Creating a Hospital Nurse-Driven Mobility Program - Why and How Physical Therapist Should Lead the Way, GCS University of North Georgia Grady Health System
The Problem The Solution The How To
F u n c t i o n a l The Problem L e v e l Hospital Admit Medical Treatment Getting Ready for Discharge Discharge
The Problem Did not mobilize outside of their room (Zisberg, 2015) Percentage of time spent lying in bed during hospitalization (Brown, 2009) Mean number of steps per hospital day. 6,000 to 8,500 steps the norm for 65+. (Fisher, 2010) Time spent, on average, standing or walking (Brown, 2009) Time spent, on average, sitting in a chair (Brown, 2009)
The Problem Have a functional decline at time of hospital discharge (Zisberg, 2015) Had a functional decline 1 month after hospitalization (Zisberg, 2015) More likely to have decline in functional status at discharge if they had low inpatient mobility level (Brown, 2004) Discharged to destination other than home after hospital admission (Nagurney, 2017) Remain dependent at 1 year after discharge (Barnes, 2012; Boyd, 2008)
F u n c t i o n a l The Solution L e v e l Hospital Admit Nurse-Driven Mobility Program Medical Treatment Getting Ready for Discharge Discharge
The Solution In-Hospital Mobility Programs
The Solution In-Hospital Mobility Programs There was an associated 2% reduction in risk of death within the next 2 years - when steps gained in first 24 hours of hospitalization (Ostir, 2013). Likewise, there was an associated 3% reduction in risk of death within 2 years when increased steps performed during the last 24 hours of hospitalization. (Ostir, 2013)
The Solution In-Hospital Mobility Programs After implementation of a mobility program (Von Renteln-Kruse, 2007)
The How To Functional Assessment Ability Levels Activity Plan
The How To Functional Assessment Nursing staff will use a simple functional test to determine the patient s basic functional level at admission Options: Sit to Stand, Timed Up & Go, or Gait Speed
Functional Assessment Assessment Able to rise from a chair without using their arms to assist Able to rise from a chair, without assist from another person, but using their arms to assist Able to rise from a chair only with assistance from another person Unable to rise from a chair, even with assistance from another person On Medical Bedrest
The How To Ability Levels Categorize and Label each patient according to the patient s ability to perform the functional task. Example: Green = Ability to rise from a chair without use of their arms = Independent
Ability Levels Assessment Able to rise from a chair without using their arms to assist Able to rise from a chair, without assist from another person, but using their arms to assist Able to rise from a chair only with assistance Unable to rise from a chair, even with maximal assistance from another person On Medical Bedrest Category Green Yellow Blue Purple Red
The How To Activity Plans Nursing staff will implement the Activity Plan that was designed for each Ability Level. The Activity Plans for each Ability Level will center around 3 activities: Walking Bathroom Use Meals
Assessment Able to rise from a chair without using their arms to assist Able to rise from a chair, without assist from another person, but using their arms to assist Able to rise from a chair only with assistance Unable to rise from a chair, even with maximal assistance from another person On Medical Bedrest Category Green Yellow Blue Purple Red Activity Plan * Walk in hallway 3 times a day. * Eat meals in chair * Use bathroom for all elimination * Walk in hallway at least once a day. * Eat most meals in chair. * Use bathroom for most elimination and bedside commode for other. *Walk in hallway at least once a day with nursing assistance * Eat at least one meal at the side of the bed or in a chair * Use Bedside Commode with assistance for all elimination * Sit at edge of bed with nursing assistance at least once a day. * Eat at least one meal at side of bed with assistance * Use bedside commode with assistance. * No out of bed activities safe. * Must have medical indication to be considered Bedrest
The Barriers Nursing Patient & Family Physical Therapists
References Barnes, D. E., Mehta, K. M., Boscardin, W. J., Fortinsky, R. H., Palmer, R. M., Kirby, K. A., & Landefeld, C. S. (2013). Prediction of recovery, dependence or death in elders who become disabled during hospitalization. Journal of General Internal Medicine, 28(2), 261 268. https://doi.org/10.1007/s11606-012-2226-y Boyd, C. M., Landefeld, C. S., Counsell, S. R., Palmer, R. M., Fortinsky, R. H., Kresevic, D., Covinsky, K. E. (2008). Recovery of activities of daily living in older adults after hospitalization for acute medical illness. Journal of the American Geriatrics Society, 56(12), 2171 2179. https://doi.org/10.1111/j.1532-5415.2008.02023.x Brown, C. J., Redden, D. T., Flood, K. L., & Allman, R. M. (2009). The underrecognized epidemic of low mobility during hospitalization of older adults. Journal of the American Geriatrics Society, 57(9), 1660 1665. https://doi.org/10.1111/j.1532-5415.2009.02393.x Brown, C. J., Friedkin, R. J., & Inouye, S. K. (2004). Prevalence and outcomes of low mobility in hospitalized older patients. Journal of the American Geriatrics Society, 52(8), 1263 1270. https://doi.org/10.1111/j.1532-5415.2004.52354.x Fisher, S. R., Goodwin, J. S., Protas, E. J., Kuo, Y.-F., Graham, J. E., Ottenbacher, K. J., & Ostir, G. V. (2011). Ambulatory Activity of Older Adults Hospitalized with Acute Medical Illness. Journal of the American Geriatrics Society, 59(1), 91 95. https://doi.org/10.1111/j.1532-5415.2010.03202.x
References Nagurney, J. M., Fleischman, W., Han, L., Leo-Summers, L., Allore, H. G., & Gill, T. M. (2017). Emergency Department Visits Without Hospitalization Are Associated With Functional Decline in Older Persons. In Annals of Emergency Medicine (Vol. 69, pp. 426 433). https://doi.org/10.1016/j.annemergmed.2016.09.018 Ostir, G. V., Berges, I. M., Kuo, Y.-F., Goodwin, J. S., Fisher, S. R., & Guralnik, J. M. (2013). Mobility Activity and Its Value as a Prognostic Indicator of Survival in Hospitalized Older Adults. Journal of the American Geriatrics Society, 61(4), 551 557. https://doi.org/10.1111/jgs.12170 Zisberg, A., Shadmi, E., Gur-Yaish, N., Tonkikh, O., & Sinoff, G. (2015). Hospital-Associated Functional Decline: The Role of Hospitalization Processes Beyond Individual Risk Factors. Journal of the American Geriatrics Society, 63(1), 55 62. https://doi.org/10.1111/jgs.13193 Von Renteln-Kruse, W., & Krause, T. (2007). Incidence of In-Hospital Falls in Geriatric Patients Before and After the Introduction of an Interdisciplinary Teamâ Based Fall-Prevention Intervention. Journal of the American Geriatrics Society, 55(12), 2068 2074. https://doi.org/10.1111/j.1532-5415.2007.01424.x