Using a Portable Bed Scale

Skill 3-2

Using a Portable Bed Scale

Obtaining a patient's weight is an important component of assessment. In addition to providing baseline information of the patient's overall status, weight is a valuable indicator of nutritional status and fluid balance. Changes in a patient's weight can provide clues to underlying problems, such as nutritional deficiencies or fluid excess or deficiency, or it can indicate the development of new problems, such as fluid overload.

Typically, the nurse will measure weight by having the patient stand on an upright scale. However, doing so requires that the patient is mobile and can maintain their balance. Chair scales are available for patients who are unable to stand. For patients who are confined to the bed, have limited mobility, or cannot maintain a balanced upright or standing position for a short period of time, a bed scale can be used. With a bed scale, the nurse places the patient in a sling and raises the patient above the bed. To ensure safety, a second nurse should be on hand to assist with weighing the patient. Many facilities provide beds with built-in scales. The following procedure explains how to weigh the patient with a portable bed scale.

Delegation Considerations

Measurement of body weight may be delegated to assistive personnel (AP) as well as to licensed practical/vocational nurses (LPN/LVNs). The decision to delegate must be based on careful analysis of the patient's needs and circumstances as well as the qualifications of the person to whom the task is being delegated. Refer to the Delegation Guidelines in Appendix A.

Equipment

Bed scale with sling
Cover for sling
Sheet or bath blanket
PPE, as indicated

Assessment

Assess the patient's ability to stand for a weight measurement. If the patient cannot stand, assess the patient's ability to sit in a chair or to lie still for a weight measurement. Assess the patient for pain. If necessary, give medication for pain or sedation before placing the patient on a bed scale. Assess for the presence of any material, such as tubes, drains, or (intravenous) IV tubing, which could become entangled in the scale or pulled during the weighing procedure.

Actual or Potential Health Problems and Needs

Many actual or potential health problems or needs may require the use of this skill as part of related interventions. An appropriate health problem or need may include:

Impaired Mobility
Impaired Nutritional Status
Overweight

Outcome Identification and Planning

The expected outcomes to achieve when weighing a patient using a portable bed scale are that the patient's weight is measured accurately without injury to the patient, and the patient experiences minimal discomfort. Other outcomes may be appropriate, depending on the specific diagnosis or patient problem identified for the patient.

Implementation

Action	Rationale
1. Check the prescribed interventions or plan of care for frequency of weight measurement. More frequent measurement of the patient's weight may be appropriate based on nursing judgment. Obtain the assistance of a second caregiver, based on the patient's mobility and ability to cooperate with the procedure.	This provides for patient safety and appropriate care.
2. Perform hand hygiene and put on PPE, if indicated.	Hand hygiene and PPE prevent the spread of microorganisms. PPE is required based on transmission precautions.
3. Identify the patient.	Identifying the patient ensures that the right patient receives the intervention and helps prevent errors.
4. Close the curtains around the bed and close the door to the room if possible. Discuss the procedure with the patient and assess the patient's ability to assist with the procedure.	This ensures the patient's privacy. Explanation relieves anxiety and facilitates cooperation.
5. Place a cover over the sling of the bed scale.	Using a cover deters the spread of microorganisms.
6. Attach the sling to the bed scale. Lay the sheet or bath blanket in the sling. Turn on the scale. Balance the scale so that weight reads 0.0.	Scale will add the sling, blanket, and cover into the weight unless it is zeroed with the sling, blanket, and cover.
7. Adjust the bed to a comfortable working position (VHACEOSH, 2016). Position one caregiver on each side of the bed, if two caregivers are present. Raise side rail on the opposite side of the bed from where the scale is located, if not already in place. Cover the patient with the sheet or bath blanket. Remove other covers and any pillows.	Having the bed at the proper height prevents back and muscle strain. Having one caregiver on each side of the bed provides for patient safety and appropriate care. Side rail assists patient with movement. Blanket maintains patient's dignity and provides warmth.
8. Turn the patient onto their side facing the side rail, keeping their body covered with the sheet or blanket. Remove the sling from the scale. Place the cover on the sling. Roll cover and sling lengthwise. Place rolled sling under the patient, making sure the patient is centered in the sling.	Rolling the patient onto their side facilitates placing the patient onto the sling. Blanket maintains patient's dignity and provides warmth.
9. Roll the patient back over the sling and onto the other side. Pull the sling through, as if placing sheet under patient, unrolling the sling as it is pulled through.	This facilitates placing the patient onto the sling.
10. Roll the scale over the bed so that the arms of the scale are directly over the patient. Spread the base of the scale. Lower the arms of the scale and place the arm hooks into the holes on the sling.	By spreading the base, you are giving the scale a wider base, thus preventing the scale from toppling over with the patient. Hooking sling to scale provides secure attachment to the scale and prevents injury.
11. Once the scale arms are hooked onto the sling, gradually elevate the sling so that the patient is lifted up off the bed (Figure 1). Assess all tubes and drains, making sure that none have tension placed on them as the scale is lifted. Once the sling is no longer touching the bed, ensure that nothing else is hanging onto the sling (e.g., ventilator or IV tubing). If any tubing is connected to the patient, raise it up so that it is not adding any weight to the patient.	The scale must be hanging free to obtain an accurate weight. Any tubing that is hanging off the scale will add weight to the patient.
12. Note the weight reading on the scale. Slowly and gently, lower the patient back onto the bed. Disconnect the scale arms from the sling. Close the base of the scale and pull it away from the bed.	Lowering the patient slowly does not alarm the patient. Closing the base of the scale facilitates moving the scale.
13. Raise the side rail. Turn the patient to the side rail. Roll the sling up against the patient's backside.	Raising the side rail is a safety measure.
14. Raise the other side rail. Roll the patient back over the sling and up facing the other side rail. Remove the sling from the bed. Remove gloves, if used. Raise the remaining side rail. Perform hand hygiene.	The patient needs to be removed from the sling before it can be removed from the bed. Hand hygiene deters the spread of microorganisms.
15. Cover the patient and help them to a position of comfort. Place the bed in the lowest position.	Ensures patient comfort and safety.
16. Remove the disposable cover from the sling and discard in the appropriate receptacle.	Using a cover deters the spread of microorganisms.
17. Remove additional PPE, if used. Clean equipment based on facility policy. Perform hand hygiene.	Proper removal of PPE reduces the risk for infection transmission and contamination of other items. Cleaning equipment prevents transmission of microorganisms. Hand hygiene deters the spread of microorganisms.
18. Replace the scale and sling in the appropriate spot. Plug the scale into the electrical outlet.	Scale should be ready for use at any time.

Evaluation

The expected outcome has been met when the patient has been weighed accurately without injury, and the patient has experienced minimal discomfort.

Documentation

Guidelines

Document weight, unit of measurement, and scale used.

Sample Documentation

Developing Clinical Reasoning and Clinical Judgment

Unexpected Situations and Associated Interventions

As the patient is being lifted, the scale begins to tip over: Stop lifting the patient. Slowly lower the patient back to the bed. Ensure that the base of the scale is spread wide enough before attempting to weigh the patient.
Weight differs from the previous day's weight by more than 1 kg: Weigh the patient using the same scale at the same time each day. Check scale calibration. Make sure that the patient is wearing the same clothing. Make sure that no tubes or containers are hanging on the scale. If the patient is incontinent, make sure undergarments are clean and dry.
Patient becomes agitated as the sling is raised into the air: Stop lifting the patient and reassure them. If the patient continues to be agitated, lower them back to the bed. Reevaluate necessity of obtaining weight at that exact time.

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Skill 3-2