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Class III Obese Patients Experience Adverse Events More Frequently Than the General Adverse Event Patient Population

HARRISBURG, Pa., March 4, 2013 /PRNewswire-USNewswire/ -- Class III obese patients are more likely than a patient in the general adverse event population to experience a harmful adverse event, according to information in the Pennsylvania Patient Safety Authority's March Pennsylvania Patient Safety Advisory released today.

The Authority analyzed 1,774 events submitted by Pennsylvania healthcare facilities over a five-year period in which class III obese patients were involved in a Serious Event (an event that caused harm to the patient). Serious Events accounted for 24% of the total number of reports submitted involving a class III obese patient. In comparison, the general adverse event patient population experiences a Serious Event in less than four percent of the time.

"Class III obese patients require special equipment that is big enough and strong enough to support them safely while they are in the care of others," Lea Anne Gardner , Ph.D., RN, senior patient safety analyst for the Pennsylvania Patient Safety Authority said. "Our analysis shows these patients experience equipment failures, treatment delays, and an overall higher risk of harm in the healthcare setting."

A further review of the Pennsylvania healthcare events identified 180 (10%) equipment-use event reports involving class III obese patients. In comparison, the general adverse event patient population equipment-related reports accounted for 0.8% of all adverse event reports in 2011. In July 2012, the Authority completed a statewide survey of Pennsylvania hospitals to determine how prepared they were to care for the class III obese patient population.

"Results from the Authority survey showed that thirty-six percent of respondents said that their hospital does not have an evacuation plan in place for moving class III obese patients to a safe location during an emergency," Gardner said. "We also found that more hospitals rent versus own equipment specifically made for class III obese patients. This may explain why, in some of the reports, patients had delays in treatment or equipment was not available."

Class III obese patients are identified as having a body mass index (BMI) greater than 40 or weighing at least 100 pounds more than their ideal body weight. From 2000 to 2005, the prevalence of individuals reporting a BMI greater than 40 increased by 50% and the prevalence of individuals reporting a BMI greater than 50 increased by 75%.

"Not all obese patients require special care and equipment, but class III obese patients have different needs," Gardner said. "Healthcare facilities need to be prepared to provide safe general medical care to class III obese patients whose size surpasses the capacity of present equipment.

"Class III obese patients should also know what kind of equipment a facility has available to meet their healthcare needs," Gardner added.

The Authority offers facilities guidance as to how they can provide safe care for class III obese patients that includes addressing patient equipment needs, staff education and sensitivity training, and structural considerations.

"There are several steps healthcare facilities can take to increase the safety of obese patients and staff caring for them," Gardner said. "Some of these steps are as simple as making sure class III obese patients have identification wristbands that are long enough to fit properly.

"Others may require more thought, such as where to place these patients if they need to be transferred to another unit quickly, but as the numbers of class III obese patients increase, the issue of delivering safe care to this patient population must be addressed," Gardner added.

For more information about the class III obesity preparedness survey, go to the March Pennsylvania Patient Safety Advisory article "Class III Obese Patients: Is Your Hospital Equipped to Address Their Needs?" on the Authority's website at An educational toolkit and consumer tips are also available with this article.

The Authority's March 2013 Advisory contains other clinical articles with toolkits and consumer tips for the healthcare provider to improve patient safety. Highlights include the following:

  • Distractions and Their Impact on Patient Safety: High levels of distraction in healthcare settings pose a constant threat to patient safety. New technologies have increased the number and types of distractions in these settings. The Pennsylvania Patient Safety Authority identified 1,015 reports that could be attributed to distraction. The majority of these events were classified as medication errors (59.6%) or errors related to procedures, treatments or tests (27.8%). Nearly all events were reported as Incidents or near misses. Forty reports specifically mention distractions from phones, computers or other technologic devices contributing to errors. Thirteen Serious Events were reported among the 1,015 events. This article examines the broader issue of distractions that cause medical errors and outlines strategies for healthcare facilities to decrease the potential for distraction and harm. Consumer tips are also available with this article, along with self-assessment questions.
  • Results of the Opioid Knowledge Assessment from the PA Hospital Engagement Network Adverse Drug Event Collaboration: As part of the Pennsylvania Hospital Engagement  Network adverse drug event collaboration sponsored by the Centers for Medicare and Medicaid Services, an 11-question opioid knowledge assessment tool for participating hospitals was developed to assess their practitioners' current knowledge about the use of opioids. More than 1,700 individual practitioners completed the assessment. The lowest-scoring questions encompassed topics identifying the predictors of respiratory depression in patients receiving intravenous opioids, defining what constitutes an opioid-tolerant patient, and choosing medications that could influence the effects of an opioid with respect to a patient's ventilation. Strategies that organizations may consider to improve education and to reduce medication errors associated with opioid use are included in this article, along with an educational toolkit.
  • Healthcare Outbreaks-Risk Assessment and Mitigation Based on Pathogen, Population and Environmental Factors: The P2E Concept: In 2009, Pennsylvania experienced one of the largest and most prolonged outbreaks of invasive group A streptococcus (GAS) within a nursing facility to date. The only known reservoirs for GAS in nature are the skin and mucous membranes of the human host. Therefore, one of the highest-risk patient populations is those who have nonintact skin. This article includes a novel framework describing proactive outbreak prevention based on pathogen, population and environment (P2E) risk assessment. Pennsylvania GAS outbreak facts are used as an example, and the framework is expanded to include carbapenem-resistant Enterobacteriaceae, demonstrating the framework's applicability to a multitude of outbreak scenarios.
  • Quarterly Update: What Body Parts and Procedures Are Associated with Wrong-Site Surgery?: This wrong-site surgery update discusses the lowest number of wrong-site surgeries (6) per quarter to date since reporting to the Authority began in mid-2004. Analysis of these events is provided, as well as an overview of the Authority's wrong-site surgery prevention project. Several educational resources are available in a toolkit for preventing wrong-site surgery on the Authority's website. Consumer tips for wrong-site surgery are also available.

For the complete 2013 March Pennsylvania Patient Safety Advisory, go to

SOURCE Pennsylvania Patient Safety Authority
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