Purpose: Prolonged bed rest in hospitalized patients leads to mobility/functional issues, sleep deprivation, delirium, altered nutritional status, increased hospital and post-hospital rehabilitation length of stay, and increased health care costs (Exum, E., & Hull, B., 2019 and Guedes, L. P. C. M., Oliveira, M. L. C. D., & Carvalho, G., D. A., 2018). The purpose of this project was to adapt the “mobility program pilot: maximizing physical therapist (PT) role integrating mobility into nursing workflow” from UAB Medicine in Birmingham, AL, to our particular setting. This evidence-based intervention integrates mobility best practices into patient care. The goal of implementing this program is to maintain baseline mobility and functional capacity during admission for elderly medical-surgical patients as measured via the activity measure for post-acute care (AM-PAC scale). Secondary outcomes related to this goal would be a decrease in falls and skin deterioration, and an increase in patient satisfaction.
Description: The previous process on this 41-bed medical-surgical unit involved waiting for physical therapy (PT) to “clear” the patient to get out of bed, and ambulate, and communicate this in a note. If a patient was not seen right away by PT, then they would typically be on bedrest. This represented an opportunity for improvement, and the mobility technician (MT) role was created based on the mobility program at UAB. The MT spends the greatest percentage of their time mobilizing patients, dependent on age, condition, and functional status, as directed by the interdisciplinary team/nurse. The MT assesses appropriate assistive devices needed for safe mobility. The MT’s other roles include communication with the interdisciplinary team before each activity to understand the patient’s mobility plan, reporting to the nurse about the patient’s status and any concerns, maintaining accurate documentation in the electronic health record (AMPAC scores and exercise/mobility interventions), and cleaning and maintaining mobility equipment after each patient use. Workflows and protocols were created to guide the MT on which patients to mobilize during their shift. Patients are eligible to participate in this program if they are not assessed as independent in their ambulation.
Evaluation/outcomes: Several metrics will be utilized to evaluate successful implementation of the MT role on patient outcomes. The primary outcomes will be the proportion of participating patients with an AM-PAC mobility score greater than 6 and the % change of AM-PAC mobility scores since admission. Secondary outcomes will include the proportion of patients documented on by the MT, the proportion of patients who agreed to ambulate with the MT out of all those asked (to approximate acceptability), average length of stay, number of falls, Braden scores, and patient satisfaction as reported by Press Ganey surveys.
Evidence-based references
1. Exum, Emelia; Hull, & Brian L. (2019). The Process of Implementing a Mobility Technician in the General Medicine and Surgical Population to Increase Patient Mobility and Improve Hospital Quality Measures: A Pilot Study, Journal of Acute Care Physical Therapy, 10 (4), 129-138.
2. Guedes, L. P. C. M., Oliveira, M. L. C. D., & Carvalho, G. D. A. (2018). Deleterious effects of prolonged bed rest on the body systems of the elderly-a review. Revista Brasileira de Geriatria e Gerontologia, 21, 499-506.
3. Nurse-Driven Early Mobility Protocols: Facilitator Guide. Content last reviewed January 2017. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/hai/tools/mvp/modules/technical/nurse-early-mobility-protocols-fac-guide.html