Promoting safe use of equipment for neurogenic bowel management

Nurses have a responsibility to monitor patient safety related to the use of equipment. Existing bowel care/shower chairs used by persons with neurogenic bowel can pose serious safety risks for patients. Twenty-four percent of persons with spinal cord dysfunction reported development of pressure ulcers and cuts from the seats, and 35% reported a history of falls from bowel care/shower chairs. Of those who reported injuries due to falls, more than 23% reported that they were hospitalized from 1 month to 4 years due to injuries from the fall. Many of the pressure ulcers and falls that occur from the use of bowel care equipment can be prevented. A combination of design flaws and user error are responsible for these safety risks. Design flaws in existing equipment include seat design, seat configuration, footrests, armrests, hand rims that are difficult to propel when wet, unreliable brakes, and chair frame instability. User error that contributes to pressure ulcers relates to poor posture in the chair. User error that contributes to patient falls relates to leaning over to wash the feet and lack of maintenance of air pressure in the tires, which affects the brakes. A series of research and development projects enabled the authors to design a new bowel care/shower chair that incorporates many new features and inventions to enhance patient safety.