic bronchoscopes.

Ms. Willey raps lightly on her desk and says she keeps a tracheostomy kit at the ready. "We haven't used it yet," she says, "but it's there just in case."

In the PACU, don't forget about having a few bariatric-grade wheelchairs on hand for the safe transport of overweight patients after surgery. If you place patients in recliners for part of the recovery process, remember that those chairs must accommodate larger individuals.

Ms. Griffin also maintains ventilator access for all post-op cases. Obese patients can experience a higher incidence of difficult extubation and may have difficulty achieving spontaneous breathing after surgery, she says. Your anesthesia provider may never experience a problem, but recognize the possibility of post-op breathing concerns in the obese patient. Make sure your facility can support the anesthesia provider's handling of these potentially difficult cases.

A welcome change
Before outfitting your facility to care for the obese patient, consider the very real discrimination overweight individuals experience on a daily basis. They might feel those negative effects when they fail to land a job they were more than qualified for, or in the nasty looks they receive when walking into a restaurant. The overweight patient is indirectly made to feel unwanted in many public arenas. Think about the size of airplane and movie theater seats or amusement park rides, to name just a few places where obese individuals feel less than comfortable. Take the time and make the effort to ensure your facility isn't included on that list.