Appendix D. Falls Engineer Instructions

The Falls Management Program Manual

The Falls Management Program is designed to prevent falls and injuries in nursing facilities. This is done by trying to make all residents' rooms and equipment as safe as possible and by correcting specific safety problems of high-risk residents. The Falls Engineer plays an important part in all aspects of the program.

The Falls Engineer makes changes and repairs to residents' rooms and equipment throughout the facility to improve safety. The Falls Nurse Coordinator will give you the Engineer Inspection List and the equipment inspection forms. The Engineer Inspection List is a list of changes and repairs to make to the resident's living space. The equipment inspection forms will guide you to inspect, repair and adapt residents' equipment.

For high-risk residents, the Falls Therapist or Nurse Coordinator may also ask you to make other changes. These changes will help the resident to be safer when walking, propelling a wheelchair, transferring and during unsafe behaviors.

All of the tasks, the tools and supplies you will need are explained in this section. Supplies and sources of equipment are listed in Appendix A.

In summary, the Falls Engineer has three assignments:

  1. Make changes or repairs listed on the Engineer Inspection List.
  2. Complete the equipment inspection forms.
  3. Make other changes for high-risk residents as requested by the Falls Team.

1. Make Changes or Repairs Listed on the Engineer Inspection List

The Engineer Inspection List is a list of changes and repairs to make to residents' rooms and equipment. The Falls Nurse Coordinator will give it to you and explain each task. Each list will include the tasks you are being asked to do for a group of 14 beds. The Falls Nurse Coordinator or Nursing Assistant will put a check beside the tasks you need to do for each bed. The size of your nursing facility will determine how many lists you will be given. Because most residents will have at least one repair or change to their bedroom or bathroom, there will be one or more tasks checked for each bed.

A list of all the possible tasks on the Engineer Inspection List is shown in Figure 1. The reason for the task, the supplies needed, and instructions to do each task follow.

Figure 1. Engineer Inspection List
Unit:Date:Room Number:_____________________
Signature: ________________________________________Bed:_____________
1. Paths1. Make tiebacks for divider curtains.             
2. Tie electrical cords out of path (TV, phone, heater).             
2. Furniture3. Clean, repair, or replace broken bed wheel locks.             
4.  Fix unstable furniture.             
5. Secure loose bathroom handrails.             
6. Replace missing rubber tips on bedside commode.             
7. Replace missing rubber tips on handrails that rest on floor.             
8. Secure raised toilet seat to commode.             
4. Lighting9. Replace burned out or flickering bulbs. Use max wattage.             
10. Repair broken room lights or call lights.             
11. Replace broken call light cords or lengthen cords.             
5. Floor12. Repair or replace floor covering.             
13. Replace high, broken, or missing thresholds.             
14. Add grading to thresholds between room and bathroom.             
6. Equipment15. Inspect wheelchair (for all wheelchairs found).             
16. Repair cane.             
17. Repair walker.             

Task 1. Make tiebacks for divider curtains.

Reason: Pushing a curtain back can be hard for small, frail residents with poor balance. The purpose of a tieback is to clear the resident's path.

Supplies: About 1 yard of ½-1 inch ribbon, a small metal hook.

Instructions: Screw the hook into the wall at a suitable height for staff to pull back the curtain. Tie the ribbon around the hook and allow ribbon lengths to hang so that they can be used to tie the curtain back. If the metal hook protrudes, place it high enough so that it will not injure the resident.

Task 2. Tie electrical cords out of path.

Reason: Electrical cords should be kept out of the way so that the resident does not trip on them. This includes cords to the TV, telephone, oxygen tank, and heating/cooling units.

Supplies: Electrician' s ties, plastic wrap around ties.

Instructions: Coil the cords out of the way and put electrical ties around the cords to secure them.

Task 3. Clean, repair or replace broken bed wheel locks.

Reason: Locks on bed wheels or other locking mechanisms must hold the bed firmly in place so that it does not roll away when the resident gets in or out of bed. At least two of the wheels must have locks that work, one at the head of the bed and one at the foot on the alternate side. Many locks do not work because of dirt and grime. Others are broken and need to be replaced. If you make the bed stable by taking off wheels or moving the bed against the wall, you may violate fire codes. Check state and local codes.

Supplies: Denatured alcohol or degreaser, silicone spray or lithium grease, new bed wheel locks.

Instructions: If possible, remove wheel locks and clean them. Remove dirt with denatured alcohol or any type of degreaser. Dry and then lubricate them with silicone or white lithium grease. Do not use WD-40 to lubricate locks because it does not last. Put the wheels back on the bed and see if the locks hold it in place. If not, order new wheel locks from a local vendor or from one of the sources in this section. To order wheels with butterfly locks (Figure 2), measure the caster wheel, stem diameter, and stem length. A common size is a 3 inch caster wheel with a stem that is 7/16 inch thick and 3 5/8 inches long. Some wheels have leg lock pads (Figure 3) with a leg lock assembly. If they cannot be cleaned and repaired, order new ones from a local vendor, the bed manufacturer or from a source in Appendix A.

Figure 2. Butterfly Lock

drawing of a wheel with a butterfly lock

Figure 3. Leg Lock Pad

drawing of a leg lock pad with a leg lock assembly

Task 4. Fix unstable furniture.

Reason: Residents often lean on furniture for support while walking. If the furniture is unstable it may tip over or rock causing the resident to lose her balance.

Supplies: Scraps of lumber cut into small wedges, cardboard, glue.

Instructions: Place wedge underneath the short leg of the furniture and glue into place.

Task 5. Secure loose bathroom handrails.

Reason: Residents need support when getting on and off the commode. The handrail must be secure to support the resident's weight.

Supplies: Screws, bolts, screwdriver.

Instructions: Replace missing screws and bolts. Replace any broken hardware. Check to be certain the handrail is strong enough to support the resident's weight.

Task 6. Replace missing rubber tips on bedside commode.

Reason: Rubber tips help keep the bedside commode (Figure 4) from sliding or tilting during transfer.

Supplies: Measure diameter of the commode leg to get the right size rubber tip. Local hardware stores carry them in different sizes.

Instructions: Replace missing or uneven rubber tips.

Figure 4. Bedside Commode

drawing of a bedside commode

Task 7. Replace missing rubber tips on handrails that rest on the floor.

Reason: Some handrails reach to the floor (Figure 5) and have rubber tips. If the tips are missing, the handrail may not be stable.

Supplies: Measure the diameter of the leg of the handrail to get the right size rubber tip. Local hardware stores carry them in different sizes.

Instructions: Replace missing or uneven rubber tips.

Figure 5. Commode Handrails That Reach to Floor

drawing of a commode with handrails that reach to the floor

Task 8. Secure raised toilet seat to commode (Figure 6).

Reason: Some raised toilet seats become loose over time. If a toilet seat is loose or tilts when the resident transfers on and off the commode, the resident may lose her balance.

Supplies: Screws, bolts, screwdriver.

Instructions: Replace missing screws, bolts and any other hardware that is broken or missing. If the raised toilet seat cannot be made secure, ask the nurse or occupational therapist to order a new one. Generally, raised toilet seats with steel fasteners are recommended because they can be secured firmly to the commode. To order new raised toilet seats, refer to sources in Appendix A.

Figure 6. Raised Toilet Seat

drawing of a raised toilet seat with handrails that is secured to a commode

Task 9. Replace burned out or flickering bulbs. Use maximum wattage.

Reason: Residents need 2-3 times as much light as younger adults to see clearly. Burned-out bulbs or ones that flicker can prevent the resident from seeing well.

Supplies: New light bulbs.

Instructions: Replace bulbs in resident's rooms, night lights, halls, and bathrooms. Use bulbs with the full recommended wattage.

Task 10. Repair broken room lights or call lights.

Reason: Residents must be able to see during the daytime and at night. They must be able to call the nurse for help when needed.

Supplies: New fixtures or parts.

Instructions: Repair or replace light fixtures and call lights.

Task 11. Replace broken call light cords or lengthen cords in bedroom and bathroom.

Reason: The resident must be able to reach the call light button or cord when seated on the commode or while in bed. If the resident cannot reach it, she may try to get up by herself or lean over and fall.

Supplies: Nylon cord, small rubber ball if cord needs a new end for resident to grab.

Instructions: Tie the cord to the bell. If using a ball, make a hole through the ball and thread the cord through it. Knot or tie the cord so that the ball stays in place.

Task 12. Repair or replace floor covering.

Reason: Elderly persons may not lift their feet high enough to avoid curled carpet edges or changes in floor surfaces.

Supplies: Glue, nails, caulking, cement.

Instructions: Glue or nail any loose edges of carpet. Replace missing tiles or linoleum pieces.

Task 13. Replace missing or broken thresholds.

Reason: Elderly persons may not lift their feet high enough to avoid tripping on changes in floor surfaces.

Supplies: Metal or wooden thresholds from hardware store.

Instructions: Add a low threshold or strip of metal or wood to cover an open seam in the floor.

Task 14. Add grading to thresholds between room and bathroom.

Reason: Many residents shuffle their feet when they walk. If a resident shuffles over a raised threshold, she may trip. Also, a resident may not be able to roll a wheelchair over a high threshold. Thresholds should be low or have grading on both sides.

Supplies: Cement or other material for grading, tools to remove a high threshold.

Instructions: Add a slope of cement to either side of a high threshold or remove the threshold.

2. Complete the Equipment Inspection Forms.

There are three equipment inspections:

  • The Engineer Wheelchair Inspection
  • The Engineer Walker Inspection
  • The Engineer Cane Inspection

You will need to inspect all residents' wheelchairs in the facility. If the resident has a wheelchair, there will be a check beside "15. Inspect Wheelchair" on the Engineer Inspection List.

As part of the inspection of the resident's living space, the nurse or nursing assistant will look at each resident's cane or walker. If there are no problems, you will not be asked to inspect it. If there are problems, you are asked to inspect and repair it. There will be a check beside "16. Repair Cane" or "17. Repair Walker" on the Engineer Inspection List for each one.

The Falls Nurse Coordinator will give you an inspection form for all the wheelchairs, canes and walkers you need to inspect. Some residents may use more than one piece of equipment and will need more than one inspection done.

Each inspection is explained below.

Engineer Wheelchair Inspection

The Falls Nurse Coordinator will give you an Engineer Wheelchair Inspection form for each resident who uses a wheelchair. Each resident will have her own form with name and room number at the top. The inspection form has seven parts. Read the instructions in each part. Look for each item on the chair that you are asked to check. If you need help or have questions, use the wheelchair picture to find the parts or contact the therapy department or the wheelchair dealer. Check the box beside each job which you think applies to the resident's wheelchair, then make repairs as directed. Write your initials beside the task when it is done.

Wheelchairs should have regular care and cleaning. Use the same Engineer Wheelchair Inspection form and repeat your inspection after six months to check the resident's wheelchair again. Add the date at the top of the form and make notes beside each task as needed.

A list of tools that you will need to repair most wheelchairs is given in Figure 7.

Figure 7. List of Tools for Wheelchair Maintenance and Repair
  • Spoke wrench
  • Regular screwdriver
  • Philips screwdriver
  • Crescent wrench 8"
  • Pliers
  • Hammer
  • White lithium or teflon-based spray grease
  • Bearing grease
  • Chrome cleaner
  • Tire pump, tire gauge
  • File, sandpaper
  • Silicone spray
  • Solvent
  • Fine steel wool
  • Wipe rags
  • Vice grips

A list of changes and repairs which you may need to make is given in Figure 8. Each task is explained below.

Figure 8. Repairs for Wheelchairs
  1. General cleaning and lubrication
  2. Frame check
  3. Wheel and caster check
  4. Brake check
  5. Armrest check
  6. Seat and back upholstery check
  7. Footrest and legrest check
Task 1. General cleaning and lubrication.

Reason: The wheelchair must be clean and well lubricated for the joints and other moving parts to work well.

Supplies: Soap, water, rags, brush, fine steel wool, white lithium or teflon-based spray grease, silicone spray.

Instructions: Clean all parts of the chair with soap and water. If necessary, use steel wool to remove old grease and dirt. Wipe dry. Spray silicone on all dry joints. Use WD-40 for cleaning only. If the slide does not move smoothly when you fold the chair, use white lithium grease or silicone to lubricate the slide post and inside the slide tube. To do this, tip the chair back and put the lubricant into the slide tube from the bottom. Fold and unfold chair a few times to spread the grease or silicone. Never oil wheels or bearings of a wheelchair. Oil may wash out the grease of the bearings and cause damage. Bearings should be cleaned and repacked yearly. This is best done by a dealer. Peeling chrome or cracks in joints or on the frame may mean there is a broken weld which could cause the chair to break. Call the dealer to repair or replace it.

Task 2. Frame check.

Reason: A sturdy frame is an important part of a safe wheelchair. The chair should move smoothly and hold its shape when the resident transfers in and out of it and propels it.

Supplies: Screws, bolts, screwdriver, file, sandpaper, order all other parts from dealer.

Instructions: Tighten all loose fasteners and replace missing screws. Check the center pin, rail guide tips, rail plug, and spring catch. Replace if worn, bent or cracked. Replace worn or broken lifting straps. Replace cracked or bent rail posts. File or sand burrs on screw heads. If the frame is cracked or has a loose weld, it should be discarded or returned to the dealer.

Task 3. Wheel and caster check.

Reason: Wheels and front casters should roll smoothly without side play so that the resident can control the wheelchair when propelling it. A soft air-filled tire can cause uneven steering. Solid tires must be firm with no cracks or they may become loose and come off the rim. Dirty casters may not move freely, which can cause the chair to stop or veer to one side. Loose handrims can make the resident lose control of the chair.

Supplies: File, rubber tips, pliers, screwdriver, spoke wrench, sandpaper, tire gauge, tire pump, order all other parts from dealer.

Instructions: 1) Check the axle nut and bolt, bearing, nuts, and washers (Figure 9). If the spoke guard is loose or worn, tighten or replace it. Tighten all hardware and replace any missing pieces. Replace or tighten all wheel spokes evenly around the wheel. File sharp edges. Replace missing or worn rubber tips. 2) To clean the caster axle area (Figure 10), remove the nut from the caster axle. Pull the axle out of the axle housing. Remove hair and dirt. Grease the axle. Replace the felt washer that covers the bearing before you put the axle and casters back on the chair. Replace worn or bent fork and stem. Replace the casters if they are cracked or uneven. If you need to adjust the caster fork swivel, remove the dust cap from the top of the caster stem. Tighten the stem nut so that the fork swivels freely but does not wiggle up and down. 3) If the tire is air-filled and low, fill it while the resident is out of the chair. Fill to the pressure recommended on the side of the tire. If the tire is solid and is cracked or worn, replace it. 4) To adjust the wheel, remove the hubcap from outer end of the axle. Loosen the axle nut on the inside of the wheel. Tighten the axle by turning the head of the axle clockwise. Tighten until side play stops, but not so tight as to restrict free turning of the wheel. Tighten the axle nut. Hold the axle firmly in place with one wrench and tighten nut with the other. Lift the wheel off the ground so that it can spin freely while you look for side play. If the axle is too loose, the wheel will wobble. You may need to replace wheel bearings if this is the case. If the axle is too tight, the wheel will stop spinning quickly. It should coast slowly to a stop. Replace hubcap. 5) With brakes locked, tug on each handrim to see if it feels solid. If it wiggles, see which points are loose. Tighten the bolts that hold the handrim to the clip. If the handrim is loose because rivets holding the clips are loose, contact the dealer. If bolts are loose and go into the spokes, it is unsafe and the bolts should be replaced.

Figure 9. Axel/Hubcap/Stem Bearings

drawing detail of the axle nut and bolt, bearing, nuts, and washers of a wheel assembly from a wheelchair

Figure 10. Caster Axle Area

drawing detail of the caster axle area of a wheel assembly from a wheelchair

Task 4. Brake check (Figure 11).

Reason: Brakes that do not lock the chair securely into place are very common in nursing facilities. Brake repair is one of the most important things that can be done to prevent falls. A resident is likely to fall if the chair moves during transfer. Brakes must lock the wheelchair firmly into position. The lock must bite into the tire 1/8 inch when engaged.

Supplies: Silicone spray, wrench, pliers, order all other parts from dealer.

Instructions: If the brake lever does not bite 1/8 inch into the tire, it may be because the tire pressure is not correct or that the tire is worn. If the lock does not bite when the tire is in good condition, the lock may need to be moved closer to the wheel. To do this, loosen both bolts that hold the lock to the side frame. Ease the lock back on the frame tubing until it is in the right place to bite into the tire. Tighten the bolts to hold the lock in place. If locks are too stiff to engage, they may have worked forward on the frame tubing. Use the same process to push them back. Lubricate the locks with a few drops of oil or silicone spray. If the brake lever or latch is worn, replace it. If the rubber tip on the brake is worn or missing, replace it or change it when you add brake extensions.

Figure 11. Brake Lever
drawing of Brake Lever from a Wheelchair Wheel
Task 5. Armrest check.

Reason: Residents need stable armrests for support during transfer.

Supplies: File, sandpaper, screwdriver, screws, foam padding, vinyl upholstery.

Instructions: If armrests are loose, tighten the screws underneath the armrest tubing (Figure 12). Replace torn upholstery. File or sand any sharp edges. If screws stick out through the padding, tighten them back down through the padding. Replace or add padding or purchase new armrests if more cushion for the armrests is needed. If the armrests have become sprung so that they don' t fit in the holders, place the front post in the holder. Pull up on the armrest to spread the space between the posts. Push down to reduce the space.

Task 6. Seat and back upholstery check.

Reason: Residents must have a firm seat and back for good posture and support during transfer.

Supplies: Fasteners, screwdriver, order all other parts from dealer.

Instructions: Tighten any upholstery screws that are loose. Make sure screws and bolts go all the way through the holes in the metal splines along the edge of the upholstery so that it will not tear. If the seat upholstery is cracked or torn, replace it. If the seat upholstery sags, tighten it by removing the fasteners and lifting up on the upholstery. Refasten upholstery after pulling it tight and making new holes if needed. If it cannot be tightened, replace it. But, before tightening back upholstery, check with the occupational therapist. If the resident has a back deformity, tightening the upholstery may be the wrong thing to do.

Figure 12. Armrest

drawing of an armrest from a wheelchair

Task 7. Footrest and legrest check (Figures 13a-b).

Reason: Footrests should be secure and work well so that the resident's feet are supported. It is also important that the resident be able to clear them during transfer. The foot plates must stay up out of the way during transfer so that the resident will not trip. Footrests should clear the floor and have secure hardware. Heel loops should be secure and not be torn. There should not be sharp edges on legrests or footrests.

Supplies: Pliers, wrench, screws, nuts, bolts, file, fabric webbing, Velcro, order all other parts from dealer.

Instructions: Adjust the lock of the legrest or replace it if it is not secure. Tighten or replace all hardware. File sharp edges. Replace the leg panel if it is cracked or frayed. Replace missing or worn heel loops with webbing from fabric store. Make a loop of webbing. Remove the foot plate and wrap the fabric around the posts. You can use rivets, or Velcro, or sew it into place. Replace missing bumper tips on the front of the legrest bar and replace the spring of the foot plate if it is missing or worn.

Figure 13a. Legrest

drawing detail of a legrest from a wheelchair

Figure 13b. Footrest Check

drawing of a wheelchair with a footrests

Engineer Cane Inspection (Figure 14).

The Falls Nurse Coordinator will give you an Engineer Cane Inspection form for each resident who uses a cane which needs repair. Each resident will have her own form with name and room number at the top. There are two questions on this form. After you have inspected the cane, answer each question yes or no. If the answer to the question is yes, follow the arrow down to the next question. If the answer to the question is no, follow the arrow across to the list of tasks. Check the box beside each task which you think applies to the resident's cane, then make repairs as directed. Write your initials beside each task when it is done.

Reason: A cane helps the resident balance during transfer and while walking. It must be stable with all hardware present and have a clean, even rubber tip on the end.

Supplies: Rubber tip from hardware store, screws, bolts, screwdriver.

Instructions: Replace missing bolts or screws. If any are loose, tighten them. If a rubber tip is missing or uneven, replace it. Measure the tip of the cane so that you purchase the right size rubber tip. If it is a quad cane, check all four rubber tips.

Figure 14. Wooden Cane, Metal Cane, Quad Cane

drawing of three walking canes: one wooden, one metal, one a quad cane with four feet

Engineer Walker Inspection

The Falls Nurse Coordinator will give you an Engineer Walker Inspection form for each resident who uses a walker which needs repair. Each resident will have her own form with name and room number at the top. There are three questions on this form. After you have inspected the walker, answer each question yes or no. If the answer to the question is yes, follow the arrow down to the next question. If the answer to the question is no, follow the arrow across to the list of tasks. Check the box beside each task which you think applies to the resident's walker, then make repairs as directed. Write your initials beside each task when it is done.

Reason: A walker helps the resident balance during transfer and while walking. It must be stable with all hardware present and have clean, even rubber tips on the ends of the legs (Figure 15a). If the walker has caster wheels (Figure 15b), they should be firm, in good shape, and roll smoothly.

Supplies: Rubber tips from hardware store, screws, bolts, new caster wheels, oil, screwdriver.

Instructions: Replace missing bolts or screws. If any are loose, tighten them. If a rubber tip is missing or uneven, replace it. Measure the end of the walker legs so that you purchase the right size rubber tip. If the walker has caster wheels that do not roll smoothly, lubricate them. Replace them if they are worn or cracked.

Figure 15a. Walker

drawing of a walker

Figure 15b. Rolling Walker

drawing of a walker with caster wheels

3. Make Other Changes for High-Risk Residents as Requested by the Falls Team

The Falls Therapist and Nurse Coordinator may also ask you to make additional changes to rooms and bathrooms of residents who are at very high risk of falling. There are also changes which may need to be made to the resident's wheelchair. You will be asked to do these tasks in addition to those on the Engineer Inspection List and equipment inspections. A list of changes which you may need to make is given in Figure 16. An explanation of each task follows.

Figure 16. Engineering Tasks for Resident's Room, Bathroom, and Wheelchair

Room and Bathroom

  • Exchange high bed for low bed
  • Add or move handrail
  • Adjust length of chair legs
  • Check outdoor area0s for safety

Wheelchair

  • Label chair
  • Add brake extensions

Task 1. Exchange high bed for low bed.

Reason: Residents' feet must rest flat on the floor when they sit on the edge of the bed in preparation for transfer. If a resident's feet do not rest firmly on the floor, they are more likely to lose their balance.

Supplies: Bed that can be lowered.

Instructions: Exchange beds with another resident. Ask staff to find a resident who is bedridden and does not need a bed which can be lowered. If you cannot exchange beds, ask the administrator about the purchase of a new one. To order a new bed, refer to sources in Appendix A.

Task 2. Add or move handrail.

Reason: The handrail must be situated in the right place for the resident. Some residents need support on both sides. Towel racks are not sturdy enough to support a resident during transfer and should not be used for this.

Supplies: Handrail, screwdriver, screws or bolts.

Instructions: Move the current handrail or secure a new one where the therapist tells you to place it. The handrail should be 1-1¼ inches in diameter. In general, you should mount a handrail 33-36 inches from the floor and no more than 1½ inches from the wall. The exact height for placement depends upon the height of both the commode and the resident. To order new handrails, refer to sources in Appendix A.

Task 3. Adjust length of chair legs.

Reason: Many residents sit in a lounge chair during the day. The chair must be the right height for the resident to sit down and stand up safely. If the chair is too low, the resident will have difficulty getting out of the chair. If the chair is too high, the resident's feet will not rest firmly on the floor when rising. Either could cause the resident to lose her balance.

Supplies: Wood glue, plywood or hardwood to make small boxes for each leg or to make a long rectangle for each side of the chair, saw, screws, screwdriver, fastener bit or expandable auger.

Instructions:

  1. To increase chair height. Find out from the therapist how many inches you need to raise the chair. Measure the thickness of each chair leg. Make four boxes or cut solid squares out of wood for each chair leg of the height you need to raise the chair. If the chair leg is square or rectangular, use plywood or hardwood to frame the leg with a box (Figure 17). Make sure there is a tight fit. Use glue and nails to make the box. Fasten each box onto the chair leg with a screw. If the 0chair leg is round, use a solid block of hardwood and drill a hole the size of the leg into the block (Figure 18). Fasten each box or block onto the leg with a screw. If the chair is large, use a brace style riser (Figure 19), for added support. Use ½­¾ inch plywood to make two open-ended rectangles which extend from the front leg to the back leg. Cut an insert to fit inside the rectangle. Cut out or drill a section at either end for chair legs. Secure the insert into the rectangle with glue and nails or screws. Fasten each leg into the rectangle with a screw. If the chair has two wooden risers instead of four separate legs, make a platform riser (Figure 20). Measure the width and length of each side. Make two open-ended rectangles out of plywood. Make an insert for each one which fits inside the rectangle and allows chair risers to be screwed into place.
  2. To lower the chair. Find out from the therapist how many inches you need to remove from the chair legs. If the chair cannot be adjusted, exchange it for one that is the right height.
Figure 17. Square Leg Riser

three-dimensional drawing of a square-leg riser for adjusting chair height

Figure 18. Round Leg Riser

three-dimensional drawing of a round-leg riser for adjusting chair height

Figure 19. Brace Style Riser

three-dimensional drawing of two types of brace-style risers for adjusting chair height

Figure 20. Platform Riser

three-dimensional drawing of two types of platform risers for adjusting chair height

Task 4. Check outdoor areas for safety.

Reason: Uneven pavement, moving cars or any other unsafe conditions may cause residents to fall when they go out of the building.

Instructions: Talk to the administrator and nursing staff to see what barriers, door alarms, door locks, signs or other things can be used to keep the resident out of unsafe areas. Purchase supplies as needed.

Task 5. Label chair.

Reason: When a wheelchair has been adapted to a resident's special needs, it should only be used for that resident. However it is common for staff to switch wheelchairs between residents. To make it easier for staff to use the right chair, the resident's name should be on the wheelchair and on any of the resident's seating items.

Supplies: Paint pen with indelible ink, felt tip marker, resident name bracelets.

Instructions: Turn the chair over and write the resident's name on the bottom of the seat with the paint pen or write the resident's name on a resident name bracelet and attach it to the chair frame. Also attach one to the armrests and legrests if they can be removed and to any seating items.

Task 6. Add brake extensions (Figure 21).

Reason: Residents must be able to reach the brakes, grab and lock them before transfer. If a chair moves while the resident is getting in or out of it, a fall is likely.

Supplies: 16 inches of ½ inch steel electrical conduit from hardware store, 2 rubber tips ¾ inch each, hammer, tape measure, hacksaw, file, sandpaper.

Instructions: Cut an 8 inch piece of conduit. Flatten one end with a hammer so that it fits over the brake lever. Remove the rubber tip from the brake lever. Slide the conduit over the brake lever about 2 inches. Ensure a tight fit. Put a rubber tip over the end of the conduit. Make sure there are no sharp edges. For purchase of break extensions, refer to sources in Appendix A.

Figure 21. Brake Extension

drawing detail of a brake extension for a wheelchair

Page last reviewed February 2010
Internet Citation: Appendix D. Falls Engineer Instructions: The Falls Management Program Manual. February 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/injuries/fallspx/fallspxmanapd.html