bariatric bed "too big"

[mltbsncen]

I have a concern/question... A morbidly obese patient presents to the ED, very uncomfortable on the ED stretchers, so a bariatric bed from med/surg floor is made available to accomodate this patient. Patient is admitted to ICU and the bariatric bed is too big to make it into an ICU room. IS this an ethical issue...how do they appropriately care for this patient. What route should I take to address it?

[iluvivt, BSN, RN]

The solution to this problem can be mutifactorial. You could find an ICU room that the bed does fit in. Many hospitals rent some of their equipment on as a needed basis or have contracts with such companies. The company can come in and assess the physical environment and the patient and select the bariatric bed that meets all needs or central supply can order what is needed. Call central and tell them what you need and they need to get it for you. In desperation you could keep the patient in a nursing areas such as ED or PACU that does have the space needed but of course, you would have to staff that around the clock. I would only suggest this as a temporary measure. It is also a standard of care issue. In order to provide the standard of care the patients needs a bed that fits their boy habitus. Working with the morbidly obese is very challenging and I am grateful we have bariatric commodes and beds and equipment now. That is not the way it used to be and I can think back at all the make shift measures I used to have to come up with to meet their needs. When my patients could not fit through the bathroom door I used to hunt down this one chair we had without arms..put a towel over the seat,place a bedpan on it and use that as a commode. Thank God that chair was wide and I stayed with them the entire time as well.

[SolaireSolstice, BSN, RN]

The bariatric beds we have can be "broken down" to fit through the doorways. They simply expand along each side. Was this an issue with the bed not being able to fit through the doorway, in which it was an issue of lack of equipment teaching? Or did the room not accomodate the bed? Which I cannot fathom how small the room must be to not fit a bariatric bed.

We had an issue once where the patient, on a bariatric bed, needed to go down in the bed for a procedure. We broke down the bed to fit through our doorway, but somehow, halfway through the doorway, the bed frame popped back wide and the bed was hoplessly stuck in the door frame, with the patient on the bed. Was a stupid hour long issue that had our superviser demanding maintenance to remove the doorframe. We ended up transferring the patient lengthways onto another bed, took the headboard off one and the footboard off the other. Took 7 of us. Once she was off it, it was easy to manipulate the bed to get it free. Reminded me of that puzzle of a truck stuck under an overpass and the little boy says to "let the air out of the tires".