Authors (including presenting author) :
Wong MYA, Chan MW, Yam CLY, Kong TS, Leung TSS, Cheng KH, Chan YL, Yuen FCG
Affiliation :
Occupational Therapy Department, Ruttonjee and Tang Shiu Kin Hospitals
Introduction :
Occupational Therapy (OT) Department of Ruttonjee and Tang Shiu Kin Hospitals (RTSKH) initiated a pilot project to modify the geriatric chairs in a subacute ward in Ruttonjee Hospital for improving patients’ seating quality.
Risk factors and shortcomings of the geriatric chairs had been identified. Despite having the reclining system, these chairs lack a tilting system to maintain appropriate seat-to-back angle. Patients tended to slide down from chairs leading to increased fall risk. Pelvic holder used by ward staff for refraining patients from sliding out exerted pressure on patients’ skin and limit their body movement, also affecting the sitting comfort level. The pressure relieving property of the chairs was unsatisfactory. Patients’ sitting tolerance was poor.
Objectives :
1.Modify geriatric chairs to reduce fall risk and pressure injury;
2.Improve patients’ seating quality by improving their sitting tolerance, sitting posture, pressure distribution and comfort level.
Methodology :
10 patients (5 bedbound and 5 chair-bound) were selected in the project. Seating assessments, including computerized pressure mapping, were performed. The chairs were modified accordingly; including foam wedge (with 5-10° tilt-in-space angle adjustment) and seat cushion prescriptions. Parameters including sitting tolerance, sitting posture, pressure distribution and self-reported comfort level were selected for outcome measurement.
Result & Outcome :
Sitting tolerance was significantly improved. All 5 bedbound patients were able to sit out with the modified geriatric chairs. The mean sitting tolerance of all 10 patients increased from 0.7 to 32.5 minutes. The mean sitting-out frequency increased from 0.1 to 1.3 time per day.
Improvement in sitting posture with better sitting stability was noticed. Problem of sliding out had been markedly reduced after using the modified geriatric chairs.
Improved pressure distribution of the seating area was manifested by (i) 27.6% decrease in the mean coefficient of variation indicating more even pressure distribution and (ii) 13.5% decrease in the dispersion index (i.e. another index indicating improvement in pressure distribution).
The self-reported comfort level (mean score of 8.7/10) was good amongst the participants. There were no complaints of pain or discomfort.
Conclusion
The results of the outcome measurement indicated that the pilot project “Modification of existing geriatric chairs” is effective to minimize fall risk and to improve seating quality. The benefits of improvement were well recognized by nursing staff. The project can be extended to cover other geriatric chairs with similar problems in the future.
