Wheelchair Seating & Positioning Clinic Protocol

Transcription

1 heelchair ing & ositioning Clinic rotocol urpose: to provide a comprehensive screening of all resident s seating safety, comfort, and healthful positioning, while offering onsite solutions to routine (non skilled) problems and general cleaning, maintenance, & inventory of equipment. 1. Set up a meeting with key personnel to discuss program implementation. Include: administration, key nursing personnel, activities, maintenance, housekeeping, and therapy staff (OT, RM or RD) 2. Topics for discussion at initial meeting: a. Date, time, and location of clinic (large space such as dining area will be necessary.) Area with 2 doorways to promote flow into and out of the clinic without disrupting the line is preferred. b. Duties of various personnel (basic repairs-maintenance, w/c cleaninghousekeeping, transport-nursing, theme development & promotionactivities, prep & collection of positioning items to be issuedhousekeeping, inventory of supplies/wheelchairs-clerical staff.) c. rainstorm a fun theme for the event Suggestions: rodeo, circus, old west, 50s dance Activities can organize music, food, games, contests that correlate to the theme. Residents will be waiting in line to have their w/c cleaned, inspected by therapy etc. and these events help to pass the time. 3. eneral Requirements of the Clinic: Organize a schedule of bringing residents in shifts to the event. Assigned times help CNAs prepare. There should be a facility staff member assigned to just getting the w/c/gerichair/broda chair users to the clinic in a timely manner. lan on 3-5 minutes per resident per therapist. 1

2 Setting up for the clinic Set up the dining room (or whatever space you re using) with the following stations: Therapy check up station: you will need a table, rolling stools for each therapist, log sheets on clip boards to document clinic findings, communication forms, variety of extra seat cushions, extra footrests, backrests, supports, assorted wide foam Velcro and sticky back hook (for temporary solutions ie. feet falling off of footrests posteriorly,) and a roll of sherpa fabric. ait belts for standing patients when switching out cushions, a CNA assigned to help at the station, and a clerical person to inventory the w/c and seating equipment that belongs to the facility if desired is also helpful. Maintenance station should be set up with 1-2 maintenance staff prepared to adjust w/c brakes, footrests, armrests, etc. on site. Communication forms will be sent from the therapy station with the therapist stating what is needed. If there are larger problems such as upholstery repair needs, etc. then the maintenance department should follow up on them at a later time. Recommended supplies/replacement parts to order in advance of the clinic are: brake handle pads, brake extensions, upholstery patching material, solutions for slinging upholstery (plywood inserts cut to fit and/or anti-sling cushion bases Cleaning station will need general facility cleaning supplies that are safe to use with the resident seated in the chair. Housekeeping can wipe down the chair surfaces that are readily accessible and make note of chairs that need to be more thoroughly cleaned at a later time. Communication forms should be provided to housekeeping when soiled cushions are identified for follow up later. Activity Station (optional) can be set up with a game that relates to the theme. For example, with the rodeo theme there may be a staff member passing out bandanas when the resident enters the arena and a country western band playing music. The activity station may be a lasso or horseshoe game. Activities may also be responsible for advertising the event, creating/posting flyers, and coordinating the theme. 2

3 reparation Checklist for heelchair Clinic Date of Clinic: / / time: to Location: Task to be completed in advance of clinic date Staff Responsible Reserve Location Theme Development& promotion of event Activities (rodeo, circus, race day, etc.) ames, contests, snacks, music that correlate to Activities theme to engage residents while they wait in line Collection & preparation/cleaning of positioning Housekeeping items (footrests, cushions, un-used wheelchairs, laptrays, brake extenders,etc.) location to be stored: Inventory of items collected in advance of event Scheduling residents for clinic. Share this schedule with other clinic team members. Organizing staff for getting resident s up and transporting according to schedule. One C.NA. at therapy station day of event to stand residents. Communication to nursing staff re: event Signs for stations and flyers to advertise event Rehab Task to be completed on clinic day Staff responsible Therapy Station Rehab Rolling stools ait belts Velcro, foam padding, sherpa, etc. Collected inventory of w/c devices on cart Log sheets, communication forms, clip boards, pens Tape measure Maintenance Station Maintenance basic tools for minor repairs lubricant/oil Cleaning Station Housekeeping Notepad/pen Cleaning supplies Activity Station Activities

4 Time expectations: If well prepared, one therapist can see around 60 w/c residents in 3 hours. If there are 2 therapists assigned to the clinic, then expect to see 120 in 3 hours and so on. If using the dining room, the clinic will need to be set up around meal times OR a meal time activity incorporated into the clinic theme. Caseload development: e prepared to identify a significant number of residents that would benefit form some type of skilled seating intervention. A list based on priority needs may be necessary. Examples of patients that would benefit from skilled therapy are: those with reduced trunk stability leaning in chair to side or forward, patients sliding forward in w/c, patients who have skin issues and are not using the appropriate pressure relieving device, those with hemiplegic extremities or poorly positioned contractures, patients with frequent skin tears/injuries resulting from w/c use, patients who have had a functional decline and/or would benefit from cognitive assessment to determine potential for mobility and self care tasks, patients with feeding issues impacted by current seating and so on. asic adjustments to brakes or footrests, replacing a foam cushion with a similar cushion, replacing standard footrests with elevating footrests, etc. are not skilled tasks and can be done at the clinic or assigned to a facility staff member for follow up. (It helps to identify who this person will be in advance of the clinic, maintenance, an experienced CNA, etc.) Forms (use the attached or create your own.) heelchair clinic log Communication Forms Flyers Station identifiers lease contact Amie Martin at ext 262 if you have questions about starting this or a similar program in your facility! 3

5 ing and ositioning Clinic Communication Form Resident: Maintenance please repair/adjust: (seat armrest footrest) Footrest (left right) needs to be lowered needs to be raised needs replaced with elevating footrests needs replaced with standard footrests rakes (left right) need tightened need loosened Maintenance ork completed by: (initials) on / / Housekeeping please follow up on: Laundering cushion cover and/or deep cleaning cushion Deep cleaning this wheelchair or gerichair Housekeeping ork completed by: (initials) on / / 4

6 Special Considerations ressure Areas oor posture ind swept deformity Cushion choice based on braden score/risk level Hammocking seat upholstery Sliding Feet falling from footrests No footrests in a resident that is propelled by staff oor trunk support ack ain oor head control Upper extremity positioning Contractures Self propulsion ability depth width Ability to recline back or tilt in space Tolerance to be up in w/c Restraints and last reduction attempt 5

7 Type Special Inventory Items problem X=rake roblem X=ressure Relief roblem X=Footrest roblem Facility: Date of Clinic: / / Resident ing and ositioning Clinic Log Maintenance Requested X= Needs Deep Cleaning X= Therapy Evaluation Needed Skilled therapy needs ack ack ack ack ack ack ack ack ack ack rakes rakes rakes rakes rakes rakes rakes rakes rakes rakes Key: =wheelchair =erichair =roda =ower Chair XL=extra wide HH=hemi height R=reclining back AMartinOTR/LupdatedJune2009