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mobility program cbl (2).pptfinal


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Power Point Presentation on how increasing Mobility improves outcomes in our hospitalized elderly population

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mobility program cbl (2).pptfinal

  1. 1. Mobility Program Trial
  2. 2. Why Consider Mobility and Function In Our Older Patients? <ul><li>Immobility can be devastating! </li></ul>
  3. 3. <ul><li>Cardiovascular - stroke volume, cardiac output </li></ul><ul><li>Respiratory – respiratory excursion, oxygen uptake, potential for atelectasis </li></ul><ul><li>Muscles - muscle strength, muscle blood flow </li></ul><ul><li>Bone – bone loss, bone density </li></ul><ul><li>GI – Malnutrition, anorexia, constipation </li></ul><ul><li>GU – Incontinence </li></ul><ul><li>Skin – Sheering force, potential for skin breakdown and pressure ulcers </li></ul><ul><li>Psychological – social isolation, anxiety, depression, disorientation </li></ul>Negative Effects of Bed Rest
  4. 4. Decline Can Happen Quickly! <ul><li>Begin a functional assessment on admission and provide early nursing interventions to prevent or minimize deconditioning and functional decline. </li></ul>
  5. 5. The Costs of Functional Decline Are Both Human and Financial <ul><li>Increased risk of illness and death </li></ul><ul><li>Often irreversibly diminished quality of life </li></ul><ul><li>Less autonomy and greater dependence </li></ul><ul><li>May lead to nursing home placement </li></ul><ul><li>Increased length of hospital stay and readmissions </li></ul>
  6. 6. Positive Effects of Mobility <ul><li>Maintain strength </li></ul><ul><li>Maintain daily activities </li></ul><ul><li>Promote good circulation </li></ul><ul><li>Prevent infection </li></ul><ul><li>Prevent skin breakdown </li></ul><ul><li>Prevent complications </li></ul>
  7. 7. So Let’s Get Moving!! <ul><li>“ Assessment of function and targeting interventions during hospitalization are critically important to acute care of older adults.” </li></ul><ul><li>Patient Safety and Quality: An Evidenced-based Handbook for Nurses. AHRQ, 2008. </li></ul>
  8. 8. Program Goals <ul><li>Nurses will assess patient’s prior activity and functional status. </li></ul><ul><li>Maintain patient’s daily routine. </li></ul><ul><li>Promote safe mobility consistent with the medical plan of care. </li></ul><ul><li>Up for meals. Ambulate in the hall. </li></ul><ul><li>ROM for patients on Bed Rest. </li></ul><ul><li>Educate patient and family on importance of activity and ambulation. </li></ul><ul><li>Shift report to include patient’s physical activity. </li></ul>
  9. 9. Target Population <ul><li>Our elder patients </li></ul><ul><li>All patients age 70 and older will be included in the Mobility Program. </li></ul>
  10. 10. Prior Functional Assessment <ul><li>Complete a prior functional assessment for all patients age 70 and older on admission </li></ul><ul><li>Katz Independence of ADL’s Scoring Tool (see next slide) </li></ul><ul><li>What was the patient’s prior level of function? </li></ul><ul><li>Ask what activities the patient could perform and what assistance they needed two weeks prior to this hospitalization </li></ul>
  11. 11. Katz Independence of ADL’s Scoring Tool Score of 0 = Low, Patient is very dependent Score of 6 = High, Patient is independent Total Points: ____________ (0 POINTS) Needs partial or total help with feeding or requires parenteral feeding. (1 POINT) Gets food from plate into mouth without help. Preparation of food may be done by another person. FEEDING Points:______ (0 POINTS) Is partially or totally incontinent of bowel or bladder. (1 POINT) exercises complete self control over urination and defecation. CONTINENCE Points:______ (0 POINTS) needs help in moving from bed to chair or requires a complete transfer. (1 POINT) Moves in and out of bed or chair unassisted. Mechanical transfer aids are acceptable. TRANSFERRING Points:______ (0 POINTS) Needs help transferring to the toilet, cleaning self or uses bedpan or commode. (1 POINT) Goes to toilet, gets on and off, arranges clothes, cleans genital area without help. TOILETING Points:______ (0 POINTS) Needs help with dressing self or needs to be completely dressed. (1 POINT) Get clothes from closet and drawers and puts on clothes and outer garments complete with fasteners. May have help typing shoes. DRESSING Points:______ (0 POINTS) Needs help with bathing more than one part of the body, getting in or out of the tub or shower. Requires total bathing. (1 POINT) Bathes self completely or needs help in bathing only a single part of the body such as the back, genital area or disabled extremity. BATHING Points:______ Dependence (0 Points) WITH supervision, direction, personal assistance or total care Independence (1 Point) NO supervision, direction or personal assistance Activities Points (1 or 0) Katz Index of Independence in Activities of Daily Living
  12. 12. Daily Mobility and Functional Assessment <ul><li>Falls Risk Assessment Score </li></ul><ul><li>You are already completing this as part of the Falls Prevention Program </li></ul><ul><li>Note the patient’s mobility/balance level </li></ul><ul><li>Note independence/dependence with activities of daily living </li></ul><ul><li>Note patient’s risk for falls </li></ul><ul><li>Assess daily for progress or decline in patient’s mobility level </li></ul>
  13. 13. Mobility Cards <ul><li>Mobility cards are a screening tool and cue for the Mobility Program </li></ul><ul><li>All patients age 70 and older will have a Mobility Card posted by their bed </li></ul><ul><li>3 levels of mobility determined by the Falls Risk Assessment Score and *activity medical orders </li></ul><ul><li>* Always check the patient’s medical orders for activity . </li></ul><ul><li>Update the patient’s Mobility Card as their status or activity orders change </li></ul>
  14. 14. Mobility Card Levels <ul><li>Determined by the Falls Risk Assessment Score </li></ul>3  = / > 5 2  3 to 4 1  < 1 = 2 Mobility Card Falls Risk Assessment Score
  15. 15. Mobility Card – Level I
  16. 16. Mobility Card – Level II
  17. 17. Mobility Card – Level III
  18. 18. Nursing Assessment Key Points <ul><li>Assess all patients age 70 and older </li></ul><ul><li>Katz Independence of ADL’s Scoring Tool on admission </li></ul><ul><li>Falls Risk Assessment Score daily </li></ul><ul><li>Determine medical orders for activity level </li></ul><ul><li>Assess for impediments to mobility such as arthritis, neurological disease, cardiopulmonary activity intolerance, pain, medical devices and others. </li></ul><ul><li>Continued… </li></ul>
  19. 19. Nursing Assessment Key Points Continued… <ul><li>Evaluate need for assistive devices. </li></ul><ul><li>Safety needs </li></ul><ul><li>Risk for pressure ulcers </li></ul><ul><li>Nutritional status </li></ul><ul><li>Patient and family concerns and motivation </li></ul>
  20. 20. Let’s Get Moving! <ul><ul><li>Collaborate with physician, patient, family and health care team to develop a plan of care for mobility </li></ul></ul><ul><ul><li>Promote safe mobility consistent with medical plan of care </li></ul></ul><ul><ul><li>Maintain patient’s daily activities </li></ul></ul><ul><ul><li>Utilize the Mobility Card to communicate patient’s mobility level </li></ul></ul><ul><ul><li>Utilize the SBAR to communicate patient specific activities and medical orders </li></ul></ul><ul><ul><li>Utilize the Mobility Care Plan Sticker to plan nursing care. </li></ul></ul>
  21. 21. Mobility Nursing Care Plan Sticker
  22. 22. SBAR
  23. 23. Bed Rest <ul><li>Patients on Bed Rest: </li></ul><ul><li>Encourage and assist patients to stay as active as possible by turning themselves in bed and participating in their care as possible </li></ul><ul><li>Turn patient at least every 2 hours when they cannot participate in their care </li></ul><ul><li>Perform active/passive range of motion TID as needed </li></ul><ul><li>Assess daily with physician the need for continued bed rest </li></ul>
  24. 24. Up To Chair <ul><li>Patients who are able to get up to the chair – </li></ul><ul><li>Encourage to get up to chair independently or with assistance, preferably for meals </li></ul><ul><li>Encourage self feeding as able while up in chair </li></ul><ul><li>Up to commode for toileting as able. Consider a toileting routine to promote continence. </li></ul>
  25. 25. Ambulation <ul><li>Patients who are able to ambulate – </li></ul><ul><li>Encourage and/or assist with ambulation 3 times a day as tolerated </li></ul><ul><li>Encourage walking in the hallway if able </li></ul><ul><li>Promote use of bathroom and activities outside of the room as appropriate </li></ul>
  26. 26. Lift Equipment <ul><li>Utilize appropriate lift equipment </li></ul><ul><li>Have transfer sheet and other lift equipment available in patient’s room </li></ul>
  27. 27. Nursing Intervention Key Points <ul><li>Plan for mobility </li></ul><ul><li>Minimize bed rest </li></ul><ul><li>Safety / Falls Prevention </li></ul><ul><li>Pressure Ulcer Prevention </li></ul><ul><li>Pain management </li></ul><ul><li>Judiciously use medications, especially psychoactive medications </li></ul><ul><li>Continued…. </li></ul>
  28. 28. Nursing Intervention Key Points Continued…. <ul><li>Explore alternatives to physical restraints </li></ul><ul><li>PT/OT referrals for functional decline </li></ul><ul><li>Minimize use of foley catheters </li></ul><ul><li>Toileting schedules to promote continence </li></ul><ul><li>Nutritional support for energy </li></ul><ul><li>Nutrition consult for intake < 50% </li></ul><ul><li>Education and support for elders and their families </li></ul>
  29. 29. Tips from PT/OT <ul><li>Encourage all patients to get out of bed and walk as able </li></ul><ul><li>Up in chair for meals </li></ul><ul><li>Stand or sit at the sink to complete light hygiene </li></ul><ul><li>Encourage patients to use the toilet as soon as possible </li></ul><ul><li>Encourage patients to be up with their visitors </li></ul>
  30. 30. Tips for Continence <ul><li>Transient Incontinence </li></ul><ul><li>Hospitalized older adults are at risk for developing transient incontinence. </li></ul><ul><li>Transient incontinence is characterized by a sudden onset. </li></ul><ul><li>Transient incontinence is often preventable or reversible. </li></ul><ul><li>Mobility dependency is a risk factor for new on-set, transient urinary incontinence. </li></ul><ul><li>Transient incontinence may become established incontinence if not recognized and resolved. </li></ul>
  31. 31. Tips for Continence <ul><li>Causes of Transient Urinary Incontinence </li></ul><ul><li>D - Delirium or confusional state </li></ul><ul><li>I - Infection, UTI </li></ul><ul><li>A - Atropic urethritis/vaginitis </li></ul><ul><li>P - Pharmaceuticals </li></ul><ul><li>P - Psychologic, especially depression </li></ul><ul><li>E - Endocrine (hypercalcemia, hyperglycemia) </li></ul><ul><li>R - Restricted mobility </li></ul><ul><li>S - Stool impaction/constipation </li></ul>
  32. 32. Tips for Continence <ul><li>Key Points </li></ul><ul><li>Being able to walk, having use of a bedpan or commode and nursing assistance with toileting fosters continence in the geriatric patient in the acute care setting. </li></ul><ul><li>Minimize the use of indwelling urinary catheters (which may impede mobility). </li></ul><ul><li>Set up a toileting schedule every two hours and provide verbal cues and assistance with toileting as needed. </li></ul>
  33. 33. Tips From Nutritionist <ul><li>The Importance of Nutrition and Mobility in Older Patients </li></ul><ul><li>Need for higher nutrient density due to body muscle changes. </li></ul><ul><li>Close link between physical function and nutrition at old age. </li></ul><ul><li>Maintained or increased need for nutrients, such as protein, calcium and vitamins D, B 6 , B 12 and C. </li></ul><ul><li>Improved physical function only when combining exercise (resistance training) and nutrition. </li></ul><ul><li>May need nutritional supplements to reach proper nutrition. </li></ul>
  34. 34. Tips From Nutritionist <ul><li>The Importance of Nutrition and Mobility </li></ul><ul><li>Document % PO intake. </li></ul><ul><li>Does the patient consume at least 50% of food at meals? If not, refer to RD. </li></ul><ul><li>Assist with feeding and supplements as needed. </li></ul><ul><li>Patient and family education. </li></ul>
  35. 35. Working Smarter to Meet the Needs of Our Elder Patients <ul><li>Workflow Guidelines for Mobility Program </li></ul><ul><li>The Mobility Program will be introduced to patients and families on admission along with the Mobility Program Education flyer. </li></ul><ul><li>SBAR report RN to RN to include daily mobility goals (see SBAR Activity section). </li></ul><ul><li>RN to CNA report. </li></ul><ul><li>Vital sign times: 0800, 1200, 1600, 2000, 2400, and 0400. </li></ul><ul><li>Day shift RN will do 0800 V/S and CNA will do 1200 & 2000. </li></ul><ul><li>CNA to perform AM Care and first ambulation. </li></ul><ul><li>Hourly rounding. </li></ul>
  36. 36. Working Smarter to Meet the Needs of Our Elder Patients <ul><li>Workflow Guidelines for Mobility Program – cont. </li></ul><ul><li>Baths to be given on Tues, Thurs & Sat for ODD numbered rooms and Mon, Wed, Fri for EVEN number rooms. Sunday baths given prn. Charge nurse will assign baths. </li></ul><ul><li>AM and PM hygiene care will be given to all patients every day. </li></ul><ul><li>Linen changes will be done with baths and when soiled. </li></ul><ul><li>All patients will be out of bed for at least 2 meals a day as tolerated unless strict bed rest is ordered. </li></ul><ul><li>RN to communicate with Physicians to obtain appropriate mobility/activity orders for patient. </li></ul><ul><li>Utilize Mobility Care Plan Sticker, SBAR report and Mobility Cards to communicate mobility plan for patient. </li></ul>
  37. 37. Scripting – Patient & Caregiver <ul><li>Linen and bathing – </li></ul><ul><li>Notifying patient of scheduling on admission: </li></ul><ul><ul><li>“ Personal hygiene care is provided daily and complete baths are encouraged every other day. Linens are changed with the bath every other day. We encourage you to participate in your bath and shower as able. Please let your nurse know if you need additional care.” </li></ul></ul>
  38. 38. Scripting – Patient & Caregiver <ul><li>Mobility Program – </li></ul><ul><li>Inform patients and caregivers of the Mobility Program and goals upon admission: </li></ul><ul><ul><li>“ Staying active with your usual activities such as walking, bathing and sitting up for meals is important for your health and helps to maintain your strength. The Mobility Program is designed to help you with this.” </li></ul></ul><ul><ul><li>Give patient and families the Mobility Program Flyer. </li></ul></ul>
  39. 39. Scripting – Patient & Caregiver <ul><li>Patient Motivation – </li></ul><ul><li>Provide encouragement about the benefits of mobility and activity: “You will get stronger, be less likely to fall...” </li></ul><ul><li>Provide encouragement about the patient’s ability to perform the activity. Reassurance: “You can do it.” </li></ul><ul><li>Practice. Encourage actual performance / practice doing the activity – walking, bathing…acknowledge patient effort and successes. </li></ul>
  40. 40. Educate Elders and Family <ul><li>Educate elders and family on the value of independent functioning and the consequences of functional decline </li></ul><ul><ul><li>Strategies to prevent functional decline </li></ul></ul><ul><ul><ul><li>Exercise </li></ul></ul></ul><ul><ul><ul><li>Nutrition </li></ul></ul></ul><ul><ul><ul><li>Pain management </li></ul></ul></ul><ul><ul><ul><li>Socialization </li></ul></ul></ul>
  41. 41. Patient and Family Flyer
  42. 42. Patient and Family Education <ul><li>Provide Mobility Program information and flyer on admission </li></ul><ul><li>Teach back daily with education questions </li></ul>
  43. 43. Teach Back for Patient Education <ul><li>Day 1 </li></ul><ul><li>“ Who will be helping you at home so that we can include them in your daily education?” </li></ul><ul><li>What is: </li></ul><ul><ul><li>Our Mobility Program? </li></ul></ul><ul><ul><li>Your mobility Goal for today? </li></ul></ul>
  44. 44. Teach Back for Patient Education <ul><li>Day 2 </li></ul><ul><li>Why should you: </li></ul><ul><ul><li>Exercise today? </li></ul></ul><ul><ul><li>Exercise every day? </li></ul></ul><ul><ul><li>Know the signs and symptoms of when to stop exercising? </li></ul></ul>
  45. 45. Teach Back for Patient Education <ul><li>Day 3 </li></ul><ul><li>How will you: </li></ul><ul><ul><li>Exercise every day when you are at home? </li></ul></ul><ul><ul><li>Change your lifestyle to increase your activity every day at home? </li></ul></ul><ul><ul><li>Know when to stop exercise? </li></ul></ul><ul><ul><li>Assist us with today’s plan of care? </li></ul></ul>
  46. 46. Documentation <ul><li>Katz Index on Mobility Care Plan Sticker </li></ul><ul><li>Falls Assessment Score in NA&I/Falls </li></ul><ul><li>Activities NA&I/ADL </li></ul><ul><li>Repositioning NA&I/Pressure Ulcer Prevention </li></ul><ul><li>Education NA&I/Education/Activity and Exercise </li></ul>
  47. 47. Mobility Program Summary <ul><li>1. Katz Functional Assessment on Admission </li></ul><ul><li>2. Falls Assessment Score daily </li></ul><ul><li>3. Mobility Card in patient room </li></ul><ul><li>4. SBAR Activity Communication </li></ul><ul><li>5. Mobility Care Plan Sticker </li></ul><ul><li>6. Document in HED </li></ul>