NHS ill prepared to care for obese patients

The authors analysed patient safety incident data reported to the National Reporting and Learning System, which is run by the National Patient Safety Agency.

They looked for all incident reports relating to, or caused by, obesity over a period of three years from 2005 to 2008, to identify any common themes.

During the study period, some 555 patient safety incidents were reported, of which 389 related to obesity.

Of these, 148 incidents related to the assessment, diagnosis, or treatment of obesity.

These included 63 incidents associated with anaesthesia, such as difficulty ventilating a patient or securing their airway, and 27 incidents involving critical care, most of which were pressure sores. Surgical errors included haemorrhage, unintended damage to surrounding structures, and deep vein thrombosis.

The bulk of incidents (213) related to NHS infrastructure, of which one in three (33%) related to specially adapted equipment either not being available or normal equipment not working properly when used with obese patients.

Around one in five of these incidents (22%) were associated with theatre sessions, including inadequate peri-operative assessment and listing for locations where the staff or facilities were not equipped to deal with obese patients.

A further 7% (27)* related to staffing issues including inadequate numbers on hand to take care of an obese patient safely.

Overall, most of the incidents were classified as causing little or no harm (86%). But around one in 10 (12%) were classified as causing moderate harm. Four were classified as severe, and three were fatal.

"The majority of safety incidents associated with obesity were related to infrastructure, suggesting there is inadequate provision in place for the care of obese patients," the authors write. "While levels of harm were mostly low, the occurrence of incidents resulting in severe harm or death highlights the specific dangers associated with the care of the obese patient," they add.

"Further planning and development of operation policies is needed to ensure the safe delivery of healthcare to patients in the future," they conclude.

Provided by British Medical Journal