ESTABLISHING A WHEELCHAIR AND SEATING EQUIPMENT
CAPITAL
REPLACEMENT PLAN FOR A MULTI-SITE ORGANIZATION
Guylaine Desharnais BSc. OT
In
British Columbia, therapists working in acute care hospitals, rehabilitation
centres and extended care facilities usually have a set inventory of
wheelchairs and seating equipment to meet clients / residents’ needs.
Following an occupational therapy department initiative, a special project was implemented to prepare a Capital Replacement Plan for the purchase of wheelchairs and seating equipment for Vancouver Hospital and Health Sciences Centre (VHHSC). VHHSC is comprised of 5 sites and represents approximately 900 wheelchair users.
§ To ensure that each client / resident has appropriate equipment on a daily basis
§ To enable a client / resident to achieve optimal level of independence in wheeled mobility
§ To optimize participation in preferred daily activities
§ To ensure appropriate amount of equipment level
§ To ensure that wheelchair and seating equipment is up-to-date with current technology to promote ability; not create excessive disability
§ To ensure that wheelchair and seating equipment can be successfully used and re-used by the client/resident population
§ To ensure access to consistently safe, functional, serviceable wheelchair and seating equipment
§ To establish a capital replacement plan which is supported by the inter-professional teams and programs
§ To identify more accurately future needs for wheelchair and seating equipment
1. Establishing Standards
for Wheelchair and Seating Equipment
To
establish standards and criteria for wheelchair and seating equipment which are
used to determine wheelchair make and model, and seating equipment requirements
to meet residents / clients’ seating and wheeled mobility needs specific to
each clinical area.
An initial set of standards were defined for:
§
Wheelchairs
These were based on requirements related to positioning in a wheelchair and specific to the different methods of propulsion, i.e. upper extremity propeller, foot propeller, attendant propelled and powered mobility.
Seat cushions were classified in 3 categories according to the skin protection offered. Minimum standard requirements were established for individuals at low risk for skin breakdown in order to ensure comfort in long term sitting.
§
Backrest
Backrests were classified in 4 categories according to the following factors:
§ Backrest’s primary shape, i.e. designed to support normal spinal alignment or to accommodate a spinal deformity
§ Type and amount of postural control offered
2. Survey
A survey was completed for the clinical areas of 3
out of 5 sites, representing approximately 750 wheelchair users.
Objectives
§ To determine residents / clients needs specific to each clinical area
§ To assess pre-established standards
§ To assess inventory of wheelchairs and seating equipment presently used
§ To establish equipment requirement for each clinical area
Wheelchair
and seating equipment are not purchased or prescribed for specific individuals
but rather for the purpose of providing a generic inventory that hopefully
meets the needs of multiple users.
Therefore, all residents / clients were reviewed to ensure the largest possible sample to establish with the greatest possible accuracy the wheelchair and seating equipment requirement in terms of type / size / number.
The survey results were used to prepare:
§ Capital Replacement Plan. For example, wheelchair replacement rates per year.
§ Purchase order. For example, number, type and sizes of seat cushions required for a specific clinical area, e.g. acute spinal cord injury unit versus long term care facility.
3. Capital
Replacement Plan
The capital replacement plan is set as a 2-step process.
The objective is to replace wheelchair and seating equipment identified during the survey that meet one or more of the following criteria.
§ Equipment that cannot meet clients / residents’ seating and wheeled mobility needs
§ This may become a safety issue. For example, a wheelchair with a fixed angle of tilt can be unsafe for eating/swallowing.
§ It may result in creating excessive disability. For example, a power chair that cannot be programmed to match a driver’s ability can mean loss of independent mobility for an individual with a severe disability that cannot use this old technology.
§ For example open-cell foam cushions do not meet infection control requirements.
Maintenance
and repair. Equipment needs replacement when:
§ It is broken and cannot be repaired. For example, cracked backrest shell.
§ Parts required for the repair exceed the equipment’s current value
§ Repair history proves that the equipment does not warrant further servicing
§ It is no longer possible to purchase parts for maintenance and repair as the model has been discontinued by the manufacturer
Wheelchair and seating equipment not available. As identified during
the survey:
§ Clients / residents using a wheelchair without any seat cushion
§ Clients / residents bed bound due to the unavailability of appropriate wheelchair and/or seating equipment
The second year and subsequent years, aging equipment is replaced by equipment:
§ That meets established standards
§ At a rate based on their estimated life span and in number sufficient to meet inventory level requirement
§ According to types / models of wheelchair and seating equipment required for each clinical area which is based on the survey results
§ By replacing equipment gradually and on an on-going basis, it ensures access to new technology as it becomes available.
4. Purchasing
Plan
For
4 sites of VHHSC, the average length of stay of the residents / clients
population is much lower than the estimated life span of wheelchair and seating
equipment. Therefore the wheelchair and
seating equipment inventory must be generic and estimated to meet the needs of
a population “X”. The survey results can be used as is to prepare an actual
purchase order.
For one site, a long-term care facility for adults with severe disability, the average length of stay is 12.74 years, which exceeds the estimated life span of wheelchairs and seating equipment.
The purchase of wheelchair and seating equipment is client specific and in numbers necessary to meet the estimated amount of equipment required in inventory. The advantage is an optimal fit for the first user.
Wheelchair and seating equipment must meet the established standards to ensure that equipment can be successfully re-used by possible subsequent clients.
5. Re-Assessment
· To ensure that the inventory continues to meet clients / residents seating and wheeled mobility needs
· To establish with greater accuracy the life span of wheelchair and seating equipment
When
50% of the wheelchairs and seating equipment meet the established standards,
standards should be reviewed, the survey conducted again and compared with the
previous results.
· To keep track of data such as purchase date and disposal date of wheelchair and seating equipment
· This information can be used to establish with greater accuracy the life span of specific equipment. In turn, this information could be used to justify / prepare future purchasing plan.
·
For
example, the estimated life span of seating equipment is based on an average of
4 years. In the course of the survey, we found Roho High Profile seat cushions
that were 10 years old, still being used and in good condition.
Conclusion
At VHHSC, there was no clearly defined process for the acquisition of wheelchairs and seating equipment. This is an initial attempt at organizing a capital replacement plan. It is hoped that it can be used as a template and starting point to build upon.
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