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Q:“Are Broda’sTilt-in-Space chairs or wheelchairs considered restraints?”

 

A: NO, they are not restraints rather they are Supportive Positioning Devices.
When Broda’s Tilt-in-Space Seating Systems are used properly following the obtainment of a physician’s order and in accordance with the patient care plan they are not considered a restraint.

 

Let us explain, by definition “A restraint is any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely” (CFR 482.13(e)(1)).¹ However, 482.13(e)(1)(i)(C) clarifies that “a restraint does not include devices, such as orthopedically prescribed devices…” (typically used for medical-surgical care). As such, this definition does not apply to wheelchairs, seating systems, and secondary supports when used to provide postural support, stability, pressure distribution and pressure relief, as opposed to intentionally immobilizing or reducing movement. The movement may be limited by this seating technology; however, the intent is postural support, stability, pressure distribution and pressure relief for improved function, not a limitation of movement.

According to RESNA², “The purpose of tilt and recline technologies is not that of restraint, but rather re-orienting or repositioning the body for any of the following reasons: pressure redistribution, pressure relief, postural control, pain and fatigue management, post-seizure management, catheterization, dressing, transfers, feeding, and passive range of motion (Dicianno, 2009).

There have been cases when these technologies, particularly tilt, have been perceived as a restraint due to the fact that it is more difficult for an individual to get out of the wheelchair if it is tilted rearward. It is true that attempting to exit a wheelchair when it is tilted is very difficult and may result in a fall. However, when tilt or recline is used for any of the purposes stated above it should not be considered a “restraint” despite its limiting effect on the person’s ability to exit from the wheelchair. In this case, the clinical benefits may still outweigh independent exit.”

Q: “How do we keep from getting cited for using Broda’s Tilt-in-Space Seating systems during CAHPS survey?

 

A: By using a DETAILED PHYSICIANS ORDER, CLEAR CLINICAL DOCUMENTATION AND A COMPLETE PATIENT CARE PLAN.

 

The patient care plan and the contents thereof holds the possibility of multiple deficiencies if the documentation is not accurate, clear, complete, detailed, reviewed and timely. The patient care plan has been one of the top 2 deficiencies cited during survey since 2014. Understanding what is required in the patient care plan is vital to the successful completion of your survey. It is vitally important that the Clinical Assessment and Documentation clearly detail and support the use of Broda’s Tilt-in-Space seating as well as any additional supportive devices that are medically necessary. Being prepared with clean, clear and accurate clinical documentation can mean the difference between a deficiency-free survey and one that will require an extensive plan of correction.

Broda Tip To Remember:
Any time Broda chairs are needed for patient use, you must ensure that the following is completed to maintain compliance:

1) Complete a Comprehensive Clinical Assessment detailing the need for the equipment.

2) Obtain an order from the patients Attending Physician detailing the type of equipment, reason for use and length of time equipment will be used.

3) Update the Patient Care Plan to include the use of the Durable Medical Equipment including; Assessment, Indication for use, Interventions, Goals and Expected Outcome.

4) Review and document continued the need for ALL equipment including, Reassessment of the patient, Indications for extended use, Interventions, Goals and Expected Outcome.

5) Obtain Attending Physicians signature on all care plans and other documents as applicable.

6) Review and ensure the Attending Physicians order for the equipment is current, up to date and included in the patient’s clinical record.

7) Complete and Document ALL staff education and training related to the equipment being used and have available upon request.

8) If the equipment or secondary supports are or may be considered a restraint, ensure that safety checks are completed and documented per facility protocol, State, and Federal Regulations and are included in the patient’s clinical record.

9) Ensure all equipment is used following facility protocol, State / Province, and Federal Regulations.

 

Sources:
  1. ELECTRONIC CODE OF FEDERAL REGULATIONS SUBPART B 482.13 

2. The Application of Wheelchairs, Seating Systems, and Secondary Supports for Positioning vs. Restraint

We have not had any skin breakdown with our residents in the Broda's Elite Tilt Recliners since we started using them four years ago. We attribute this to the design of the straps allowing for moisture wicking as well as the ability to easily position recline position for pressure relief. We have not had any skin breakdown with our residents in the Broda's Elite Tilt Recliners since we started using them four years ago. We attribute this to the design of the straps allowing for moisture wicking as well as the ability to easily position recline position for pressure relief.

Mitch C.

"We were at a loss with one of our residents who has frontal lobe dementia. He had trunk lean, stopped feeding himself and appeared to be in pain. We attempted to address the pain; however, any medication we used caused him to have increased behaviors. Since using Broda's Synthesis Tilt Recliner, he has been feeding himself, he smiles and laughs like he used to and is showing no signs of pain anymore. Thank you for producing a great product that brings the quality of life back to our residents!"

Kelly J., Director of Nursing |Sister Bay, WI

"The Broda Revive Tilt and Recline Shower Commode meets our patient's needs. He indicates he feels safe and his own care each morning. He is safe at all times while in the chair, and the caregivers are safe at all times while providing his care. All staff report being pleased with the commode and find it much easier to assist him."

Pam, Director of Nursing

We have not had any skin breakdown with our residents in Broda's Elite Tilt Recliners since we started using them four years ago. We attribute this to the design of the straps allowing for moisture wicking as well as the ability to easily position recline position for pressure relief.

Jaclyn A., OTR/L Director of Occupational Therapy |New Hartford, NY

"Our gliders [Tranquille Auto-Locking Gliders] are always disappearing out of our common areas and end up in our patients' rooms We don't know how they get there, but they love them and prefer sitting in them more than anything else. One patient with a back injury told us this was the only chair he could sit comfortably in. He wanted to take it home with him after his rehabilitation was complete."

Josiah D., Facility Administrator |Pocatello, ID