Preventing perioperative complications in the patient with a high body mass index

Patients with a high body mass index (BMI) are being seen more frequently in perioperative settings, and staff members must be prepared to prevent complications (eg, difficult intubation, respiratory insufficiency, positioning injuries) that occur in this patient population as a result of comorbidities. After two sentinel events occurred during a six-month period at a community hospital in northern California, a task force was created to examine issues related to the care of patients who are morbidly obese and to develop and implement policies and procedures to reduce the risk of adverse patient outcomes. Chart audit results confirm that the quality improvement project was successful; 92% of 50 charts showed inclusion of the BMI on the surgery schedule, and 94% showed inclusion of the BMI on the preoperative checklist. No positioning incidents or intubation emergencies have occurred in patients with a high BMI since January 1, 2009.