WORTH THE WEIGHT Bailey Medical Center in Owasso, Okla., added this bariatric-grade table when it updated its ORs.

You've probably noticed that patients aren't getting any smaller. If your surgical table can't safely accommodate the growing number of obese individuals presenting for surgery, now's the time to invest in a model designed to protect heavier patients and the staff members who care for them. Your surgical team will appreciate working around a surface specifically designed to provide safe care to a patient population that deserves added attention.

Essential features
Bailey Medical Center is an accredited facility of the Metabolic and Bariatric Surgery Quality Improvement Program and we've been providing bariatric services for years, but the volume of procedures has increased, sending even more patients with higher BMIs to us for surgical care. In order for us to safely care for all of our heavier patients, we needed to upgrade the table in at least one of our ORs.

The table we replaced held up to 500 pounds, but when it was articulated into various positions or taken off center, it could not support more than 400 pounds, depending on the position of the bed. We needed a table that could hold our heaviest patients in whatever position was required for the procedure at hand.

We trialed 3 different tables, assessing the usability and the level of safety each provided patients and staff. Although originally we believed we would stick with the manufacturer of the tables we already owned, the user-friendly design, safety features, and price we were able to negotiate, led to a switch.

We settled on the new table in part because it rated for the highest weight capacity: 1,200 pounds when the surface is centered and 1,000 pounds when it's articulated in various positions. That was key to our decision. The table gave us the most confidence in our ability to safely care for our patients, no matter how much they weigh. It also came with a pair of 5-inch-wide side extensions that widen the surface area, another nice feature that adds to the support and comfort of obese patients.

OBESITY
Guard Against Pressure Ulcers

GROWING SUPPORT Consider the needs of obese patients when outfitting your ORs.

Obese patients are at increased risk of suffering pressure ulcers on the OR table, says Susan Gallagher, PhD, MSN, MA, RN, CBN, HCRM, CSPHP, a certified bariatric nurse, healthcare risk manager and certified safe patient handling professional based in Pasadena, Calif. The 3 leading reasons:

• skin folds compress against skin folds on the table's hard surface;
• procedures performed on larger patients tend to last longer; and
• the skin-to-weight ratio can cause moisture to accumulate on the skin's surface.

Heavier patients are also at increased risk of skin injury when being transferred from one lateral surface to another. "Imagine the shearing injuries that can occur when you drag 400-pound patients from one lateral surface to another," says Ms. Gallagher.

She points out that relatively inexpensive transfer devices can help your staff move patients between surfaces and decrease their risk of suffering debilitating and potentially career-ending injuries.

Ms. Gallagher suggests you look at emerging technologies designed for improving the care of bariatric patients in the OR. But it's not enough to bring in new equipment and simply provide staff training, she says, adding that there has to be some sort of process in place that lets caregivers develop confidence in using equipment that accommodates obese bodies of various shapes and sizes. For example, the transfer technology your staff employs has to be used correctly — failing to center a patient on a lateral transfer device puts them at risk of being dropped, she says.

Excess weight can gather in the legs, back or buttocks. "You have to match bariatric equipment to the patient, rather than thinking one size fits all," says Ms. Gallagher. "Just because you successfully cared for a 400-pound patient today, doesn't mean you can use the same technology tomorrow, because the patient's body configuration could be totally different."

There's an economic component to improving patient safety and quality of the care your staff provides to bariatric patients. The mishandling of obese patients might result in staff injuries that increase your workers' comp premiums or leave you short-staffed. Nurses might also work in pain, putting patients at further risk.

"We want to protect obese patients from all harm, to move to a zero-preventable-harm environment," she says. "To do that, you need to consider not only the business case for protecting patients and caregivers, but also the humanistic perspective."

— Daniel Cook

The table's surface rotates 210 degrees on the pedestal stand. That versatility and time-saving feature lets us use the table for many specialties besides bariatric procedures — and helped us justify the purchase. The table's handheld remote that staff members use for hands-free positioning of the surface is intuitive and very durable, which is especially important in the OR, where expensive equipment needs to be sturdy enough to withstand repetitive use without damage.

We opted to upgrade the depth of the table's padding to 5 inches to better protect the skin of morbidly obese patients, who are at increased risk of sustaining pressure injuries during surgery. An additional gel-top pad helps absorb patients' weight and adds to the protection of their skin integrity.

Another key safety feature: Straps that are long enough to be wrapped comfortably and securely around patients' thighs without causing constriction. In addition, footboards attach to the foot of the bed to prevent patients from sliding down when the surface is articulated to reverse Trendelenburg.

Our table cost about $75,000. Money shouldn't matter when patient safety is at stake, but it's a significant consideration because we're running a surgical business that needs to be profitable. Sure, we invested a lot in the new table, but consider the revenue we'd lose if we could no longer, in good conscience, schedule surgeries for the patients who present for surgery weighing more than 400 pounds. Because you can't put a price tag on patient safety, investing in a table that can accommodate heavier patients shouldn't be a difficult decision. Focus instead on making the best purchase based on functionality, safety features and weight capacity.

Decide which table makes the most financial sense for your facility only after you identify the model that hits on those essential features. Can you leverage the promise of future business when negotiating the purchase price? (We'd like to upgrade the table in at least one more OR, for example.) Also focus only on the features you actually need. Some reps might try to sell you numerous attachments you'll only use periodically. Adding such an attachment doesn't make financial sense if it tacks a couple of thousand dollars onto the final price of the table, especially if you can provide safe patient care without it. Like any large capital purchase, breaking down a proposed quote to only what you truly need makes the purchase more likely to be approved.

A sense of relief
Our staff was relieved when we purchased our new heavyweight table. When they articulate the bed with a morbidly obese individual on the surface, they know they won't be forced to support the patient. The surgical team has peace of mind knowing that the safety of the patient they are caring for won't be compromised by the abilities of a piece of equipment. They have confidence in the bed and appreciate its role as a valuable addition to their arsenal of equipment designed to provide safe patient care.