Practice No.
448
Reference: 10/06
Version 1
Page 1 of 13
New
December 2009
This replaces
procedure 22/92
ASSESSMENT, PROVISION AND USE OF WHEELCHAIRS AND
OTHER MOBILITY AIDS
This summarises the arrangements within the home to ensure residents are correctly
assessed and provided with wheelchairs and other mobility aids that are appropriate
and safe for their use.
1.
Obtaining a mobility aid
When there is concern that a resident may require the use of a wheel chair, or other
mobility aids such as walking support frames, on a temporary or permanent basis, a
referral must be made to the appropriate General Practitioner or service occupational
therapist.
Prior to referral, there will need to be a full review of the care plan, which will
evidence the concerns and substantiate the request for assessment. A summary
should be made for reference of the GP or OT.
The aid provided, following assessment, will have been assessed as meeting the
individual’s particular needs, but a risk assessment must still be undertaken and filed
in the mobility section of the individual care plan.
2.
Using a mobility aid
Because the use of mobility aids, particularly wheelchairs, has been demonstrated to
be hazardous and in some cases has resulted in serious injury and death, it is vital
that the use of all mobility aids is risk assessed and the assessments recorded in the
individual’s care plan.
The risk assessment must include:
 A full assessment of the use of the particular equipment, including its use
around inanimate objects such as furniture
 A manual handling risk assessment for all mobility aid users, whether or not
they need assistance from care staff to move them whilst using the aid
 A manual handling risk assessment for moving and storing the mobility aid
when not in use, or the wheelchair when unoccupied
 A manual handling risk assessment for lifting a wheelchair into a vehicle and
transporting it
 A manual handling risk assessment for transporting a wheelchair with the
occupant seated, using an appropriate vehicle where it can be safely
clamped.
3.
Identifying hazards
Most hazardous incidents have been caused by inappropriate use of the equipment,
inadequate information or instruction, or fundamental human error, including incorrect
maintenance and modification. [Medicines and Healthcare products Regulatory
Agency (MHRA)]. All staff must be aware that the risk associated with the use of wide
wheelchairs, whether manual or motorized, will be increased in proportion to the
width of the chair and the weight of the user. (Risk Assessment forms can be found
in Appendix A.)
Hazards associated with wheelchairs include:
 Manual handling injuries
 Instability of, and falls from, wheelchairs
 Injury from inappropriately fitted accessories or unauthorised adaptations
 Inappropriate operation of electric wheelchairs
 Crush and entrapment injuries
Before using a mobility aid, all users and carers should be given
 Practical advice and instruction on how to use the aid
 Where appropriate - practical advice and guidance on the safe use of
manual and electrically powered wheelchairs
 Information on the appropriate manual handling requirements
 Advice on, and where necessary assistance with, appropriate
maintenance
 Advice and procedures surrounding transportation
 Advice on the safe fitting of accessories such as ‘grab’ sticks and ‘wing’
mirrors
4.
Wheelchairs
4.1
Manual Wheelchairs
Before an individual uses a manual wheelchair the following points
must be considered :
 Ensure that all wheelchairs are visually inspected prior to handling,
to check they are in a safe working condition. Particular attention
must be paid to brakes and tyres
 Ensure the wheelchair is unfolded and locked in the open position
 Ensure that the brakes are applied when the wheelchair is not in
motion
 Bags and holdalls must not be placed on the handles of a
wheelchair as this alters the centre of gravity and makes it less
stable. There is the also a risk of the bag and contents becoming
loose and causing injury. There may be an exception to this where
there is a manufacturer’s approved accessory bag fitted
 Any accessories to the chair must be compatible with the type of
wheelchair and must be correctly fitted
 Where posture straps are fitted, these must be used at all times
 Where lap straps are fitted, these must be used where a risk
assessment identifies the need. e.g. where the individual chair
user may be confused and not understanding the need to remain
seated when in the wheelchair. This will present a risk to both the
user and others
 Ensure the correct footrests are in place, correctly adjusted, and
feet are on the footrests during transportation. Where this is not
possible this must be recorded on the risk assessment and the
alternative action for management used. This may require an
authorised adaptation to the chair
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4.2
5.
All care staff must wear appropriate clothing and footwear for all
conditions, in accordance with moving and handling training
Refusal to use a wheelchair in accordance with the risk
assessment and manufacturer’s instructions, must be recorded on
the risk assessment, signed as understood by the individual where
possible, and all care staff must be made aware of the potential
increased risk
Privately owned or supplied wheelchairs must only be used by the
person for whom they have been supplied and are subject to the
above controls.
Before Moving and handling a manual wheelchair
 The weight of the chair user and the distance it is to be pushed
must be considered
 Plan the route and ensure access is appropriate
 Use ramps or dropped kerbs where available
 Use the tipping lever on the back of the wheelchair to assist with
going up a step or kerb
 When transporting an unoccupied collapsible wheelchair in a
vehicle, it must to be stored securely to prevent it becoming loose
during transportation/impact
Motorized Wheelchairs
5.1
Use of an Electric / Motorized Wheelchair
It is important to remember that electric wheelchairs are designed to give
independence to the occupant. Consequently, the risk of care staff operating
the chair for the individual will enhance the risk of accident or injury.
Where an individual is not able to operate a motorized chair, either on a
temporary or permanent basis, a referral for alternative equipment must be
made.
The chair user should have received instruction on use of the electric
wheelchair from the supplier. If a resident is admitted with a motorized chair,
they should be asked to demonstrate their ability to manoeuvre the wheelchair
as part of the risk assessment. If this raises any concerns they will need to be
reassessed. Where this highlights a change in the physical or cognitive ability
to operate the chair this will be addressed by provision of suitable equipment.
All of the pre use checks as in 4.1 will also apply to motorized chairs
5.2
Assisting an individual using a motorized chair
Where it is necessary to assist the use of a motorized chair, e.g. when giving
personal care, the chair must be placed into manual mode/control pad
isolated, to ensure that the controls are not accidentally activated, risking
injury to the user and carer. This may create a manual handling risk and must
be included in the overall risk assessment. Where it is assessed that a carer
may operate a chair for the service user, the conditions under which this may
be done and the actions to be taken must be recorded and staff must be
assessed as competent to do this. For wheelchairs where there is no manual
brake, the clutch must be engaged with the power switched off, the clutch will
then have a braking action. Manufacturer’s instructions must be consulted.
Where no instructions are available, a copy should be requested directly from
the manufacturers, or in some cases it may be possible to download
instructions from a manufacturer’s web site.
5.3
Battery charging
A specific area must be designated for the charging of wheelchair batteries.
This should be out of the main thoroughfare of the home, well ventilated and
secure.
 Ensure the battery is not damaged
 Only charge the battery following the manufacturers guidelines
 Ensure the battery charger cables are not trailing across the floor
 Ensure that there is adequate ventilation during the charging process
 Ensure the battery-charging unit receives annual P A Testing.
6.
Wheelchair Maintenance
Regular maintenance of wheelchair systems, seating and accessories is important
for the health and safety of the user and carers.
Daily visual inspection and battery checks,
Weekly checks on tyre pressures and braking systems,
Annual servicing
This is a minimum standard and must be recorded in the mobility section of the
individual’s care plan.
6.1
Weekly inspections
 All wheelchairs must have a weekly inspection. The weekly
Inspection checks of each wheelchair must be completed and the
findings documented on the checklist form. (Appendix B), which
must be filed in the Mobility section of the individual’s care plan
 Any defects identified must be noted and rectified without delay
 Where wheelchairs are privately owned or supplied by the NHS,
any defect should be notified to enable it to be rectified as soon
as possible
 Where a defect has been identified with the structure or
safety of the wheelchair it must not be used until the defect
has been rectified
.
6.2
Annual Servicing, Maintenance and Repairs as necessary
 Maintenance schedules must be recorded in the mobility section
of the individual care plan. All servicing arranged by the county
council must be documented and the records from the
recommended suppliers must clearly detail the individual serial
number of the wheelchair. Where a wheelchair has no legible
serial number it must be given its own unique number. Repairs
undertaken must also be documented and traceable to the
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6.3
individual wheelchair by the written records. Records of all
servicing and repairs must be kept in the individual’s personal file
Wheelchairs owned by the county council (including those
donated for use) must receive an annual service and
maintenance to ensure their safety
Donated wheelchairs must receive a service and maintenance
check prior to being put into use
Defective wheelchairs must be taken out of use until repaired or
disposed of
Where wheelchairs are supplied by an NHS Primary Care Trust,
arrangements should be in place for them to be serviced every 12
months
If a wheelchair is privately owned, the service user/ family/carer
should be encouraged to have a servicing contract in place
When arranging for the servicing of wheelchairs it is important to
remember to have all accessories such as lap/posture belts,
headrests etc serviced with the wheelchair.
Posture Belts and Lap Belts
Lap belts and posture belts must be assessed and fitted to meet the needs of
the user and, where appropriate, their carer. This includes the type and length
of adjustment and the method of fastening and releasing the belt. Users or
carers with poor co-ordination, limited strength in their hands or cognitive
impairment, may not be able to operate some types of mechanisms which
require a firm grip or dexterity, to adjust, release and fasten the belt.
Careful selection of the adjustment, release and fastening mechanism will
reduce the risk of the user slipping down in the seat and the belt pressing
against the user’s neck. This can occur if the belt is incorrectly adjusted by as
little as 150 mm. The risk is increased for users who have limited
comprehension, reduced co-ordination or insufficient strength to push
themselves back into the wheelchair.
Lap and posture belts must be fitted and adjusted in line with manufacturer’s
instructions, to provide an appropriate sitting position. The belt adjustment
must be regularly checked to ensure that the required posture is maintained.
Inspection and maintenance of the belts and their fittings must be included
within the annual servicing of the wheelchair.
6.4
Seating and Cushions and hand protection
A paramount concern in the use of mobility aids of any description, is the
effect on tissue viability from prolonged use. Within the risk assessment,
consideration must be given to the pressure areas likely to be compromised
by the device.
It may be necessary to consider pressure relieving cushions, limited periods
of use before transfer to alternative seating and the use of gloves or hand
protectors, particularly for users of self propelling chairs, where there is
repeated friction on the hands. All pressure relieving equipment must be
included in the daily check of the device or chair.
APPENDIX A
Wheelchair Risk Assessment Record
Home ……………………………………………………
1. Name of Resident……………………………
3. Type of Device being assessed and unique serial number of chair …………………………………………………………………………
What are the
hazards?
Who might
be harmed
and how?
List the control measures
already in place
What is the
risk rating –
H, M, L?
See section
5
1. Manual
Handling
Carers –
pushing,
pulling, lifting.
Manual handling training.
Manual handling risk
assessments completed.
Daily, weekly annual checks and
servicing of wheelchair to ensure
it is in good working order prior to
use.
Whenever possible the route is
planned and assessed taking into
account access and distances
wheeled.
Employees wear appropriate
clothing and footwear for all
conditions.
Medium
Is any further action necessary,
if so what action is to be taken
by whom and by when?
Action
Completed
State the date
completed and
sign.
What is the
risk rating
now – H, M,
L?
See section 5
2. Instability of
the wheelchair
Carers and
wheelchair
user –
wheelchair
tipping over
3. Persons
falling out of
wheelchairs
Carers and
service users
4. Injury from
inappropriately
fitted
accessories
Carers and
chair users –
incorrect
modification
5. Crush and/or
entrapment
injuries
Carers and
service users
Ensure wheelchair is in good
working order prior to use.
Bags, holdalls etc are not placed
on the handles of the wheelchair.
Chair users not to be tipped back
on level surfaces.
Annual servicing of wheelchairs.
Chair users requested to wear lap
straps and/or posture straps
where appropriate.
Individual risk assessments
completed for chair users with
cognitive impairment, who may
not understand the need to
remain seated.
Brakes applied when wheelchair
is not in motion.
Ensure wheelchair is in good
working order prior to use.
Weekly checks carried out on all
wheelchairs and documented in
individual care plan.
Annual servicing of wheelchairs.
Medium
Carers wear appropriate clothing
and footwear.
Gangways and doorways kept
free from obstructions.
Low
Medium
Low
6.
Transportation
Carers and
chair users –
Road traffic
accident,
impact, falls
from vehicle.
Transportation risk assessments
carried out and procedure
documented.
Chair user given guidance on
safe use and transportation of
wheelchair on all transport.
Where possible vehicle with a tail
lift is used.
Staff must be trained to use the
tail lift.
Use of ramps to be assessed and
incline not to exceed 1:12.
Ramps wide enough for safe use
with wheelchairs.
Staff must be trained to use the
ramps.
Where possible chair user
transferred to a fixed seat and
wheelchair stored securely.
Where the chair user is unable to
transfer to vehicle seating,
appropriate wheelchair restraint
straps and anchor points must be
fitted in the vehicle.
Staff must be trained to use the
restraints and anchor points.
Gangways kept clear.
Medium
7.
Environmental
hazards
(slippery
surfaces,
restricted space)
8.
Inappropriate
operation of a
motorized chair.
(accidental
operation of
controls)
Staff and
chair users –
slips, trips,
falls.
Staff and
chair users –
Crush and/or
entrapment
injuries
Gangways and doorways kept
free from obstructions.
Care taken in wet or icy weather.
Use dropped kerbs, access
ramps etc to assist with manual
handling
Wheelchair is only used by the
person for whom it is supplied.
Assessment made on the chair
user’s ability to manoeuvre
wheelchair.
Control pad isolated during
personal care or manual handling
activities.
Individual risk assessment
completed for those situations
where a member of staff is
required to operate the
wheelchair on behalf of the chair
user.
Carers wear appropriate clothing
and footwear for all conditions.
Gangways and doorways kept
free from obstructions.
Assessment made on the chair
user’s ability to manoeuvre
wheelchair.
Low
Medium
9. Battery
Charging
(trailing cables,
battery acid,
fumes)
Staff and
chair users –
Slips, trips &
falls, inhaling
fumes,
explosion,
burns
Batteries charged following
manufacturer’s guidelines.
Location of charging area
assessed for suitability.
Adequate ventilation during
charging process.
Battery charging unit receives
regular P A Test.
Low
4. Tick if any of the identified hazards relate to any of the following specific themes:
Hazardous
Substance
Batteries
Manual
Handling
yes
Fire
Charging
of batteries
Work Equip /
Machinery
Use of hoists
Individual Person such as vulnerable staff
member of chair user. (Staff risk assessments)
If any are ticked a specific risk assessment form must be completed separately. For example a COSHH form must be completed if a
hazardous substance is used.
5. Risk Rating
The risk rating is used to prioritise the action required. Deal with those hazards which are high risk first.
Risk Rating
Description
Action Priority
High
Where harm is certain or near certain to occur and/or major
Urgent action
injury or ill-health could result
Medium
Where harm is possible to occur and/or serious injury could
Medium priority
result e.g. off work for over 3 days
Low
Where harm is unlikely or seldom to occur and/or minor injury No action or low priority action
could result e.g. cuts, bruises, strain
6. Assessment
Signature of Assessor(s):
Signature of Line Manager:
Date Assessed:
Review Date:
7. Reviews
Signature of Assessor(s):
Signature of Line Manager:
Date Assessed:
Review Date:
Appendix B
Wheelchair Unique Serial
Number :
General condition
 The wheelchair unfolds and folds
easily
 The wheelchair moves in a
straight line (no resistance or
drag)
 Missing or loose parts
 Handgrips securely in place
Manual Brakes
 The brakes are easy to operate
and lock in position.
 The wheels do not turn when the
brakes are applied – put on
brakes and apply downward and
forward pressure on handles to
ensure wheels do not turn.
 The brakes do not touch the
tyres when moving
Cross bars
 Are not worn or bent
 Cross brace locks easily into
position
Armrests
 Firmly attached but easy to
remove
 Padding is in good condition
Seat and backrest upholstery
 Good condition and clean
 Tears or undone stitching
Wheelchair Weekly Checklist
Date
Y N
Action
Date
Y N
Action
Date
Y N
Action
Date
Y N
Action
Wheels
 Wheel nut and sealed bearings
are tight
 Wheels run free with no “wobble”
when lifted from the ground and
turned
 Quick release axles correctly
locked
 Bent, broken or slack spokes
Tyres
 Pneumatic tyres are correctly
inflated – check pressure with a
gauge or by squeezing with
thumb and index finger on either
side of the tyre. The tyre should
remain firm.
 Running surface of tyres should
be free from cracks and not
excessively worn
Footrests
 Compatible with type of
wheelchair
 Both footrests the same make
 Fitted correctly
 Lock into position
Lap/Posture Belts
 Compatible with wheelchair
 Fitted correctly
 Secured to wheelchair
 Signs of wear and tear
Assessor
Print name:
Print name:
Print name:
Print name:
Signature:
Signature:
Signature:
Signature: