Is your Homecare Patient Sleeping in a Recliner? Our Change in Practice to Improve Off-loading.

Extensive studies and treatment plans have been developed for pressure injuries and prevention for bedbound and wheelchair bound patients. However, homecare clinicians see patients at risk for pressure injuries not often though about; those who spend day and night in their recliner. Sleep apnea, acid reflux, dyspnea while lying flat and the effects of aging make it difficult to sleep flat in bed. Extended time spent in a recliner present challenges in turning, positioning and offloading pressure areas.

Working with occupational therapists, various seating products were reviewed. We searched for an affordable support surface effective in a recliner. An air-filled cushion was selected, and pressure mapping studies performed. A pressure mapping pad was applied to the patient’s recliner and pressure assessed with and without the offloading cushion.

Accumulated literature review data, current published pressure risks and pressure mapping helped identified inclusion criteria for evaluating offloading cushions. Clinicians were instructed in offloading but also that turning, and repositioning should not be overlooked. An off-loading, recliner-sized air-filled cushion was selected to trial. It was affordable, low profile, and provided airflow to reduce moisture.

Using pressure mapping, the air cushion showed significant pressure reduction/redistribution.

Ten patients received the product and were contacted frequently asking their opinion of the cushion. Clinicians continually monitored the patients during the trial.

Outcomes suggested that all recliners are not created equal. Older chairs were often structurally unsound and did not support the pad. Keeping the pad in place was problematic in lift chairs. Narrow chairs did not accommodate the width of the pad. We are working with the manufacturers on identified problems and improving the product.

Clinicians stated that the cushion was beneficial for pressure reduction and improved wound healing. Patients that used the recommended seating expressed high satisfaction, easier repositioning, and greater comfort.