Move to Improve: The Feasibility of Using an Early Mobility Protocol to Increase Ambulation in the Intensive and Intermediate Care Settings
Prolonged bed rest in hospitalized patients leads to deconditioning, impaired mobility and potential for longer hospital stays.Objective
The purpose of this study was to determine the effectiveness of a nurse-driven mobility protocol to increase the percentage of patients ambulating during the first 72 hours of their hospital stay.DesignA quasi-experimental design pre- and post-intervention was used for the study in a 16 bed Adult Medical/Surgical ICU and a 26 bed Adult Intermediate Care Unit (IMCU) at a large community hospital.MethodA multidisciplinary team developed and implemented a mobility order set with an embedded algorithm to guide nursing assessment of mobility potential. Based on the assessments, the protocol empowers the nurse to consult physical or occupational therapy when appropriate. Daily Ambulation Status Reports were reviewed each morning to determine each patient's activity level. Retrospective and prospective chart reviews were performed to evaluate the effectiveness of the protocol for patients 18 years of age and older who were hospitalized 72 hours or greater. RESULTS: /b>In the three months prior to implementation of the Move to Improve project, 6.2% (12 of 193) of ICU patients and 15.5% (54 of 349) IMCU patients ambulated during the first 72 hours of their hospitalization. During the six months following implementation, those rates rose to 20.2% (86 of 426) and 71.8% (257 of 358), respectively.LimitationsThe study was carried out at only one center. CONCLUSIONS:/b>Our initial experience with a nurse-driven mobility protocol suggests that the rate of patient ambulation in an adult ICU and IMCU during the first 72 hours of a hospital stay can be increased.
- Physical Therapy 02/2013; 93(2):128-33. DOI:10.2522/ptj.2013.93.2.128 · 3.25 Impact Factor
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ABSTRACT: BACKGROUND: Functional decline has been identified as a leading negative outcome of hospitalization for older person. Functional decline is defined as a loss in ability to perform activities of daily living including a loss of independent ambulation. In the hospital literature, a patient's loss in ability to independently ambulate during the hospital stay varies between 15 and 59%. Lack of ambulation and deconditioning effects of bed rest are one of the most predictable causes of loss of independent ambulation in hospitalized older persons. Nurses have been identified as the professional most capable of promoting walking independence in the hospital setting. However, nurses do not routinely walk patients. OBJECTIVE: The purpose of this study was to explore the relationship between nurses' attributions of responsibility for ambulating hospitalized patients and their decisions about whether to ambulate. METHODS: A descriptive, secondary analysis of data gathered for a parent study was conducted. Grounded dimensional analysis was used to analyze the data. Participants consisted of 25 registered nurses employed on medical or surgical units from two urban hospitals in the United States. RESULTS: Nurses fell into two groups: those who claimed ambulation of patients within their responsibility of practice and those who attributed the responsibility to another discipline. Nurses who claimed responsibility for ambulation focused on patient independence and psychosocial well-being. This resulted in actions related to collaborating with physical therapy, determining the appropriateness of activity orders, diminishing the risk and adjusting to resource availability. Nurses who attributed the responsibility deferred decisions about initiating ambulation to either physical therapy or medicine. This resulted in actions related to waiting, which involved, waiting for physical therapy clearance, physician orders, risks to decrease, and resources to improve before ambulating. CONCLUSIONS: Nurses who claimed responsibility for ambulating patients within their domain of practice described actions that promoted patient independent function and were more likely to get patient s up to ambulate.International journal of nursing studies 03/2013; 50(9). DOI:10.1016/j.ijnurstu.2013.02.007 · 2.25 Impact Factor
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ABSTRACT: Standardized assessment of patients' activity limitations in acute care settings can provide valuable information. Existing measures have not been widely implemented. To provide evidence for validity of scores on '6-Clicks' measures of Basic Mobility and Daily Activity in acute care. Retrospective measurement study. We used a database from one health system containing '6-Clicks' scores from first and last physical and occupational therapist visits for 84,446 patients. Validity was analyzed by examining differences in '6-Clicks' scores across categories of patient characteristics; ability of '6-Clicks' scores to predict patients' having more than one therapy visit; correlation of '6-Clicks' scores with Functional Independence Measure (FIM) scores; and internal responsiveness over the episode of care. Internal consistency reliability was also determined. '6-Clicks' scores differed across patients' age, pre-admission living situation, and number of therapy visits (P=.000). The areas under receiver operating characteristics curves derived using '6-Clicks' scores at the first visit to predict patients receiving more than one visit were 0.703 and 0.652 using Basic Mobility and Daily Activity scores, respectively. '6-Clicks' scores at the final visit were correlated with scores on subscales of FIM completed on admission to in-patient rehabilitation facilities (r=0.65 and 0.69). Standardized response means were 1.06 and 0.95, and minimal detectable changes (MDC90) were 4.72 and 5.49, for Basic Mobility and Daily Activity scores, respectively. Internal consistency reliability of Basic Mobility and Daily Activity scores was 0.96 and 0.91, respectively. Using clinical databases for research purposes has limitations including missing data, misclassifications and selection bias. Rater reliability is not known. This study provides evidence for the validity of '6-Clicks' scores for assessing patients' activity limitations in acute care settings.Physical Therapy 11/2013; 94(3). DOI:10.2522/ptj.20130199 · 3.25 Impact Factor