Progressive Mobility at AUMC
Why do we need Progressive Mobility Program? National Data shows that Mobility Programs: Reduces hospital LOS/reduces ICU LOS Reduces Ventilator days Reduces Pneumonia/VAP Reduces Pressure Injuries Reduces complications after surgery (ileus/contractures/vte)
WHY? Mobility is part of our basic NURSING standards of care. Mobility is a basic nurse driven activity similar to nutrition and hygiene. Immobility is a risk factor for prolonged recovery, physical deconditioning, skeletal muscle atrophy and bone loss.
WHAT is Progressive Mobility AU is implementing an evidence based progressive mobility program from the American Association of Acute/Critical Care Nurses (AACN). Historically at AU activity in patient orders has defaulted to bedrest. The Progressive Mobility Protocol will be within all Adult inpatient power-plans and will be the default for activity.
WHAT? The nurse will complete an assessment of the patient and determine which Progressive Mobility Level is appropriate. The assessment is based on patients current clinical status and pre-hospital mobility. Progressive Mobility has 4 Levels and also criteria that rules out the patient for progressive mobility.
WHAT? Patients mobility will be assessed every shift and specific interventions implemented at each level. Patients may begin at different levels based on the nursing assessment. Progressive Mobility charting is located in Routine Care under Basic Care
Orders and Documentation Progressive Mobility Orders are within all PowerPlans Once ordered A Progressive Mobility Assessment will fire every 12 hours for the RN to complete When a Level (1-4) is chosen, a mobility intervention task will fire every 8 hours. You will only complete the interventions appropriate for your patients clinical condition.
Documentation Reference text is available for the nurse to review level by clicking of blue text.
WHAT? The nurse will first assess for any exclusion criteria prior to selecting level. Once level is selected documentation for each level will open.
Level 1 Level 1 Passive ROM TID Turn every 2 hours Active Resistance Sitting Position 20 minutes TID Bed mobilization with elevated head of bed 30-45 degrees Reverse Trendelenburg if patient has contraindication for hip flexion Beach Chair Position. When able to move arm against gravity progress to level 2
Level 2 Level 1 activity plus Sitting on edge of bed Bed dangling When able to move leg against gravity progress to level 3
Level 3 Level 2 activity plus Active transfer to chair 20 minutes/day (utilize lift equipment as appropriate) When tolerating OOB to chair >20 minutes/day progress to level 4
Level 4 Level 3 activity plus Ambulation Marching in place Walking in halls
WHAT? Only document what interventions are completed. Not all interventions are appropriate for each patient.
WHEN should Progressive Mobility be performed? Mobility should be assessed every shift and with any change in patient condition. Progressive Mobility interventions should be assessed for tolerance and increased or decreased based on patient condition per guidelines located within the reference text A Task will fire 3 times a day but can be adjusted.
WHO will have Progressive Mobility ordered? All patients > 4 years old will be assessed for progressive mobility. If a patient has specific activity restrictions, the physician will have to place those orders. Only the nurse will complete the assessment of the progressive mobility level. Nurses and/or PCTs may complete progressive mobility interventions.
WHERE will Progressive Mobility be implemented? Progressive Mobility will be implemented in all In- Patient Units for patients > 4 years old. Documentation within CERNER will Go-Live on January 31 st, 2017. Education roll-out and full implementation will be on-going.