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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

"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 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.

"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

" My father, enlisted in the Air Force and trained as a machine gunner on B17’s during WWII. Photographs of the “Flying Fortress” grace the walls of his room in the Kansas Veterans' Home in Winfield, Kansas where he has been living for the past 6 years.

For the first 2 years in the Veterans’ Home, my father used a power wheelchair for mobility and independence. But at the age of 82, with advances in his Parkinson's and dementia, his power wheel chair was taken away for safety concerns. He was provided with a standard issue VA manual wheelchair with no tilt or recline. His posture in that chair was terrible ... he was very slumped over and leaning to the side. Even his breathing was limited as a result of his poor posture. All he could do was stare at the floor. It was so disheartening to see him this way. I would have to kneel on the floor to see him eye-to-eye due to his hunched posture from Parkinson's disease.

In a fortunate twist of fate, it was determined that my father was an ideal candidate for a chair from Broda. And as a vested veteran, he qualified for the VA to fund the chair. He has now had a Broda chair for over 4 years!

Since he's been in the chair from Broda we can now sit beside him on visits and look at each other face-to-face. Being able to tilt back in the chair and look upward, he can enjoy watching John Wayne westerns in the VA lounge. He can even use the Broda chair when he travels by transport for dental appointments. He can stay in his chair for the bus ride and in the office, since the chair can be tilted enough for the dentist to work on his teeth.

Broda's chair has been a blessing for my father, his caregivers and my family. The chair improves his quality of life and I can't imagine him not being in it over the past few years. We are fortunate that the VA will fund Broda chairs for Veterans like him who need them."

Kent P., Family Member

"Broda chairs and wheelchairs make it easier for caregivers to provide optimal care with less stress on the client and the caregiver. For example, easier transfers, easier re-positioning, less maintenance, and easier mobility."

Carole P., MS/OTR |Easton, MD