Mobility Recommendations: Facilitating Critical …...responsibility of patient safety and updating...
Transcript of Mobility Recommendations: Facilitating Critical …...responsibility of patient safety and updating...
H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE,
AN NCI COMPREHENSIVE CANCER CENTER – Tampa, FL
1-888-MOFFITT (1-888-663-3488) | MOFFITT.org
Background
Mobility Recommendations: Facilitating Critical
Transitional Communication
Nancy Keating, PTA; Christine Alvero, DPT, MBA; Amy Patterson MSN, RN, AOCNS®, BMTCN™;
Cassandra Vonnes, ARNP, MS, GNP-BC, FAHA; Lisa Grady, RN, BSN
Tampa, Florida
Results
Discussion
Falls and falls with injury continue to be a top adverse event and even more
important in a vulnerable oncology population in which 40% are over 65
years of age. A comprehensive fall and injury prevention program was
initiated in concert with this communication tool. The prevention plan
included a valid and reliable instrument to assess risk, post fall assessment
and team huddle to discuss the fall events, implementation of environmental
changes along with adaptation of environment.
Although this communication tool did not demonstrate a statistically
significant difference related to outcomes, the mobility card provided an
opportunity to relay to an interprofessional team critical elements related to
patient transfer abilities during transitions in care. It was found anecdotally
to enable the transport team to offer a “mobility needs handoff” to diagnostic
and interventional non-nursing clinicians. Clinical team members outside of
nursing service may have historically been outside the assessment and
interventions related Falls Prevention Program. Addition of “bed alarm”
and “chair alarm” include an element of accountability for patient safety.
Yearly NDNQI competency requirements reflect the Mobility
Recommendation Card completion. As part of new hire orientation, the
Mobility Recommendation Card is reviewed including the shared
responsibility of patient safety and updating mobility recommendations.
After two years in use, the mobility card is hardwired into the Inpatient Fall
and Injury Prevention Standard and bedside hand-off.
Setting
Methods
• An Interprofessional and support service team developed universal
signage identifying patient transfer requirements (such as gait belt,
assistive devices or lift team assistance) fall risk, transport needs and
alarms.
• Pilot study on Blood and Marrow Transplant Unit was well received by
physical therapy and nursing. Respiratory therapy and Transporter
services were included after the pilot was complete As part of a
comprehensive fall prevention program, the Fall Prevention Committee
(FPC) reviewed the pilot study recommendations and amended fall
protocol to include Mobility Recommendation Card.
• Guidelines for ongoing evaluation of patients’ mobility needs and
documentation is open to all members of direct care team including
technicians who often can provide insight into patient capabilities.
• Patient advisors participate in the FPC strongly reviewing the card for
confidentiality and layperson terminology.
• Standardized laminated Mobility Recommendations are present on all
patient doors.
• Implementation included extensive cross department education.
Mobility Recommendation Cards Talking Points
Proposed changes (devised from feedback from the direct patient care
staff) on filling out the patient mobility recommendation cards at the
last in-patient nursing council committee meeting.
Necessary items staying the same on the card:
When should card be completed: Card should be completed upon
admission or if any status changes occur
Who fills out card: Nurse, Oncology Tech, Physical/Occupational
therapist, Lift tech
Date: the date needs to be filled out daily and kept current
If patient is independent: then just fill out date and write independent
on card.
Discharges: Card should be wiped clean and placed back on door to
be ready to be used for next patient
Changes:
You still need to complete assistance level required section for only
the following categories: minimal, moderate, or maximum: example:
min assist x 1(how many caregivers); mod assist x 2 etc.
While the Lift techs are completing their rounds they will assist in
making sure that the information on the mobility cards are wiped clean
if they see that a patient has been discharged.
Monitoring Adherence
Rehab Services provides documentation within the daily progress
notes to include mobility recommendations.
Safe Patient Handling and Nursing Quality Department monitor
adherence to mobility card completion quarterly.
References
Agency for Healthcare Research and Quality ( January 2013). ‘Preventing
Falls in Hospitals: A Toolkit for Improving Quality of Care”
http://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtoolki
t.pdf.
Appendix B6: Mobility and Transfer Assessment. October 2014. Agency for
Healthcare Research and Quality, Rockville, MD.
http://www.ahrq.gov/professionals/systems/long-term-
care/resources/injuries/fallspx/fallspxmobility.html
Boynton, T., Kelly, L., Perez, A., Miller, M., An., Y., & Trudgen, C. (2014).
Banner mobility assessment tool for nurses: instrument validation. American
journal of safe patient handling movement, 4(3): 86-92.
Hurley, A., Dykes, P.,et al. (2009) “Fall TIP: validation of icon to
communicate fall risk status and tailored interventions to prevent patient
falls.” Studies Health Technology Informatics 146: 455-459.
Decreased mobility commonly occurs during hospitalization. After one day in
bed, up to 3% of muscle mass can be lost. It takes 3 to 6 days to recover the lost
strength.
Maintaining mobility and functional status during hospitalization helps
maintain strength, improves balance, prevents falls and skin breakdown, and
shortens hospital stays.
Health care team members are at risk for work related musculoskeletal
disorders when patient limitations are not communicated during handoff.
Patient specific ambulation requirements and risk for fall or injury are critical
interprofessional communication.
Oncology patients may require an extended length of stay and demonstrate
functional decline and in many situations suffer a fall. Support services often
do not receive a handoff delineating patient safety.
Transitions in care are a vulnerable time frame and injury to patient and health
care team member can occur..
• At our NCI-designated inpatient cancer treatment center located in the
southeastern United States, 40% of the total discharges are over the age of
65.
• The average length of stay ( including Blood and Marrow Transplant unit)
is 6.8 days.
• A Blood and Marrow Transplant unit was targeted for this initial piloting
initiative due to a prolonged length of stay. This patient population receives
chemotherapeutic interventions, management of oncologic treatment
consequences including steroid induced myopathy, and cancer progression
care.
• Full time transporter services provide wheelchair and stretcher transport for
perioperative, discharges, diagnostic and interventional procedures.
Approximately 10,000 patients transports per month occur.
Acknowledgements
The Fall Prevention Committee would like to acknowledge to acknowledge
the nurses and physical therapists that work in the Blood and Marrow
Transplant Unit. Special thanks to Yvonne Perez , DPT for the review and
preparation of this poster presentation.
To develop a tool that can communicate patient fall risk, assistive needs, and
alarms to an interprofessional direct care team in real time in a concise and
convenient method.
Purpose
Outcomes
• Reduction in patient injuries related to falls
• Reduction of team member injuries related to patient mobilization
0
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2011 2012 2013 2014 2015
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Team Member Injuries Mobilizing Patients
# injuries mobilizing pts.
Implementation in May
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2011 2012 2013 2014 2015
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Inpatient Falls and Falls with Injury
Falls Falls with injury
Implementation in May