by Jessica Flanary, RN, BA, BSN, CBN
About the Author
Jessica Flanary is a certified bariatric nurse (CBN) and serves as the Director of Bariatric Services at Turkey Creek Medical Center. Flanary completed her BA in English/Education from King College in 2002 and her BS in Nursing from King College in 2006. She has worked with the bariatric surgery patient population for the past seven years. Flanary is a member of the Obesity Action Coalition as well as the American Society for Metabolic and Bariatric Surgery. Ms. Flanary also moderates the hospital-based support groups and writes and circulates the monthly Bariatric Bulletin newsletter and Support Group Bulletin.
Bariatric Times. 2012;10(4):32–33
FUNDING: No funding was provided.
DISCLOSURES: The author reports no conflicts of interest relevant to the content of this article.
Welcome to the Tennova Center for Surgical Weight Loss at Turkey Creek Medical Center
Located in East Tennessee, Tennova Healthcare operates six acute-care hospitals and many other healthcare facilities across the region. More than 1,000 of the area’s physicians are on active staff at Tennova facilities. One of East Tennessee’s largest employers, Tennova has more than 5,000 associates dedicated to providing compassionate care using the latest medical technology.
The Tennova Center for Surgical Weight Loss works in partnership with Dr. Stephen Boyce and Dr. Keary Robert Williams and the New Life Center for Bariatric Surgery located in Knoxville, Tennessee. The Tennova Center is the newest comprehensive surgical weight loss program in the region. The program is designed to help patients who are unable to sustain significant weight loss, have weight-related medical issues, and are ready to make life changes to become healthier.
Given the growing population of individuals in East Tennessee with morbid obesity and comorbid conditions, such as high blood pressure, diabetes, sleep apnea, and high cholesterol, it became evident that a top-notch bariatric surgical program was crucial. In 2012, Health Management Associates (HMA) invested $1.4 million in capital to create a dedicated bariatric surgery unit on the fourth floor of Turkey Creek Medical Center. A dedicated unit and staff was imperative to ensuring safety and high-quality patient care.
We currently have 10 licensed staff (8 registered nurses and 2 licensed practical nurses), one care partner, and two unit clerks. The director, RN, LPN, care partner, and unit clerk work together as a team to provide coordination of patient care. Surgery-specific care plans, order sets, protocols, and discharge education are implemented to ensure continuity of care from admission to discharge.
The rooms in the new Tennova Center for Surgical Weight Loss are larger than the average patient hospital room and are aesthetically pleasing. Each bariatric suite is equipped with specialty furniture to provide safe and comfortable accommodations for the bariatric surgical patient. Each suite has an in-room refrigerator, flat-screen television, and a state-of-the-art bathroom designed with comfort and safety in mind. Family members and/or support persons have a separate seating and sleeping area as well.
The dedicated bariatric suites on the Tennova Center for Surgical Weight Loss have floor-mounted, wide-based toilets with additional floor support and height. All public toilets throughout the facility are braced for extra support. A steel-supported 800lb capacity shower bench chair with additional steel wall reinforcement is located in each patient bathroom. All showers are extra large in capacity and have a wheelchair-accessible entrance to allow those patients in need of handicap accommodations to use all facilities. Bariatric wheelchairs, walkers, bedside commodes, scales, lifts, benches, and stretchers are located on the bariatric unit as well as throughout the facility.
According to Bariatric Medical Director Dr. Stephen Boyce, one of the highlights of the new center is the addition of an in-room bariatric lift, capable of supporting up to 1,100lbs. This lift can be used for safe ambulation and rehabilitation of the postoperative surgical patient.
“Everything in the new unit is designed to give the patient and family members the best possible clinical care,” Boyce said.
Other amenities include complimentary Tennova Center for Surgical Weight Loss protein tumblers, Tennova Center for Surgical Weight Loss toiletry kits, and a personalized Tennova green ink pen to record oral intake.
The bariatric program moved facilities in March 2012. Since the move to Turkey Creek Medical Center, Drs. Stephen Boyce and Keary Robert Williams have completed almost 400 bariatric surgeries at the new facility to date. Annual volumes for 2013 are anticipated at 500 surgeries or more. Collectively, Drs. Boyce and Williams have performed over 3,000 bariatric surgeries.
An Accredited Center
The Tennova Center for Surgical Weight Loss at Turkey Creek Medical Center has been accredited as a Level 1 facility by the Bariatric Surgery Center Network (BSCN) Accreditation Program of the American College of Surgeons (ACS) since January 2013.
The office practice was originally designated as a Center of Excellence by the American Society for Metabolic and Bariatric Surgery (ASMBS) back in 2005. The New Life Center for Bariatric Surgery was the seventh center in the country to receive this designation.
Patient Adherence and Long-term Follow Up
In addition to routine post-surgical follow up and dietary progression, patients are seen annually in the office practice by a certified bariatric nurse coordinator, registered dietitian, and exercise physiologist for counseling and are referred back to the bariatric surgeon either by patient request or observations by the provider. Patients are also encouraged to continue lifelong monthly attendance to one of the hospital-facilitated support groups.
The ability to permanently modify one’s lifestyle is the primary obstacle for success after weight loss surgery. We strongly encourage our patients to attend monthly bariatric support groups and adherence to office follow-up appointments, which can help decrease the risk of falling back into old habits.
Managing Patient Care
All bariatric surgery patients are treated with dignity and respect while under the care of the healthcare providers on the Tennova Center for Surgical Weight Loss. Patients and support persons are given surgery specific plans of care that outline mutual expectations of the patient and staff during the hospital stay. This includes ambulation and dietary requirements and criteria for discharge. An in-room communication board tailored for bariatric surgery patients is updated each shift by the bariatric team. This ensures each patient is involved in the plan of care and promotes maximum communication between caregivers and patients. All bariatric team members attend annual Health Insurance Portability and Accountability Act (HIPAA) compliance training and receive annual bariatric sensitivity training.
All prospective patients are enrolled by the New Life Center for Bariatric Surgery for an initial informational seminar either in person or online. This seminar includes information about the disease process, surgical alternatives, anesthesia, risks of surgery, and the patient’s responsibilities throughout the surgical pathways. Written recommendations from the patient’s primary physician, a written medical history, and a detailed diet history are also required. All patients undergo an initial consultation with the bariatric surgeon to evaluate surgical appropriateness, including indications and contraindications. The surgeon evaluates the patient’s health status and comorbid conditions for a risk-versus-benefit analysis, including the assessment and discussion of surgical risks.
All bariatric unit team members complete new hire and annual training on proper body mechanics and safe patient handling through the assistance of the physical therapy department as well as the lift representative. In addition to the in-room lift, an air lateral transfer device and a portable lift are available for staff use to maximize both patient and employee safety.
All dedicated bariatric unit team members complete an orientation to all preoperative patient educational opportunities, including the pre-operative office diet class, and seminar/support group attendance. All bariatric staff also complete a comprehensive surgical observation following a patient pre-op, intra-op, and post-op. Initial new hire and annual job-specific bariatric inservices and competencies for all staff on the bariatric unit, emergency department, and radiology/imaging department are conducted. Annual bariatric sensitivity training is completed for all hospital employees.
The Bariatric Bulletin newsletter is circulated monthly to all hospital and office practice staff by the Director of Bariatric Services. The newsletter includes updates and reminders, tips for recognizing complications, and instructions on managing bariatric surgery patients.
A Unique Facility
Our bariatric unit is a speciality floor dedicated to the care of the postoperative weight loss surgery patient. I have employed two of our previous weight loss surgery patients as registered nurses. With a background in critical care, I feel that these nurses bring a heightened level of empathy and compassion to our patients. This understanding of the bariatric surgery process has made them advocates in the community as well as ambassadors in our support groups.
For more information about Turkey Creek Medical Center, visit www.tennova.com. For more information about the Tennova Center for Surgical Weight Loss, visit www.tennovaweightloss.com.
Patient rooms, Bariatric Medical Director Dr. Stephen Boyce and Director of Bariatric Services
Jessica Flanary pose for a picture at the new facility, Pictured here are Dr. K. Robert Williams, Jessica Flanary, and Dr. Stephen Boyce at the community open house in March 2013.