When transferring the plus size patient between care facilities, it is important to ensure that skin integrity is maintained. The plus size patient is more at risk of skin trauma and the development of pressure damage due to poor circulation to adipose tissue.
Pressure from the sides of equipment such as transfer trollies, wheelchairs and chairs that do not fit correctly may cause breakdown over areas at high risk. It is essential to ensure that the correct equipment is used to support the patient’s size and width without causing increased pressure over these vulnerable areas.
Medical devices that can exert pressure on to patients skin, or be trapped between skin folds, such as catheter or oxygen tubing, should be positioned carefully to prevent skin damage.
Careful positioning of limbs and pannis, with the appropriate moving and handling equipment, is essential if the risk of damage to vulnerable skin is to be reduced from shear and friction forces.
Effective communication and early planning is required when organizing the transportation of plus size patients. Risk assessment, planning and training are essential components that facilitate safe and effective transfer of vulnerable patients. When transfer times are kept to a minimum there is a reduction in the risk of and exposure to pressure, shear and friction forces on vulnerable areas of skin.
The Haslar Team completed a pre-admission assessment to establish the needs of the service user and those of the staff that would care for her if she were accepted into the reablement placement.
A comprehensive assessment covering the service users nursing needs, handling requirements and rehabilitation plan was completed. This included discussion with the nursing and therapy staff caring for her in the acute setting and a detailed discussion with the service user to establish her immediate priorities as well as her long- and short-term goals.
Following the assessment, a plan for admission was developed in collaboration between the Haslar Team and the reablement placement Soham Lodge Care Centre http://www.sohamlodge.co.uk/. This included the structural redesign of the room identified for the patient, the procurement of specialist equipment including the equipment required for the patients care and rehabilitation, identification of a suitable therapy and care team to lead the patients care and training of these staff in the skills required to manage the patient and the product required to support her therapy plan.
During the assessment it was identified that following a 7-month acute admission the things most immediately important to the patient were the ability to socialise outside of her room and to be able to sit outside in the sun, the Haslar Team worked with the reablement placement to ensure this would be achievable on admission. It was important to the Team that this could be achieved in as near to a normal process as possible to promote the inclusivity for this patient despite her complex presentation and to boost her social confidence. Following a rehearsal exercise the equipment required and transfer route was identified to enable this patient to be able to join the other residents in the activities in the day and dining rooms and to be able to sit in the garden. Following this exercise, the care staff reported not only to feel confident in the processes to achieve these transfers but also to have an informed understanding of the relevance and importance of being able to provide truly person-centred care for the complex plus size patient.
Quotes from Sharron who’s journey this is:
“I have come on Leaps and bounds since my arrival at Soham Lodge. All aspects of my care have been centred on my needs”
“I have been supported to go outside after six months of being trapped in a bed. Which has been wonderful”
Prepared room ready for service user specialist Bed, Ceiling Tracking Hoist system, Riser recliner for Reablement, and height adjustable Tilt & Space chair for sitting out of bed.
Safe Transfer from Hospital
Outside for the first time in seven months after Physiotherapy session with HCTS’s Emma and Soham Physio support Adam.
In the garden outside for the first time.
Moving forward with positivity.
Mrs S preparing to Stand with physio support from Emma & Adam.
Using Return 7600 Stand Aid and Bari Vest (Direct Healthcare) attached to a Transverse 270 ceiling Track Hoist (prisimmedicaluk).
Mrs S is very happy having completed her standing exercise with Emma and Adam.
Showing off her new Pink Hair.