No matter how you slice it, cushions go hand in hand with wheelchairs. The reason is that because mobility impaired patients are prone to pressure ulcers, it is critical that they maintain continuity of care when going from their beds to their chairs
“Your mattress can be working 16 hours a day for the patient but those few hours when they get out of bed can cause some major issues,” says Dan Anderson, vice president and co-owner of Ft. Worth, Texas-based Woundkair Concepts Inc. “Having a seat cushion available to them when they are out of bed is extremely important.”
The reason for this is that sitting in a wheelchair without a cushion places direct and constant pressure to a specific area, cutting off blood flow to developing or existing wound sites. Moreover, the development of sores caused by lack of a cushion can confuse clinicians who might accidentally conclude that the patient’s mattress was actually the cause.
“Therefore a seat cushion is almost mandatory for the patient to use while they are out of bed,” Anderson says. Here are some important considerations to ensure patients have the right cushion:
Know the different types of cushions. There are three main types of seat cushions:
Gel and foam seat cushions work very well for patients who need them for their wheelchairs and other seating. Anderson says he uses the gel type because his experience with foam has been that it breaks down over time and has bacterial concerns.
Non-powered adjustable cushions also work well for both wheelchair and standard seating. These types of cushions contain a honeycomb of air cells that are first fully inflated, placed under the patient and then partially deflated via a release valve so that it better conforms to the patient’s body. The result is that the patient essentially floats on an approximately 1.5-inch cushion of air while sitting in the chair. These come in both high- and low-profile variations.
Powered seat cushions function like the non-powered adjustable cushions, but they include a motorized blower to circulate the air in the cushion. The motor is either plugged into an outlet or powered via battery. “Those are extremely effective products, but they’re also extremely expensive,” Anderson says. The majority of private insurance providers and Medicare do not cover the powered variety.
Understand your patients. There are two basic types of wheelchair patients, Anderson says: Active and inactive. Inactive patients use their chairs to navigate their home and possibly run errands or go to doctor’s appointments. They need the support and comfort that a high-profile non-powered adjustable cushion can deliver. Active patients go to work, play sports and perform various activities in their chairs. Those patients, because they move and flow so well, typically require a low-profile cushion to enhance their stability.
Size the cushion to the chair. Providers should do the up-front work to ensure that patients are not only comfortable and have the right pressure relief from their cushion, but that the cushion also conforms to the wheelchair’s seating surface. Make sure to measure the chair from back to front and side-to-side. Cushions come in many, many sizes to accommodate this need, but this can mean that the provider might also need to have some trial cushions on-hand to try out different fits to ensure the best arrangement before ordering.
“If you don’t do that, the patient is not going to be comfortable, the cushion is not going to fit right, and it could rub on the wheels,” Anderson says. “There are many, many things that could happen, if it’s not sized correctly.”
Ensure compliance. The provider must remember that as important as it is to ensure the patient has the right support, it is equally important to ensure that they use it. “Remember these things are extremely easy to remove from the wheelchair if they aren’t comfortable,” Anderson says. The provider has to work up front with the patient to make sure the patient will use it over the long haul, and that comes down to comfort and fit. Again, test units can help ensure this happens.
Also, providers might have to get patients acclimated to a cushion that might feel strange at first, but then demonstrates its benefit. “A lot of this is about patient education,” Anderson says. “It’s not about just making the sale.”
Points to take away:
• Know the different types of cushions available.
• Know your patients’ activity levels.
• Match the right cushion to the right patient.
• Ensure the cushion is correctly sized to the chair.
• Work up-front with patients to ensure compliance.
• Have test units on hand to try out before ordering.
For various pressure wound resources, visit the National Pressure Ulcer Advisory Panel site at www.npuap.org, and make sure you understand the NPUAP’s complete pressure wound staging guidelines, which were updated in 2007. The full guidelines are available at www.npuap.org/pr2.htm.