How to Determine Mobility Patients’ Cushion Needs

For mobility patients, who might spend much of their waking hours in a seated position, a cushion can be what’s between comfort and wound development. The same can be said for bariatric patients, who might also spend a good deal of time in bariatric chairs.

Sharon Lepper, BSN, RN, WOCN, attended Emory University in Atlanta to complete her Wound Ostomy Continence education with a certificate in WOCN. She has worked in nursing for 20 years and for the last 10 years has been involved in the treatment, prevention and education of wound and ostomy care of the acute and long-term patient. According to Lepper, here is what you need to know to meet mobility patients’ cushion needs.

The general types of seating cushions available are:

1. Static Air
2. Gel
3. Foam
4. Combination of Foam and Static Air

Each of these off-loads and redistributes pressure. Their differences are in the way they do their job.

Static Air — With Static Air cushions, patients are actually immersed into the cushion with their weight being equally redistributed so that the pressure points over bony prominences are protected. Not all static air-seating cushions are created equal. Some cushions are made of antimicrobial material. Some cushions are made to pass the fire retardant codes required in California. (California has the strictest laws regarding fire safety, so it is a difficult and expensive requirement.) Cushions that do not pass the California fire retardant code are not sold in all 50 states.

Gel — Gel seating cushions can be very comfortable when new but they present their own set of problems as they age. The gel does not allow full immersion into the product but the patient is molded into the cushion. Gel cushions retain body heat and allow it to build up and the cushions can be very warm. The warmth can lead to maceration of the patient’s skin because of a lack of evaporation and build up of perspiration. These cushions are also very heavy and can be too heavy for patients to lift or move. As the gel cushions age the material gets rigid from the loss of moisture in the gel material and the cushions can become so firm that they do not allow for off-loading or pressure redistribution.

Foam and Static Air — Foam and foam with air seating cushions are lighter weight than gel products and can be very comfortable to sit on. Some are made with memory foam and mold around the patient’s skin. The biggest problem with foam is that over time it naturally degrades and compresses, which makes the product very firm and rigid. Foam can also hold in the body heat and enhance the ill effects of moisture and perspiration. The micro-climate of the seating surface can lead to problems with shearing and friction, which is not found in static air products.

Choosing the right cushion

When choosing a seating cushion, consider a patient’s weight. Height is not an issue. Some cushions will only adequately protect patients that weigh less than 300 lbs. Other cushions are tested and safe to use for patients up to 800 lbs. Also, suggest cushions that are antimicrobial and made from the highest fire retardant material.

Patients might spend more than half of their waking hours sitting in a chair, so consideration of heat-producing products, such as gel or foam, may not be a good choice for patients sitting for long periods of time.

Challenges of finding the correct cushion are:

• Patient’s weight
• Fire retardant materials
• Antimicrobial material
• Ease of cleansing the product
• Weight of the cushion
• Warranty
• Cost

Cushion Care

Educate patients and their caregivers that caregivers should periodically check seat cushions for proper use and fit. Ill-fitting or improperly filled cushions can cause skin breakdown. Caregivers should receive instruction from the provider and be able to acquire further instructions either via email, provider-supplied DVDs, telephone or personal visits. Most manufacturers provide guidelines for proper use and fit of their products so providers should obtain these materials.

A seating cushion should be replaced every year and sometimes sooner. If a patient has a prescription written by a physician for a wheelchair, then that patient can have a seat cushion prescription written by a physician that will be paid for by insurance, Medicare and Medicaid. The key is having the wheelchair prescription first.

The Wound Ostomy Continence Nursing Association has a web site that can be accessed for assistance in finding a wound nurses in the patient’s area. These wound nurses are trained and able to help patients find information on wound prevention, treatment and healing.