Weighing wheelchair-bound, bedbound and bariatric clients
Monitoring a client’s weight regularly (eg. monthly) after a catastrophic injury is essential. Clients are often discharged from hospital and rehabilitation settings weighing significantly less than their “pre-injury” weight. This is due to drastic changes to muscle mass (as a result of inflammation and immobility), clients often not liking institutional food and/or frequent periods of being “nil by mouth” in hospital prior to surgeries and procedures. After discharge, however, weight tends to go one of two ways — clients either struggle to regain the weight they lost or they gain significant amounts of weight and end up becoming overweight or obese.
Catching problems early is the key — but clients will need to be weighed regularly in order to accomplish this.
Why monitor weight?
If someone unintentionally LOSES 10% of their body weight within a span of 3-6 months, that puts them at extremely high risk of malnutrition — this most definitely warrants a referral to a dietitian (NHS or private).1 This is outlined in the Malnutrition Universal Screening Tool, which is a recommended part of every case manager’s initial needs assessment and ties in nicely if you are doing the Waterloo score (to assess pressure ulcer risk). Similarly, I would suggest that if someone unintentionally GAINS 10% of their body weight within a similar period, this also justifies a referral to a dietitian, as it flags up issues with the client’s current routines and eating habits. If a dietitian can intervene early, before habits and routines become too embedded, it can be significantly easier for clients, families and staff to make the required changes. As you can imagine, it is significantly faster and easier to help someone lose one stone in weight versus 4-5 stone. Many clients really struggle to come to terms with the fact that they simply cannot eat the same quantity of food that they did before the accident without gaining weight. This is because they will usually have a much lower metabolic rate (meaning they burn fewer calories) as a consequence of their reduced muscle mass.
In terms of weight monitoring, stand-on scales are easy to come by and most mobile clients under 150kg will often be weighed at hospital appointments and in GP surgeries. Clients can also buy these scales with very little expense. In contrast, the most vulnerable clients who are unable to stand, very rarely get weighed. GP surgeries generally don’t have appropriate scales and while hospitals are all supposed to be weighing clients at every admission, the reality is that this very rarely gets done (even when the clients request it). That means clients can go YEARS without anyone monitoring their weight. And if the weight creeps up or down little by little, it is impossible to catch problems early.
Here are the top 5 options for weighing wheelchair-bound, bedbound and/or bariatric clients:
1. Check with local physiotherapy and/or prosthetic clinics.
Some physiotherapy and/or prosthetic clinics have wheelchair scales available to help clients monitor their weight. If clients are travelling to these clinics anyways to receive other forms of rehabilitation therapy, this can be a quick and cost effective way to get the weight information you need.
2. Order hoists & beds with integrated scales
Since you are likely purchasing or hiring new equipment for these clients anyways, whenever possible, ask the Occupational Therapist to try and order hoists and beds which come with integrated scales. Just make sure to check that the scale component can be calibrated every 12 months (at a minimum) when the hoist or bed is serviced. While external hoist scales do exist, these are only compatible with the coat-hanger style spreader bars which are becoming much less common. Also, because an external scale hangs under the spreader bar, there are often issues with hoisting the client high enough (or lowering the bed low enough), to suspend the client completely off of the bed to get an accurate reading. A hoist or bed with an integrated scale is the preferred option, because it gets around all of these issues.
3. Have clients purchase their own wheelchair scale
If clients are expected to be in a wheelchair long-term, purchasing their own wheelchair scale can be a good investment. There are a few brands which can be tipped on their side and stored up against the wall to keep them out of the way. Here are the two least expensive options.
Note: several companies will sell these specific models so be sure to shop around to get the best price.
Be aware that these scales currently have a 300kg weight limit (which includes the weight of the wheelchair). That means electric wheelchairs are generally too heavy and clients will need to transfer to a manual wheelchair or shower chair in order to be weighed.
I do NOT recommend the wheelchair weigh beam scales, for a number of reasons: 1) because it is incredibly difficult to line up the beams with the front and back wheels on the client’s wheelchair, 2) the wheels on electric wheelchairs are generally not compatible and 3) the beams are not wide enough for the front wheels to turn if you want to reverse the client off the scale. I’ve also experienced issues with weight accuracy depending on where the wheelchair is positioned on the beams.
4. Utilise a patient weighing service
If clients only need a one-off weight for a report or irregular monitoring (because their weight is fairly stable), then you may want to look into the Benmor Medical Patient weighing service. They have reps nation-wide, and will send someone out to weigh the client using a bed weigher or wheelchair scale (including bariatric clients). The cost as of June 2020 is £160 +VAT per weighing (which includes travel). I’ve only discovered them this month and definitely plan to use their services a lot more in the future! To use their bed weigher, clients need to have a bed with single-caster wheels. You either need to know the make and model of the bed and mattress (so this weight can be deducted) or you need to have a way to lift the client off the bed in order to obtain the weight of the bed + mattress separately. They need at least one other person present (preferably a health professional) to assist with rolling the client onto the scale.
5. Options for bariatric clients
While bariatric clients are able to use any of the options listed above (depending on the weight of the client), sometimes they need a scale with a higher weight limit (over 300kg) and/or require a scale with a slightly wider base of support to help with balance (but they don’t always need something as big as a wheelchair scale). Here are my top recommendations:
- Marsden M-530 (500kg weight limit)
- Seca 635 (300kg weight limit but clients can stand, use their zimmer frame or place a chair on the scale)
Of course other types of scales exist, but these options tend to be much less commonly used – there are chair scales (where clients can be transferred into a chair), platform scales (where clients can be weighed laying on a trolley), Patient Transfer Scales (where clients are weighed on a transfer board as they transfer between beds) and bed weighing scales (which go under the wheels of the bed). Contact me to discuss which scale may be most suitable for your client or check out Seca and Marsden to see all of the options available.
If you are collecting weight data, then make sure the care team are using this information and acting on it appropriately. For training staff on how to weigh patients and interpret the results, or if you want to refer a client who has unintentionally gained or lost 10% of their body weight, please contact Specialist Nutrition Rehab on 0121 384 7087 or firstname.lastname@example.org.