1. Blythe, Lorie MSN, RN
  2. White, Susan E. MSN, RN, BC, CVN

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The purpose of this clinical project was to increase the MICU staff's understanding of the special needs of obese and morbidly obese patients and provide resources to address those needs.



According to recent statistics, 24% of our state's population meets the criteria for obesity. That statistic was exceeded in our MICU patient population, with 25-30% of patients being either obese (BMI > 30) or morbidly obese (BMI > 40).



This subgroup of patients has special care needs unique to their weight and size, making routine caregiving, transport to other departments for diagnostic tests, and simple tasks, such as turning and mobilization, challenging. We found the staff avoiding these patients, and we were concerned about adverse patient outcomes and a decrease in staff morale.



The CNS assembled a team that included MICU staff nurses, a critical care pharmacist, a physical therapist, a dietitian, wound care specialists, a care coordinator, and a clinical educator. A literature search was performed and the results were shared with the team. Gaps between the literature and current clinical practice for these patients were identified. The team wrote guidelines for care of the bariatric patient, utilizing the expertise of each of the disciplines. Team members gathered information about weight and girth limits for diagnostic imaging equipment, and a CNS graduate student wrote an algorithm to assist in bariatric bed selection. All the guidelines and references were assembled into a 2-sided reference sheet that was printed and laminated for each bedside chart. Nurses in the MICU piloted the reference sheet and gave feedback to the team.



Nurses utilizing the reference sheet have expressed a better understanding of the unique care needs of this patient group and how to meet them. The reference sheet has prevented unnecessary "road trips" to diagnostic departments. Appropriate bariatric bed selection has increased, as well as referrals to the bariatric CNS. The bariatric care reference sheet has been placed on the organization's nursing Web page for all nurses to use in patient care.



The bedside reference sheet has had a positive effect on nursing staff knowledge and morale, as well as on patient care.