This article will look at the process, development and reasoning behind a series of low-cost conferences for bariatric moving and handling management. The intention of the combined workshop and seminar approach is to introduce care staff from a wide variety of disciplines to the concept of handling the plus-sized person. It is not the intention to identify particular measures for specific clients, nor is the intention to promote one method over another. The resulting Continuing Professional Development (CPD) for the attendee equates to 6 hours tuition.
Background
The course was devised and designed by Gavin Wright. Gavin, an emergency medical technician, holds a moving and handling instructors diploma issued by the combined awarding body of Oxford, Cambridge and the Royal Society of Arts (OCR). Responding to a gap in the market for instructor level training he, along with three other members of his family who were also from clinical backgrounds (child care, general nursing and mental health—two of whom were also clinical educators), formed a company specifically designed to tackle this shortfall. This company, latterly known as TLC Worldwide (TLC), in 1997 became the first to offer a five day moving and handling instructor's course through the Royal College of Nursing's Continuing Education Programme.
Having had other and similar courses accredited through the Institute of Health Care Development (IHCD), Edexel, OCR and the CPD Certification Service, his work was recognised by St. James’ House in 2008, with the publication of the 60 Years of the National Health Service tome. This publication described the first 60 years of the UK’s National Health Service (NHS), outlining its chronology and development through that period. The various chapters gave a viewpoint of one aspect, such as medical and surgical equipment, which have been used and followed up with best practice awards.
Chapter seven dealt with education, training and incentives. Best practice awards were given to 21 different organisations, such as King's College London, for continuing to find great medical pioneers, e.g. Nobel Prize winners Sir James Black and Maurice Wilkins. Another award winner was Blackwell UK for its continuing prolific publication of medical textbooks used in medical education the world over. TLC Worldwide received recognition for safe patient moving and handling training, and taking the concept to a worldwide audience.
In 2009 Gavin took on the role of national moving and handling coordinator for the South African Moving and Handling Project (SAMHP). This project is aimed at developing moving and handling interventions in South Africa in their equivalent of the UK’s NHS, the National Health Insurance (Department of Health Pretoria, 2012). This is currently an advisory role, though big things are anticipated in the near future.
Another development was the very popular Moving and Handling Instructors Newsletter of which Gavin is the author/web editor. This free online journal is accessed by individuals who are interested in moving and handling in 25 countries.
Gavin has spoken at national conferences such as Naidex and the National Back Exchange (NBE). Naidex is aimed at both the public and care workers, while the NBE conference is aimed squarely at members of the healthcare professions who are interested in tackling musculo-skeletal injuries in the workforce and safer moving and handling of people.
As Gavin has always been at the forefront of moving and handling development he joined the progressive team at Nordic Care Services Ltd in 2011. Nordic has a reputation of bringing innovative and practice changing products to the UK market. They also have a long history of exhibiting at major conferences and exhibitions. The formulation of a training wing was inevitable and so Nordic Care Training & Education Ltd (NCTE) was formed in 2012 as a not-for-profit company to expand the concept of safer patient handling.
To keep his hand in at clinical practice Gavin works on ambulances during his frequent visits to South Africa and also conducts patient assessments with Nordic Care Services products whenever requested to do so by clinical staff around the UK.
Development and format
At NCTE we were in the unique position of being regular attenders at a variety of conferences, not only as speakers but also as delegates and exhibitors. This enabled us to view the process from all three angles. In developing a format and programme for our own conference, we wanted to achieve something that would take into account the experience gained from these various positions.
As exhibitors we faced the problem of making sure all of the delegates at a conference were made aware of our products. Time is often limited during breaks and while speaking with one potential customer, we noticed someone passing by whom we had hoped would stop to speak with us. The opportunity passes by and they are lost in the crowd. To address this issue, we decided to limit the number of delegates to 96 and hold workshops for each exhibitor or sponsor. Each delegate would be timetabled to attend each workshop during the course of the day.
As a speaker, we are aware of the experience mix within the audience and the need to appeal to professional colleagues while not leaving the casual or public listener behind. This can make it difficult to know at which level to pitch the presentation. This issue was addressed by only advertising the conferences to professional groups such as readers of the Moving and Handling Instructors Newsletter and selected groups on LinkedIn.
As a delegate we are cognisant that we want information and not flimflam from a speaker trying to fill their allotted time. In addition to this we want to see products demonstrated and not to see the same thing being demonstrated 14 times at different exhibition stands before we stumble across something which we almost missed, but has the potential to change processes for the better. This matter was addressed by inviting selected exhibitors to sponsor the event. None of these sponsors would be exhibiting similar products. Although many of the sponsors had a crossover of similar products, each one was invited by NCTE due to their having a solution to a particular problem when dealing with a person.
If we were going to deliver a conference under the banner of Nordic Care Training and Education Ltd., we needed a theme. It was decided that we should start close to home in that we were knowledgeable of bariatrics. According to the Oxford Dictionary (2013), the definition of bariatric is: ‘the branch of medicine that deals with the study and treatment of obesity.’ As this would clearly be a ‘study’ day, and assisting someone to move from A to B can be referred to as ‘treatment’, the title of the conference therefore would be ‘An Introduction to Bariatric Moving and Handling Management’.
In order to address the concerns from the three aspects of conference attendees mentioned earlier, we wanted to deliver the conference in a way not previously seen in other conferences.
The delegates would be invited from a number of groups on LinkedIn.com, primarily Gavin's Moving and Handling Instructors Group. This would ensure that the delegate mix would be like minded professionals from a range of different professional healthcare disciplines. In order to keep their attention and to make the conference experience fast paced and dynamic, we drew from an idea formulated in 2011.
In 2011 we produced a DVD entitled Mini Masterclasses for Moving and Handling Instructors. This well-received production comprised 22 mini lectures from some of the best known and published personalities in moving and handling across a range of expertise. For instance, the bariatric section was conducted by Ken Cookson, co-author of the bariatric chapter in The Guide to the Handling of People (2011). The success of this collaborative effort was partly due to its format of three minute lectures.
Building on this concept and bearing in mind the title of an ‘Introduction to Bariatric Moving and Handling Management’, the speakers of our conference would be given a subject and only 8–10 minutes to put the point across to the audience.
The subjects were as follows:
For many years the author attended conferences as a delegate or speaker. The experience was seen from the opposite side when attending as an exhibitor. He felt left out. The good information that he needed to know about was being spoken of behind closed doors. The exhibition was separate to the conference. The exception to this is Naidex, where the conferences and exhibitions are held in a single large hall. However, unless you happen to have a stand right next to the theatre, you still miss out on the valuable lectures.
We wanted the exhibitors to have the opportunity to be actively involved in the conference and not there to simply sell their wares. This would enable them to work along with the medical professions in the research and development of their products. Also it would mean that the size of the conference would need to be restricted to enable all to be involved in a space large enough for the conference but small enough to not lose anyone. To this end, we didn't want the conference exhibitors to be competing with each other nor did we want them to miss out on how the moving and handling professions as a whole are developing. The problem though was that most exhibitors have a crossover of product range with other exhibitors. Therefore, to address this, we gave each of the exhibitors a problem to solve that relates to bariatric moving and handling. These were set as follows:
With a front and centre stage, the eight selected sponsors were staged around the sides of the large conference room. The delegates received a half hour introduction to the nature of moving and handling plus-sized people. It was pointed out to them that their conference name badge also had a letter under their name. This was with reference to the group they had been allocated to. Each group was assigned a starting point relating to the eight workshops hosted by the exhibitors around the conference hall. Following the initial discourse, they joined their groups at each workstation. The exhibitors were then given 20 minutes to explain their solution to the problem they were given. Following this, the delegates were asked to reconvene for the next eight minute sessions on the programme.
As the day progressed, each group of 12 delegates attended each of the workshops, where they had opportunity to question the sponsor on matters relating to their solution.
The mini-lectures
Obviously in the space allocated to this article it would be impossible to mention all aspects of the mini lectures. However, there is space to recall some of the highlights which delegates have mentioned.
One such was the concept of forward viewpoint, mentioned in Stephanie Wright's ‘Risk Assessment’ section. As most people approach a ramp to access the back of an ambulance for instance, they can see the beginning of the ramp easily and make the step up at the appropriate time (see Figure 1).
Stephanie brought out the fact that someone with ‘an extended top shelf’, as she so eloquently phrased it, can often be two, three or even four steps away from the ramp before it disappears out of their peripheral vision (see Figure 2). Of course, they can stoop forward to reduce this factor but that is then putting them at risk of a fall. Her solution was to stand at the foot of the ramp and tactfully state that the ramp starts where they are standing. Another solution, (if appropriate) is to point out the handle beside the ramp and alert the person to the fact that the ramp starts in line with where the handle is located.
The body shape and dynamics section has been handled on different occasions by the author, Irvind Sihota MCSP and Pat Alexander MCSP discusses the various classifications of body shape such apple, pear and bulbous gluteal shelf as mentioned by Cookson (2011). Sub-dividing these categories, this session goes on to explain the difficulties encountered when measuring a person for a sling, as well as their movement etc.
Falls management discusses the need for prevention rather than cure. Sturman-Floyd (2011) brings to our attention that there are three considerations to be had regarding falls prevention. These are intrinsic factors (those that come from within such as acute illness etc), extrinsic factors (environmental factors etc.) and behavioural factors (alcohol intake or ill-fitting footwear perhaps).
Dignity and respect has been handled by Dorothy Spencer CCEd. She focuses on an acronym named FREDA, which is not referring to the peanuts character but to Fairness, Respect, Equality, Dignity and Autonomy.
Implementing safer systems of work has been dealt with by Steve Kirkpatrick, who many of Nordic Care Services customers will know as their key accounts manager, but who fewer may realise also holds a moving and handling instructors certificate.
In this section Steve discusses the requirements to gaining the various National Health Service Litigation Authority (NHSLA) levels. NHSLA is a system of work designed to bring down the cost of insurance premiums within the NHS. However, this same system could be applied for non-NHS organisations when negotiating their premiums with insurance companies.
The part of the programme dealing with younger or inexperienced members of staff analyses the playground attitude that one is exposed to when growing up. The ‘fat’ child is often the focus of bullying and other forms of abuse. Even those who don't get directly involved may be just as culpable by failing to intervene on behalf of the victim. This section asks all to consider their opinion of the plus size person and find ways of advocating for their FREDA.
The final mini-lecture looks at multi-disciplinary preparation. This refers to the need to include as many agencies as you see possible, ranging from the family to the fire department. It is essential that the fire department, for instance, are aware of a potential difficulty when attending an emergency. They will assist you in taking into account evacuation procedures during such an event.
The workshops
As previously mentioned, the mini lectures were separated by workshops which the groups of delegates were to attend in turn.
One of these workshops was handled by Nordic Care Services (NCS). They were given the problem of how to gain access for personal hygiene on a bed-bound bariatric client. The delegates confirmed that a regular practice is for the carers to role a person onto their side. One will then hold the bariatric client in place while the other attends to personal hygiene. Obviously, this puts the person steadying the client at an increased postural risk. The client is aware of this and so they face embarrassment as well as a lowered self-esteem. Their solution is with the aid of their twin sheet. This device hooks up to any standard hoist (overhead or mobile), which they then use to turn and hold the client in position. The lower half of the sheet separates to allow full access for cleaning. The complete procedure can often be accomplished by just one carer without assistance from the client depending upon their individual risk assessment.
Evacuation solutions have been handled by Spectrum Healthcare Ltd. This company has a history of advising and working alongside most of the UK fire departments, as well as many overseas. The problem they were given was evacuating a non-ambulant bariatric person down a staircase, which they did without any difficulty using their snappily titled Evac-Mat.
A similar problem in reverse was given to AAT (GB). They were asked to get a bariatric person into a house with several steps when the person cannot bend their knee due to flexibility issues. Again, their inventive solution was a chair that climbs stairs. This wonderful device enables an ambulance or care worker to ascend a flight of stairs with a bariatric client at the push of a button.
The lack of limb flexibility often means that bariatric people frequently cannot get themselves up from the floor. This problem was given to Mangar International who already have their Mangar ELK on every London ambulance and many other stations the world over. This ingenious device raises a person seated on the floor to a seated position high enough where they can then stand up and step away. It can also be used to raise a scoop stretcher to a more comfortable lifting height.
The rise of the private ambulance services has seen competition heating up regarding the services they offer. As a result, many are opting for bespoke bariatric ambulances. Two ambulance companies have been involved in showing off their enthusiasm to get involved in this market. They are, Medical Services (North East) Ltd and County Durham EMS. Each have ambulances which they use in their day-to-day handling of the plus-sized person. They are fitted with Megasus stretchers and other equipment which could be needed during a bariatric transfer. They are keen to point out their rapid 24-hour response times.
The problem of lateral supine transfers was given to CJ Medical, who used their Hoverjack/mat system (which can also be used for raising from the floor and evacuation) to tackle the issue. This inspired arrangement uses forced air to move a person in the same way that a hovercraft rides over obstacles. Very little effort is needed to transfer from one surface to another.
Typically (depending upon type) beds have a safe working load of about 170 kg (27 stone). Likewise hoists are often limited to 160 kg (25 stone). To accommodate higher capacities the design must change. Ist Call Mobility are an organisation who supply, both for rental and purchase, the largest selection of bariatric solutions in this regard. They brought along to each conference an example of an extra wide bed capable of going up to 400 kg (63 stone) and a hoist with a SWL of 454 kg (71 stone).
Fitting and selecting slings can be a tricky business when dealing with the variety of body shapes involved with bariatric care. To address this issue there have been two different companies involved in sling design. Spectra Care Group and the Osprey Sling Company have both been involved in explaining how to go about selecting the right sling for your client.
Summary
Some of the major conferences have a daily rate running into the hundreds of pounds. This figure excludes many who would like to keep their knowledge up to date with current best practice.
The result is that implementation of current best practice is delayed.
The aim of these conferences was to give a cost effective means of accessing current information and services for all. To this end, the cost to the sponsors was equivalent to the cost of hiring the premises and the lunch for the delegates, while the cost to the delegate was to be as affordable as possible. The price therefore was set at just £25 plus VAT per person.
The net result has been a series of fast-paced interactive events which have introduced up to many professional people from a variety of disciplines to bariatric moving and handling management.