Best Practices, Best Outcomes

The best-laid plans often go awry. The consequences are harsh if something were to go wrong in the midst of a bariatric operation. For that reason, bariatric nurses’ best-laid plans are always backed up by best practices.

Weight-loss surgeries present a myriad of challenges to patient and healthcare provider alike; as a result of the many challenges, a commitment to best practice guidelines is a crucial aspect to making sure nothing goes awry in, before or after the surgery.

“There is a very wide spectrum of challenges in weight-loss surgeries. Nurses have the physical challenge of using proper patient lifting. With that there are issues surrounding obstructed airways, perianesthesia complications, and proper pre-operational and postoperational education,” said Ann Mulligan, RN, of Newton-Wellesley Hospital in Newton, MA.

Mulligan is keenly aware of the progress surrounding bariatric surgery best practices. Working with other researchers, Mulligan co-authored a nursing journal article for Obesity Research on the topic of best practices for perioperative nursing care.


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A Growing Body of Research

People’s willingness to have bariatric surgery has steadily increased, and with that there has also been an increase in nursing journal articles on the topic.

“The articles available for nurses to review have increased dramatically in recent years. With the number of laparoscopic adjustable gastric band (Lap-Band) and bypass procedures increasing, the body of evidence-based research has also increased; there is certainly an increasing concern for bariatric surgery best practices,” said Mulligan.

Bariatric surgery best practices continue to codify as the number of bariatric surgeries increase. Though some guidelines change from year-to-year, certain pathways will always be considered best practices.


“Nearly all bariatric surgery best practices will require collaboration between all modalities involved. For instance, one will need to consult with pharmacists to prescribe medication based on actual weight not ideal weight,” said Mulligan.

Another standard in bariatric surgery best practices is attention to outpatient needs. Though the surgery lasts a short time, the postop care lasts a lifetime.

“Many best practice guidelines suggest outpatient care must be continued for at least 5 years after the surgery. In fact, some surgeons go as far as to say the healthcare provider and the patient are married for life after bariatric surgery,” said Mulligan.

Having spent years researching the progression of bariatric surgery best practices, Mulligan always delights in tangible advancements in bariatric nursing care.

“It is amazing how things have changed since we first performed our research. When we began, there was no way for nurses to demonstrate their proficiency as a bariatric nurse. Now, there is the nationally recognized distinction of being a certified bariatric nurse,” said Mulligan.

The certified bariatric nurse (CBN) is a certification offered by American Society for Metabolic and Bariatric Surgery. The CBN certification requires a nurse to demonstrate certain best practice proficiencies.

Building a Center on Best Practices

At Mount Auburn Hospital in Cambridge, MA, Lisa Luz, MSN, RN, CBN, is making good use of her bariatric nurse certification. Luz is guiding Mount Auburn’s Weight Management Center through the Bariatric Surgery Center of Excellence accreditation process.

“A commitment to best practices is a central part of being a bariatric center; before many insurance companies will recognize a bariatric center, it has to be recognized as a Bariatric Surgery Center of Excellence,” said Luz.

Much of the Luz’s time is spent proving the Weight Management Center’s adherence to best practice guidelines.

“We started the center last year and we are in the process of obtaining accreditation. Proving our commitment to best practices has played a large role in the accreditation process,” said Luz.

Relying on the work of prior researcher, Mount Auburn’s Weight Management Center has been able to utilize best practices from its inception.

“We are fortunate to be building this program from the ground up; other programs have already laid the groundwork. It is far easier to incorporate best practice guidelines into a new program than trying to work them into an existing one,” said Luz.

Proving Excellence through Best Practices

Nassau University Medical Center (NUMC) is a recent recipient of the Bariatric Surgery Center of Excellence distinction from the Surgical Review Corp.

“We just recently received our Bariatric Surgery Center of Excellence distinction. We applied through the fast-track process and it took roughly 6 months to complete,” said Nelka Ellis, RN, bariatric nurse at NUMC in East Meadow, NY.

Though NUMC did not have to make many changes to comply with bariatric surgery best practices, there was a requirement to prove best practice guidelines were being utilized.

“We had to prove we were following best-practice guidelines as part of the process of becoming a Center of Excellence. The best practice guidelines that we had to follow were set by the Surgical Review Corp.,” said Ellis.

As happens with an accreditation process, NUMC did have to make some minor alterations and process changes in order to meet compliancy.

“To prove all of our pathways were in accordance with best-practice guidelines we had to document all of our protocols. As one would imagine, this involved many hospital staff members, as well as the purchasing of some new equipment,” said Ellis.


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Benefits of Best Practices

The benefits of bariatric surgery best practices seem apparent; one would assume following best practices results in better patient outcomes. This is an accurate assumption, but it misses some fringe benefits of best practice compliancy.

“It’s rather obvious that incorporating best-practice techniques results in a better level of care; what is less obvious is how these evidence-based techniques can be used to remove some of the stigmas that surround bariatric surgery,” said Luz.

Best practices are based on stigma-busting evidence. And best practices lead to fully accredited surgery centers.

“Medicaid will only interface with Center of Excellence facilities. Prior to receiving our distinction we had patients waiting for months to have the surgery. Through our commitment to best practices we can provide this life-changing operation to the people in our community,” said Ellis.

With so many positive outcomes, it seems any best-laid plan would incorporate best practices.

A. Trevor Sutton is a frequent contributor to ADVANCE.

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