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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

"Prior to using Broda's Elite Tilt Recliner, there were issues with safety for getting the resident out of the chair, safety for staff lifting her in, either manual/mechanical; comfort, keeping her in the chair, inability to get her body over the sides.

The chair sides raise to prevent her from throwing her legs/body over the sides; same with the extra padding along her leg area that is raised. The tilt puts her buttock in a comfortable position, but also makes it extremely difficult to push out. The chair sides also swing out to assist with ease of the mechanical tilt.

Broda's chair has given her a reason to want to get up and she enjoys her chair now. When we are using the mechanical lift she remains calm because she wants to get in it and will stay longer safely and comfortably! Staff can safely lift and position her without worrying about injuring themselves."

J. C., Unit Manager, RN |Campobello Island, NB

"Prior to the Broda chair [Synthesis Tilt Recliner], we had tried numerous positioning devices for the resident, which were ineffective. She had a tendency to lean forward and to one side. Once using the Broda chair [Synthesis Tilt Recliner], the resident's posture immediately improved. She, herself, was very thankful because she was "so comfortable". The staff couldn't believe the result. Besides this resident sitting in proper alignment, she could still self-propel with her feet."

Linda P., Restorative Coordinator |Joliet, IL

“There are many excellent features on Broda’s chairs and the best way to start to help you clients is to begin building a relationship with this company. For the right client, Broda’s chairs are the perfect solution.”

Richard W., OTR/L, ATP |New York, USA

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

"As a Social Worker in a long term care setting I want to ensure my residents have the ultimate in comfort. Upon actually getting to test one myself, I realize Broda is the ultimate in comfort for any geriatric population including ours. As the number of Broda's chairs grow, so does the comfort and improved skin integrity of our residents."

Colleen M., Social Worker |Brookfield, WI