Wheelchairs and bedpans aren't routine for patients

Goal is to maximize patient independence

Instead of routinely issuing patients equipment such as wheelchairs and bedpans, the staff at Lourdes Regional Rehabilitation Center now issue the assistive gear only to patients who have a therapeutic reason for using them.

"We've looked at all the time-honored things we give people that might impede their achieving their goals," says Tammy Feuer, MA, CCC, administrator of rehabilitation and post acute service at the Camden, NJ, hospital. "With shorter lengths of stays, we want to ensure that patients have as much practice as possible before we send them home."

The rehab staff are making the change as a way of altering the patients' concept that the rehab staff were supposed to do things for them, Feuer explains.

"People have a lifelong perception of what it's like to be in the hospital," she says. "They expect that the nurses should do for them."

In the past, patients at Lourdes were routinely assigned a wheelchair when they reached the rehab unit.

"We wanted them to be able to go out and about and be independent, and the wheelchair did give them a certain amount of independence. But having a wheelchair may not be very therapeutic for some patients, and it may not be the most appropriate way for them to get around," Feuer says.

Encouraging them to ambulate

For instance, in the middle of the night, or during the rush of getting all patients up in the morning, the staff might be tempted to use a wheelchair to take patients to the bathroom or to meals simply because it was easier and faster, even if patients were ambulatory. Now, only patients who cannot ambulate are assigned wheelchairs.

"We are encouraging all staff to be sure they ambulate a patient if the patient needs to be practicing ambulation," Feuer says.

The hospital is eliminating bedpans from the admission kits unless there is a therapeutic reason for the patient to have one.

A bedpan becomes a crutch, she says. "From the start, you're sending a message to a patient that they are in the hospital where people do things for them," Feuer adds.

Patients must be positioned upright in order to normalize their bladder habits, Feuer points out. "They can't clear their bladder the same way in the bed as they can when they are on the toilet."

If patients have a problem getting to the bathroom in the middle of the night, the staff puts in a bedside commode, she says. "This will achieve the goal of having a patients upright when they clear their bladders. This makes the patient transfer out of bed, but he doesn't have to go as far as the bathroom."

[For more information, call Tammy Feuer at (609) 757-3699.]