Design for Bariatric Care
Khang Nguyen 6 Feb 13
•
According to the Johns Hopkins Bloomberg School of Public Health, more than 40 % of U.S. adults will be categorized as obese by the year 2015.
index Goals Design Solutions Building entries Elevators Patient rooms Toilet rooms Treatment and procedure rooms Waiting areas Public, Outpatient & Emergency Areas
Design’s Goals
“ “ •
•
From a Patient's Perspective As a larger person, you notice things like seats. A lot of thought went into their design. During the pretesting and registration at the admittance desk, I remember thinking, ‘I actually fit in this chair and am comfortable.
”
It's nice to be able to talk with people who are experiencing the same thing you are.
”
Designing for dignity Strategies for accommodating obese patients By Kevin Crook, AIA
Design’s Goals • Sensitivity and respect
“
Obese patients are often fearful that new environments will not have the appropriate equipment to meet their needs. Amanda R. Budak Medical University of South Carolina.
• Comfortable
”
Design’s solutions
Building entries 1. need to be designed with comfortable ramps with handrails and 3’2� minimum door widths. 2. Create some space for amplesized wheelchairs at the front doors. 3. Standards for obese patients exceed the requirements for the disabled.
Elevators
•
Elevator doors have a minimum width of 54” to 60”.
•
Because the growing trend is to transport obese patients in their own beds, a 6,000- to 6,500-pound capacity elevator is needed to provide sufficient space for a 40”x90” bed. These elevators can hold the obese patient, bed, equipment and two staff members.
Patient rooms •
• •
Area: Bariatric rooms should be designed with 100 additional sqr ft. Expect about 270sf or more. Because obese patients often have obese family members, the family accommodations need to be geared toward the obese as well. A 5’ wide entry door is required for movement of the bed and other equipment. Clearance around the bed should be 5’ around the sides and foot of the bed. This provides the space for movement of portable lifts, oversize wheelchairs, commodes and stretchers.
Patient rooms
• •
•
•
•
Bed dimensions are up to 60”x98”. Portable floor, sitting to standing lifts and/or ceiling mounted lifts must be provided. The ceiling mounts are easier on the staff but are expensive and can limit the attractiveness of the room for use by non-Bariatric patients. Precise temperature control is desired as obese patients are hypersensitive. Nursing unit corridors will be used for ambulation exercise. The scale for weighing of patients should be unobtrusive and floor mounted, with grab bars provided. Storage space for these large equipment items must be reserved on the floor, or be readily available when needed.
Patient rooms This patient room features a ceiling-mounted patient lift system, with its track running from the patient’s bed to the toilet room.
LEFT This patient room floor plan features a ceiling lift track extending from the bed to the toilet room. RIGHT Aluminum rails that accommodate a patient lift are visible in this in-progress view of St. Vincent Seton Specialty Hospital, Indianapolis.
Toilet rooms •Door width : 3 ft 6” •Clearance of the fixture to the rear wall must be increased to at least 8”. •Clearance for staff assistance at each side of the fixture is at least 24” - 33”. • Space should permit a commode chair to turn 360 degrees, requiring a 5’ circle. •Access for either a portable lift or a ceiling mounted lift must be planned. •The doorway into the toilet space should be 60”wide.
•
Higher floor-mounted toilets.
•
A 6’ turning radius.
•
Grab bars and toilet paper dispenser should be accessible from the front of the toilet.
• •
A floor-mounted bidet should be included. Should be placed toward the center of the wall to allow room on each side of the commode for 2 caregivers.
•
Toilet walls should have extra-strength blocking to support grab bars (to support 500-800 pounds), as well as sinks that are capable of supporting the additional weight.
Toilet rooms
LEFT A bathroom with a double-leaf door provides easy access for patients. RIGHT This fixture is ceramic-tested to handle 2,000pound loads and was part of an inpatient unit renovation at the Tucson Medical Center in Arizona.
Shower Stalls in Patient Toilets • • •
•
• •
Stalls must be oversized and without a curb. At least 4’ x 5’. Some experts suggest that the entire toilet space be used for showering. But this requires greater housekeeping and may compromise safety. A hand held shower head should be provided and placed with controls where the staff can reach it. Removable showerheads with flexible hoses, which are ideal for bariatric showers. Access by a shower stretcher may best be achieved in a central shower facility where space on three sides can be provided.
Treatment & procedure rooms Doors need to be sized for movement of the wider bariatric beds and/or wheelchairs. Bariatric beds are about 40” wide with the sidebars down. A power-assisted bariatric bed is 9’ long, and a 700-pound capacity wheelchair has an overall width of 38.5”.
In areas where these oversized wheelchairs are to be used, a 72” turning radius is recommended. Examination room doors are recommended to be 3’6” wide, and the recommended opening size for patient rooms and procedure areas is 4’. Alternatively, paired doors or sliding doors on overhead tracks can be used for these wider doorways.
Waiting areas Care should be taken to avoid creating “obese-only� sections in general waiting areas. Loveseats can be a discreet way to mix this furniture with the standard waiting room furniture.
Public, Outpatient & Emergency Areas • • •
Doorways to consider include exam rooms, dressing rooms, interview offices, toilet spaces, etc. Seating in waiting areas, cafeterias… should be capable of 500 - 800 lbs. Loveseats, benches should be dispersed, not clustered.
Reference Designing for dignity Strategies for accommodating obese patients By Kevin Crook, AIA Basic Concerns in Bariatics March 1, 2007 by KATHRYN M. PELCZARSKI Bariatric considerations in healthcare design By David H. Kaufman
• Thanks for your precious time!