Patient mobility (functional) program/protocol

[Cehurstrn]

What is your hospital doing with nursing for patient function/mobility outside of the critical care area? Do you have a nurse driven program or protocol to mobilize patients?

I am working on developing a program that will focus on educating nurses and patient care technicians on the importance of maintaining function and preventing hospital acquired deconditioning. I think we incidentally developed a culture within our hospital that is so fearful of patients falling that maintaining ambulation and self care abilities of patients fell to the sideline. I want to get our practice realigned and I wanted to see what differing hospitals are doing. I know my outcomes will include:

Completion of daily shift assessments on functional status

Inclusion of addressing function during daily unit huddles/physician rounding

Decreasing use of catheters/bedpans and increase in taking patients to the toilets/showers

Increasing time out of bed including sitting up in the recliner

Nursing being able to identify when to request PT/OT/SLP consults if issues are noted

My main curiosity is how nursing determines which patients are appropriate for ambulation and how their relationship with rehabilitation therapists are in determining this. Thank you!

[Sour Lemon]

Staffing can be a huge issue. People who require a two person assist and/or lots of time are less likely to be encouraged to get up, despite their capability. Risk for fall is another big reason mobility is not always encouraged, but that goes hand in hand with staffing most of the time.

[MunoRN, RN]

I don't generally find it's a lack of knowledge or lack of sufficient intent to keep patients active, it's almost completely a workload issue. Assisting patients up to a recliner for meals takes time, assisting them to the bathroom instead of using a bedpan or BSC takes time, taking them for a walk around the floor takes time, and the problem is that particularly for floor nurses that might have 5 or 6 of these patients there are just too many demands on their time.

[Orion81RN]

Staffing can be a huge issue. People who require a two person assist and/or lots of time are less likely to be encouraged to get up, despite their capability. Risk for fall is another big reason mobility is not always encouraged, but that goes hand in hand with staffing most of the time.

My mind went straight to staffing as well. I was just thinking about all the interventions we enter in our EMRs but do NOT actually have time to do. I can't count how many incentive spirometers I saw at the patient's bedside, clearly untouched for their entire length of stay.

It certainly isn't because we aren't good nurses. We truly just did not have time to implement every intervention. We can sit around all day and come up with interventions, but it boils down to can we realistically implement them. And the answer is no.

[K+MgSO4, BSN]

Proper equipment to mobilise patients. Sara Steady, hoists, mobility aides. Enough staffing to safely mobilise patients. Families that understand it is 2018 and lying in the bed will actually kill you. Help us to help your loved one.

[RNperdiem, RN]

Physical therapists are crucial in my department. With the exceptions of the very obviously independent patient, there is a risk finding out the hard way that the patient is more than a one person assist. I am not a trained physical therapist and am very much aware that I am middle aged and about 100lbs and risk averse. PT does the first evaluation and the nurses follow their recommendations.

Time and assistance can be a problem. A confused patient who might not need a sitter in bed, often really needs a sitter or chair alarm when out of bed. You have to have staff for that.