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19 December, 2016 00:00 00 AM

Do we overlook wheelchair safety in our day to day practice?

Do we overlook wheelchair safety in our day to day practice?

Dr. M Zakirul KARIM has been working in corporate-for-profit hospitals; not-for-profit-community research hospital; and healthcare industry for more than 18 years. As an employed hospital C-level executive, Dr. Zakirul led major construction activities, service development activities and HIS system start-ups. He is particularly strong in the areas of hospital operating systems design, green-field hospital project, maintenance, reengineering and evaluation of hospital management. In these cases he was able to effectively turn-around healthcare operational and financial performance. His is committed to developing the human capital of an organization and reflects mentor approach in his leadership style. Dr. Zakirul is the former Chief Execute Officer (CEO) of the Gastro-Liver hospital and the Chief Operating Officer (COO) of the Ispahani Islamia Eye Hospital. Currently he is the Senior Adviser of Hanh Phuc International hospital which was managed by Thomson Medical group Singapore.. As a healthcare futurist, he is regular contributing LinkedIn publications focus on the 21st century challenges that hospital will face in future: https://vn.linkedin.com/in/dr-karim-m-zakirul-39b73a9.
You can reach him at 00841665728912 or [email protected]














In a hospital, the wheelchair is most important mode of transport for disable patient or visitors. The wheelchair uses to take services from the hospital or to accompany patient or to see patient. Most hospitals offer porter services for managing wheelchair. But practically we see patient’s attendance or visitors are taking the advantages to handle wheelchair and transporting people.

The most worried and concern is do they know how to use wheelchair safely? Did someone educate them about the safety of wheelchair and how to use them? Do porter are well trained. We are seeing every day in the hospital that someone pushing wheelchair. Does it trigger us to check if the wheelchair pusher is well aware about the safely handling of wheelchair and how to prevent fall of patient? Another important concern is how to ensure the wheelchair is clean after use.

How many of us check about it? Do we put a system in place to make sure each wheelchair is checked and clean after single use? Otherwise, we are carrying not only patient but also infectious bugs or super-bugs from one unit to another unit of the hospital. Besides, is there any maintenance check for wheelchair? How frequently the preventive maintenance is done? Who double check? Does infection control team aware of this situation?

Patients in the hospital, even general people use wheelchairs for a variety of reasons. This popular and safe mobility device is meant to provide the user with independence, comfort and the capability to enjoy life to the fullest. You may think using a wheelchair is easy, and for the most part it is. However, there are a variety of safety measures you will want to consider and follow to assure you are getting the best use out of your wheelchair. Let’s read this useful wheelchair safety guide to help you avoid any accidents, preventing falls and other safety tips.

Center of Gravity: When first using a wheelchair you will want to become familiar with your center of gravity. Finding your proper position is essential to your safety when using your wheelchair. In the beginning you will want to use the casters to help maintain your balance and stability.

Practice conducting a variety of activities such as bending, reaching and transferring in and out of your wheelchair. All of these movements will cause a change in weight distribution of the wheelchair. It is best to practice and feel confident with all of your movements while someone is close by in case you need assistance while adjusting to the wheelchair.
Bending Backward: At times you may need to reach for something by bending backward. You will want to position your wheelchair as close to the desired object as possible. Use the casters so they extend away from the drive wheels to create a long wheelbase. Reach back as far as your arm will extend without changing the position you are sitting in.

Bending Forward: First, you will always want to keep in mind that you will never want to attempt to reach for an object if you have to position yourself forward on the seat of your wheelchair. This can be dangerous. Instead, you will want to position the casters and extend them away from the drive wheels, then engage the wheel locks before reaching forward towards the object.

Preventing Accidents: Tipping and falling is the most common accidents wheelchair users encounter. Tipping can be caused by a variety of reasons which include making your wheelchair go to fast, unlocked brakes, slippery surfaces, the sitting stability of the user and hitting a large bump with one wheel causing the wheelchair to become unbalanced. To avoid tipping and falling, the tipping lever should be secure when needed and you should beware of your speed around tight corners and on tough terrain.

Safety Tips:
Lock the brakes before getting out or into the wheelchair. The power should be turned off of electric wheelchairs before transferring.
Adjust or lift foot rests and arm rests if needed before transferring.
Avoid placing a large heavy bag or items on the back of the wheelchair. This can cause the wheelchair to tip backwards during transferring.
Attach flashy items such as flashing taillights and flags to your wheelchair when you go out at night. This will allow people to easily see you in dark parking lots and streets.
Avoid forcing your chair down or up staircases, slopes and inclines.
Replace the casters regularly. If your are experiencing a side to side motion while going at high speeds this is a sign it needs replacing.
Adjust and program your power wheelchair settings so that you are comfortable with the speed.
Avoid the rain as much as possible. Wheelchairs can lose traction and the controls of an electric wheelchair can get wet.
Fall Prevention
Avoid leaning forward and tipping yourself out of the wheelchair
Move footrests out of the way to avoid tripping on them during transfer
Lock the brakes before getting out of the wheelchair
Don’t over reach for an object
Avoid sliding or positioning yourself too far forward on the seat

Outdoor Use: There are a variety of wheelchairs that are excellent for outdoor use. However, you will always want to be careful and avoid certain surfaces and weather conditions. Sandy surfaces should be avoided as much as possible. Even a paved sidewalk with a small amount of sand scattered on it can cause your wheelchair to become unbalanced, spin around and tip over. This happens very quickly and mostly with power wheelchairs. Sometimes you are able to gain control and prevent the fall, but this is risky.

To prevent this from happening try to avoid the sandy surface by going around the surface. Wet surfaces and puddles should also be avoided. Splashing through a puddle with your electric wheelchair can cause the entire wheelchair to become wet, slide, spin, tip and fall over. Avoiding the wet surface and going around the area is recommended for safety reasons.

If it is raining outside and you have no choice, proceed with caution and at a slow pace. When using outdoor ramps in any weather condition always inspect the condition of the ramp for uneven surfaces, slippery areas, holes and other obstacles in your pathway to the ramp. If you are approaching a ramp that you are not sure of, you can ask someone to take a closer look for you before you attempt to use the ramp.
Travel Tips
Have your wheelchair inspected and serviced before your trip
Take pictures of your wheelchair and accessories with a camera that has a date and time feature to show the condition of your wheelchair before boarding the plane
Remove leg rests and accessories from your wheelchair before handing it over to the airlines
Alert the staff that you are a wheelchair user when making reservations
Gather all wheelchair travel information, rules and regulations you will need to adhere to during your trip
Carry the contact information of a wheelchair repair shop located close to your destination for emergency purposes
Keep in mind wheelchair users are the first to board the plane and the last to depart the plane, adjust your travel schedule to have at least 2 hours between connecting flights
Conduct research and book flights with airlines that are bound by the Air Carrier Access Act
Prepare to have your wheelchair completely inspected at the security gate. This includes non-removable pouches and even your seat cushion.
Rules of Fifteen: help you to understand safety of wheelchair
1. Always lock the brakes before getting in and out of the wheelchair. On power wheelchairs, always turn the power off before transferring. This can prevent someone from bumping the joystick and it saves battery juice.
2. Don’t pull backward on doors or other objects when sitting in a manual wheelchair. A door could suddenly release and you could tip over backwards.
3. Lift the footplates up before getting in or out of the chair.
4. If you have a wheelchair with removable arm or leg rests, make sure they are secure by lifting the arms and gently trying to swing the leg rest away from the chair. Do this before each use.
5. Avoid putting heavy loads on the back of a wheelchair. This could cause the chair to tip over backwards.
6. Don’t remove the anti‐tip wheels or bars on any wheelchair. This should prevent the chair from tipping backwards.
7. Keep loose objects or lap cover away from the wheel spokes.
8. Don’t let children play with your wheelchair. They should be instructed to never touch your wheelchair or the controls. Don’t let them ride on the battery cases or on the footrest; these will break if you do.
9. Use a flag if you ride in the streets. Use headlights and flashing taillights if you ride in the streets at night. Pick bright colored wheelchairs.

10. Avoid going up or down steep inclines or slopes. You might lose control and tip your chair over
11. Beware of caster flutter. This is the side to side motion of the caster which usually happens at high speeds. If the casters flutter, replace them immediately.
12. Have the programming of your power wheelchair set so that it does not go faster than you can handle, especially in reverse.

13. Avoid riding in the rain. Wheelchairs are not waterproof and it is not safe. Controls get wet on power chairs and wheels lose traction on wet ground.
14. Just be careful and think of ways to prevent problems before they occur. Plan ahead for emergencies such as brake failure, tipping backward or the power wheelchair moving by itself.
15. Regular Maintenance is very important. Keep the wheelchair in good repair and you will prevent many accidents and malfunctions.
Inspection, Maintenance and Servicing: The inspection, maintenance and servicing of wheelchairs is often overlooked by the user or equipment supplier after the initial purchase. To operate safely and effectively, wheelchairs should be regularly inspected and maintained by the end user or supplier.

In addition, it is advisable to have wheelchairs inspected and serviced by a qualified technician at least every six months. Routine care and maintenance will extend the life and efficiency of the wheelchair, while also providing the user with a safer mode of transportation. Regular inspections should include the following areas as a minimum:

General-Wheelchairs should easily roll straight when the brake is in the released position and there should be no excessive drag or pull to one side.
Seat & Back-Upholstery should be free of rips and sturdy, with no excessive sagging and no loose or broken hardware attachments.

Rear Wheel-There should be no rough edges or peeling and there should be no wobbling. Check that quick release axle pins release easily and are adjusted so that they are slightly loose when in place. Spokes-Front and rear tires should be inspected for broken spokes.
Front Casters-Proper tension should be present so that when spun, the caster comes to a gradual stop. If wobbling or binding, the locknut may need to be adjusted or replaced. The wheel bearings should be clean and moisture free.
Tires-Tires should be inspected for flat spots, wear, or cracks and replaced if any of these conditions exists. Pneumatic tires should be properly inflated at all times.

Wheel Locks-Wheel locks should not interfere when tires are rolling. Locks should be easily engaged, with pivot points free of wear and looseness.

Electric Brakes-Check to ensure they stop the wheelchair without veering and that they hold on a slope.
Seat Straps-Any positioning straps should be inspected for wear or missing/damaged hardware.
Foot Plates/Rests-Should be present, not bent, and position easily. Latches should hold securely. Tipping Lever-Should be present and secure, to prevent wheelchair from tipping backwards.

Cleaning-All upholstery, including armrests, backrest, and seat, should be kept clean and sanitary.
Glide test-Push the chair on a smooth level floor and let it glide. It should go a long way in a straight line. If not, check the bearings, casters and wheels.

Electrical problems with power wheelchairs-Note which side is affected. If the joystick box lights are flashing, note the pattern as they number of lights or blinks generally signals a specific error code.
Drive motors-Listen for unusual noises from the motor or gearbox. Check drive belts for slippage and wear. Check for jerking motion of the chair.

Joystick control-The joystick should return to neutral freely, without binding. The seal to the joystick should be kept intact, as it keeps water and dirt out. All switches and controls should be tightly in place and the joystick clamp should hold the joystick firmly in place.

 User Safety: Even a well-maintained wheelchair may be unsafe if general safety precautions are not followed by the user. Some general wheelchair safety guidelines include:
Practice preventative maintenance-do not wait until it breaks!
For power wheelchairs, always turn off the power before transferring. It is actually best to turn off the power when not driving.
 For manual wheelchairs, always set the wheel locks before transferring.
Always lift the footplates up before getting in or out of a chair.
Make sure removable arms or leg rests are secure before use, by lifting up on the arms and gently trying to swing the leg rest out away from the chair.

When adjusting the elevating leg rest, support the frame while lowering or raising, to prevent a sudden release of the leg rest.

Keep loose objects or lap covers away from wheel spokes.
Do not pull backwards on doors or other objects when sitting in a manual wheelchair.
Do not put heavy loads on the back of a manual wheelchair-it may tip over backwards!
Do not remove the anti-tip wheels on a power wheelchair.
Do not let children play on a wheelchair or ride on battery cases or footrests.

When riding by/near the streets at night, use headlights and taillights. Pick bright colors for wheelchairs and consider a
flag when riding outdoors near traffic.

Avoid going up or down steep slopes.
For power wheelchairs, have the speed control set to avoid going faster than can be safely handled in forward and reverse.
If casters flutter (rapid side-to-side motion), get them fixed.
Avoid use in wet weather conditions, as the electronics may be damaged and wheels may loose traction.
For power wheelchairs, be aware of the effects of radio/TV stations and cell phones. The wheelchair should be turned off before using a cell phone.
Read the operating manual for the wheelchair and observe all precautions.
Finally I would like to share one story of Wheelchair.
One of the interesting story happened with one hospital while CEO was going out for a meeting and he observed that one visitor is pushing patient's wheelchair. He quickly asked the visitor if he could help them to push this wheelchair and he ultimately pushed the wheelchair and carried the patient to the doctor's room. All the line managers were quickly rushed to ask the CEO if they could help him, instead they could do it. The CEO smiled and busy to talking with patient about his experienced on this hospital.

The following days, the notice came from CEO office to all line managers that they should learn how to use a wheelchair without getting harmed and thereafter, they can again join in this hospital! The value of wheelchair safety is quickly understand by hospital staff in their heart.







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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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