After experiencing 2 sentinel events involving obese patients in the space of 6 months, a team of nurses at a northern California community hospital took action to ensure the safety of and prevent further complications among this increasing patient population.
Diane Graham, RN, MSN, CNOR, clinical nurse specialist, and her colleagues at John Muir Medical Center in Concord, Calif., noted that perioperative staffers had no advance notification when obese patients were scheduled for elective, non-bariatric surgeries.
Since obese patients often have special needs in terms of respiratory support, positioning and handling, such advance notification is critical in preparing for and delivering patient care.
For a quality improvement project published in the October issue of AORN Journal, Ms. Graham and colleagues formed a "High BMI Task Force" that aimed to boost safety through staff education, interdepartmental communication, equipment upgrades and attention to respiratory care.
One specific improvement to their surgical process, the study explains, is that patients' body mass indexes, not just their weight, should be disseminated to staff ahead of time to enable preparation.
Chart audits confirmed the effectiveness of these strategies. By the completion of the project, patients' BMIs were recorded on the surgery schedule 92% of the time and on the pre-operative checklist 94% of the time. Even better, the study authors report, high-BMI patients at the facility have not suffered a single difficult intubation incident, respiratory insufficiency or positioning injury since January 1, 2009.
David Bernard
