Mobilize Me : The Ready-Set-Go Approach to Mobilizing the Acute Elder Population

Transcription

1 Mobilize Me : The Ready-Set-Go Approach to Mobilizing the Acute Elder Population Lily Spanjevic, RN, MN & Amy dehueck, BScPT Advanced Practice Nurse Professional Practice Leader-Physiotherapy Geriatrics-Medicine Stroke Care Coordinator

2 Presentation Objectives 1. To understand the patient population on a medical unit and evaluate the effectiveness of a mobility program. 2. To learn strategies on how to engage patients and staff in changing practice. 3. To understand the impact of a mobility program on acute medicine culture.

3 The Challenge: A majority of patients on an acute medicine unit are elderly, and often have multiple co-morbidities that effect their ability to mobilize, to perform tasks independently and potentially increase their risk for deconditioning, adverse events and prolonged hospitalization. With increasing patient needs, how can staff promote and optimize mobility for this population?

4 Literature Review Joseph Brant Memorial Hospital Hospitalized patient ambulate infrequently (Callen, 2004). Bed rest creates detrimental physiological changes (Covertino, 1997). Risk factors for deconditioning have been identified (Fried et al, 2001). Lower mobility levels in hospitalized patients have been associated with discharge to nursing home (Callen 2004, Brown 2004) and death (Brown 2004). Specific foci for nursing assessment and interventions to promote patients mobility can possibly improve patient s functional outcome, however specific interventions need to be identified (Kneafsey, 2007). Nurses willingness to be involved directly in a patient s exercise activity is not well understood (Speir & Neis, 1994).

5 Documentation Development Interprofessional working group developed: Standards of Care for Mobilization Patient Mobilization Strategy algorithm: staff version and plain language version for patients/families RN/RPN Mobilization Competencies

6 The Mobility Algorithm

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9 Focus Groups: Garnering staff responses to the mobility problem Two focus groups were held with nursing and physiotherapy staff. A set of 7 questions were asked to determine how staff define, assess, and optimize mobility for their patients. Barriers and facilitators were also discussed, along with potential ideas to assist with implementing evidence-based practice at the bedside. The responses were categorized in themes to help generalize data.

10 1. What does mobility mean to you? Staff (N=32) Avoiding patient complications(20) Understanding the patient s mobility level (15) Patients (N=30) To be able to go home (23) Independence (28)

11 2. How do you assess mobility? Staff (N=32) Asking/talking to the patient (21) Understanding patients baseline (10) Physiotherapy does it (8) Patients (N=30) Compare day to day function (13) I don t know (17)

12 3. How do you provide time for mobility? Staff (N=32) During care (20) When there is time (12) Patients (N=30) After After care care (10) (10) I I need need help help from from the the staff (20) staff (20) 4. What are the facilitators? Staff (N=32) Availability of staff (18) Availability of equipment (7) Extra time (20) Patients (N=30) Availability of staff (20) Encouragement from others (8) Right type of equipment (10) Pain control (8)

13 5. What are the barriers? Staff (N=32) Lack of time (20) Availability of staff (18) Not enough equipment (20) Patients (N=30) Belief rest is best (17) Lack of encouragement (22) Lack of staff availability (24) 6. What are some potential solutions? Staff (N=32) More equipment Family involvement Dedicated time for mobility Helping others understand the impact of mobility/deconditioning Improving communication Patients (N=30) Understanding what I can do Helping the staff understand I need to get up and moving Family and nurses helping me to move Access to rehab services Getting the right gait aides

14 7. What are the comments on the mobilization algorithm? Staff (N=32) Information is not new (11) How to involve the physicians? (8) It streamlines interventions (14) Not useful (4) It will be helpful for staff and patients (30) It can improve communication with the team, family, and patients (23) Patients (N=30) I like it (25) It is easy to understand (27) I like the ability to achieve goals, it adds some targets (17) I know what I need to do (21) I m already active (9)

15 Education Staff Interactive mobilization inservices Mobilization reference manual RN/RPN mobilization competency document 1:1 coaching sessions Patients & Families 1:1 daily rounds Acute Medicine booklet Patient Mobilization Algorithm

16 Evaluating Program Effectiveness Pre-Implementation Measure staff knowledge on mobility ax and interventions. Method: survey Measure patient deconditioning level; mobility knowledge and motivation to participate. Method: 1:1 interview Post-Implementation Measure staff knowledge on mobility ax and practice change. Method: Repeat survey Measure patient s level of mobility improvement (as per algorithm); level of satisfaction with the Mobility program and perceived ability to remain active post discharge. Method: 1:1 interview (1-2 day pre-discharge)

17 Self-evaluation: Patient knowledge about mobility and motivation to participate N=32 Mean SD Pre-Implementation Post-Implementation Change % C.I Significance Value p>0.0001

18 N=30 Patient satisfaction with Mobilization program Very Satisfied with Mobility Program: 82% Satisfied : 11% Neither Satisfied or Unsatisfied: 2% Not satisfied: 5% Knowledge change about mobility More knowledgeable: 49% Perceived ability to remain active post discharge Very capable: 71% Somewhat capable: 26% Unsure: 3% Somewhat more knowledgeable: 25% No change: 26%

19 Patients over the age of 65 years old and their admitting diagnosis (N=112)

20 Joseph Brant Memorial Hospital Patient mobility and deconditioning improvement while in hospital % improved mobility % decreased deconditioning risk factor Ca rdiac Co nfusion /Dementia CH F Electrolyte imba la nce ETOH/overdose FTT GI/Lower Back Pain GI/Rectal Bleed Ne urological Mets Pneumo nia Renal Failure Respiratory Sepsis Syncope UTI

21 Results of patients deconditioning risk factors and mobility goal attainment Most active group(or highest goal level) on admission: Cardiac. Least active group (or lowest goal level) on admission: GI bleed, electrolyte imbalance, and UTI. Most deconditioned group on admission: Mets. Least deconditioned group on discharge: Respiratory and Weakness The group with the most mobility improvement while in hospital: Syncope/dizziness (87%), FTT (75%), GI/lower back pain (71%), CHF( 70%).

22 Results of patients deconditioning risk factors and mobility goal attainment The group with the least change in deconditioning: Cardiac (27%), FTT (25%) The group who made the most improvement in their deconditioning risk scores while in hospital: Renal Failure (100%), Sepsis (100%), ETOH (100%), CHF (87%), Confusion (73%).

23 Key messages... The overwhelming majority of elder patients in an acute medical unit want to mobilize regularly but need help/support from the healthcare team. More elder patients ambulated when nurse provided opportunities for ambulation, and/or families supported them. Nurses are key health care providers that need to assess and initiate mobilization with their patients. Mobilization needs to be a goal for every patient.

24 Future considerations... RESEARCH-RESEARCH-RESEARCH Initiating the Mobilization Program in the Emergency Department Determining the most effect mobilization interventions for specific medical diagnosis. Determining long term effectiveness of the Mobilization Program post discharge. Including mobilization as an area of focus in nursing curriculum.

25 Lily Spanjevic Amy dehueck