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HRET HIIN GET UP Virtual Event

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November 16, 2017

Early Mobility Matters: In & Out of the ICU

WELCOME AND INTRODUCTIONS

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Nerissa Legge, Program Manager| HRET

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Agenda for Today

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Poll: How did you hear about this event?

How did you hear about today’s virtual event?a. HRET HIIN flyerb. HRET HIIN websitec. HRET LISTSERV d. State hospital associatione. QIN-QIO f. Your organization/colleagueg. Other, please specify

GET UP! A CROSS CUTTING APPROACH TO ACCELERATE HARM REDUCTION

Jackie Conrad, RN, MBA, RCCImprovement Advisor, Cynosure Health

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Maryanne Whitney, RN, CNS, MSN Improvement Advisor, Cynosure Health

Early Progressive Mobility

Falls Pressure Injuries Delirium CAUTI

Ventilator Associated

Events

VenousThromboEmbolism

Readmissions

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G E T - U P

Cumulative impact on quality of life

• “New Walking Dependence” occurs in 16-59% in older hospitalized patients (Hirsh 1990, Lazarus 1991, Mahoney 1998)

• 65% of patients had a significant functional mobility decline by day 2 (Hirsh 1990)

• 27% still dependent in walking 3 months post discharge (Mahoney 1998)

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• Progressive mobility is defined as a series of planned movements in a sequential matter beginning at a patient's current mobility status with goal of returning to his/her baseline

(Vollman 2010)

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What is progressive mobility?

Elevate HOB

Manual turning

PROM AROM

CLRT and Prone positioning

Upright / leg down position

Chair position

Dangling

Ambulation

MUST DO #1Walk In, Walk During, Walk Out!

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• Determine pre admission ambulation status• Don’t assume a frail appearance means weakness• Use Get Up and Go or Timed Get Up and Go test to

assess ambulation skills

MUST DO #2Grab and Go Mobility Devices!

• Gait Belts in every room• Patients and staff have access to mobility devices• Safe mobilization and patient handling training for staff

11Gait belts are used to help control the patient’s center of balance.

MUST DO #33 Laps a Day, Keeps the Nursing Home Away!

• Track mobility: document frequency, distance

• Create a culture of mobility

• Make it visible

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Walk of Fame Ambulation Board instructions can be accessed in file pod

Evidence to support mobility

in ICU patients?

Dale M Needham FCPA. MD, PhDProfessor, Medical Director, Critical Care Physical Medicine &Rehabilitation ProgramJohn Hopkins University

Is EARLY activity in the ICU

SAFE?

• Adult studies of ICU mobility with safety data

• Exclusion: in-bed intervention (cycle, NMES); no report of # of sessions

• 48 publications (n=7,546 pts; 22,351 sessions) – 6 RCT, 2 non-rdm trial, 5 before-after, 22 prosp. cohort, 11 retro cohort, 2 pt prev

• 583 (2.6%) potential safety events – Most common: De-sat, hemodynamic changes, catheter removal

• Only 2 ETT removals (1 without replacement; 1 with in-bed mobility)

– Events w/ consequence, incl. stop rehab (subset of studies): 78 (0.6%) • 1 fall, 11 tube removal, 34 hemodynamic change, 18 desaturation, 14 other

Safety of Patient Mobilization and Rehabilitation in the ICU:Systematic Review with Meta-Analysis

Nydahl, P.; Sricharoenchai, T.; Chandra, S; Kundt, F.; Huang, M.; Fischill, M.; Needham, DM.Annals of the American Thoracic Society; 2017

Is early activity in the ICUBENEFICIAL?

Key ICU Rehab clinical trialsStudyYear N ICU #

TypeCoun

tryInterv. Timing Outcomes

Morris2008 280 1 MICU USA <2 day + Decreased duration of ICU & hospital stay

Earlier PT consult in ICU & out of bed

Schweickert 2009** 104 2 MICU USA <2 day + Improved physical function at hospital D/C

Decreased duration of MV & delirium

Schaller 2016** 200 5 SICU USA

EU <3 day + Increased ICU mobilization & func. at hosp D/CDecreased duration of ICU & delirium

Hodgson2016 50 5 MS-

ICUAUS NZ 3 (2-4) + Increased mobility score & milestones in ICU No

dif: MV, LOS; d/c location, 6 mo. outcomes

Morris 2016** 300 1 MICU USA ~4 - 6 ? No difference: hospital LOS; strength

Increased at 6 mo: phys func (SPPB, SF-36, FPI)

Denehy2013 150 1 MS-

ICU AUS 7(5-11) - No difference at 12 mo: 6MWD, TUG, SF-36 PF (Control - PT during MV: 52% out of bed)

Moss 2016** 120 5 MICU USA 6 - 11 - No dif: phys func (to 6 mo); MV, ICU, hosp LOS

(Control - PT during MV: 20 min., 3x week)

Wright2017 308 4 MS-

ICU UK ~8 - No difference to 6 mo: SF-36, Grip, 6MWT, LOS (Control - PT during MV: 10 min/d less than interv


TypeCoun








Hodgson2016

50pilot

5 MS-ICU

AUS NZ 3 (2-4) + Increased mobility score & milestones in ICU No



TypeCoun











TypeCoun








Hodgson2016 50 5 MS-

ICUAUS NZ 3 (2-4) + Increased mobility score & milestones in ICU No










Full text: https://iii.hm/ddw

Design: RCT at U of Chicago & U of Iowa

Subjects: 104 MICU patients require MV

Intervention vs. Control: daily sedation interruption, plus:

• PT & OT (7d/wk –ICU & ward) starting at Day 1-2 vs.

• “Usual care” PT & OT starting at Day 6 -10

Lancet May 2009

Benefit is from receiving PT/OTEARLY while on mech. ventilation

Intervention• PROM• AAROM• AROM• Bed

Mobility• Transfers

(sitting)• Sitting

balance• ADLs• Transfers

(standing)• Ambulation

InterventionN=49

ControlN=55

Median duration of therapy:

After MV (minutes/day) 13 [5 to 20] 11 [0 to 23]

During MV (minutes/day)* 19 [10 to 29] 0 [0 to 0]

* p<0.0001

How was PT/OT provided to get benefits?

• International, 5-center, RCT (USA x 3; Austria, Germany)

• Subjects (N=200): Mech Vent <48h & expected MV for >24h – Exclusion: functionally dependent or hospital LOS >5 days

• Early goal-directed mobilization (w/i 1 d of consent) v. Usual care– SICU Optimal Mobiliz’n Score: 0-None; 1-PROM; 2-Sit; 3-Stand; 4-Ambulate

– Set daily SOMS goal as per ICU team & work on barriers to reach goal

The Lancet 2016

ICU delirium-free days 25 (16-27) 22 (15-25) 0.016

The Lancet 2016

Mobility (n=104) Control (n=96) P value

Total PT minutes in ICU 60 (0-110) 48 (20-128)

Sedation Score (RASS) -0.7 (0.1) -0.8 (0.1)

Mean SOMS in ICU 2.2 (1.0) 1.5 (0.8) <0.001

Walking at ICU D/C 52% 25%ICU / Hospital LOS 7 (5-12) / 15 (11-27) 10 (6-15) / 22 (15-30) 0.005 / 0.01

Func Indepen / DC home 51% / 51% 28% / 27% 0.003 /<0.001

• RCT: 120 pt, MV ≥4-5 day, 5 hospital in Denver, CO

• Intervention: PT 7 d/wk (mean ~40 min) up to 28 days – starting Day 6-11 (not early) – same timing as Control in prior RCT

• Control: PT 3 d/wk (mean ~20 min) up to 28 days – not usual care for most ICU

• Research subjects (Intervention vs. Control) – Older: median 56 vs. 49 years

– Weaker at randomization: 11- 25% lower MMT, Grip & Bed Mobility

• Result: no effect on PFP-10 phys func scale at 1 month– Only 33% with assessment (N = 20 & 19 in each group)

• 45% LTACH/facility (25% at 3 mo.)

• Concl: ?Higher intensity, late-onset PT may not have benefit– Older/weaker patients in intervention group – Control more rehab than most centers – decreasing treatment effect– Did not measure outcomes in 50% of patients d/c to facility

– Focus on early start to PT (i.e., replicate Schweickert Lancet RCT)

– Focus on getting ICU patients to PT at least 3x/week

• Single-center, assessor-blinded RCT• 300 MICU MV patients• Standardized Rehab Therapy (SRT) vs Usual Care

• Outcomes: ICU & hospital d/c + 2, 4 & 6 month

• SRT: 3 session/day, 7 d/week, during entire hospital stay:• Passive range of motion• PT: bed mobility, transfer and balance training• Progressive resistance exercises

• Usual Care: PT on week days, if ordered

Days to first therapy, median (IQR)

SRTPROM PT Strength

1 (0-2) 3 (1-6) 4 (2-7)

Usual Care 7 (4-10)

Days to first therapy, median (IQR)

Days of therapy per patient,median (IQR)

SRTPROM PT Strength PROM PT Strength

1 (0-2) 3 (1-6) 4 (2-7) 8 (5-14) 5 (3-8) 3 (1-5)

Usual Care 7 (4-10) 1 (0-8)

• Primary outcome: Hospital length of stay median (IQR)

• SRT vs. Usual Care: 10 (6 -17) vs 10 (7 -16), p=0.41

• Adverse Events:• 1 episode asymptomatic bradycardia <1min; pt completed session

• 2ndary outcomes: Grip, Handheld dynamometry, MMSE• No statistically significant differences at all time points

Short Physical Performance Battery Score (SPPB)Least Square Mean (95% CI)

SRT Usual Care

PValue

Hospital D/C 4.7(4.0-5.4)

4.7 (4.0-5.4)

.97

2 Months 8.7 (8.1-9.4)

7.8 (7.1-8.5)

.05

4 Months 8.9 (8.2-9.6)

8.0 (7.2-8.7)

.06

6 Months 9.0 (8.3-9.7)

8.0 (7.2-8.7)

.04MCID (Minimal Clinically Important Difference) = 1

SF-36 Physical Function & Physical Health SummaryLeast Square Mean (95% CI)

SRT Usual Care PValue

Phys

ical

Fu

nctio

nSc

ale Hosp D/C 39 (33-44) 38 (33-44) .97

2 Months 47 (42-53) 43 (37-49) .29

4 Months 52 (47-58) 47 (41-53) .22

6 Months 56 (50-62) 44 (38-50) .001Ph

ysic

al H

ealth

Su

mm

ary

Hosp D/C 30 (28-32) 30 (28-32) .96

2 Months 33 (31-36) 32 (31-34) .43

4 Months 36 (34-38) 34 (31-36) .16

6 Months 37 (35-39) 34 (31-36) .05MCID: PF = 10; PCS = 3-5

Functional Performance Inventory (FPI) scoreLeast Square Mean (95% CI)

SRT Usual Care

PValue

2 Months 2.0 (1.9-2.1)

2.0 (1.9-2.1)

.74

4 Months 2.2 (2.1-2.3)

2.1 (1.9-2.2)

.11

6 Months 2.2 (2.1-2.4)

2.0 (1.9-2.2)

.02

MCID = 0.2

• Study Limitations:• No sedation protocol: delayed start & # of session (esp strengthening)

• Up to 3.3 d for consent + 3 d for PT to start (?early enough)

• Loss to f/u ~30% of survivor: under-powered for post-d/c outcomes

• Conclusions:• SRT vs. usual care did not decrease hospital LOS• All physical function measures higher, increasing over 2- 6 mo.

• Future: • Pair rehab + sedation (?use cycling or NMES for early ICU)

• Over-sedation compromises the ability to participate in rehabilitation• Review of sedation practice is key to improving mobility• Target RASS -1 to +1 rather than Daily Interruption of sedation infusion

- Green J Multi-D Healthcare 2016

• Mobility, sedation, delirium, and sleep are inseparably linked• To successfully mobilize patients, sedation, sleep & delirium monitoring

must be routine and vigorously addressed- Clemmer CCM 2014

• ICUs that implemented exercise with both sedation interruption &delirium screening were 3.5 (CI 1.4-8.6) times more likely to achievehigher exercise levels in ventilated patients

- Miller Annals ATS 2015

The Importance of Sedation to Early Mobility

How to Start Early PM&R?The JHH MICU Experience

Exposure to rehab in JHH MICU is low:

- PT & OT in only 17% & 20% of ARDS pts

opportunity for Quality Improvement

Barriers to Activity in ICU• Time requirements and adequate staffing• Need for staff training• Need for team work and coordination• Over-sedation of ICU patients• Dislodgement of devices (CVC, ETT, feeding tubes)

• Worsening gas exchange• Unstable hemodynamics• Inadequate patient comfort, pain control

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Review of 40 studies • 28 unique barriers

– Severity of illness, pain, mental status, devices/equipment– Staffing, lack of guidelines and equipment– Culture, lack of knowledge

• 70 strategies– Inter-professional team/champions with training & rounding– Safety guidelines and screening– Mobility protocols & daily goals sheets– Creating business case, dedicated staffing

QI Project DescriptionMulti-faceted QI focused on ventilated pts in MICU:

- dedicated OT & PT in MICU (pilot test)

- OT, PT, RN & MD training & education

- guidelines for consultation of OT and PT in ICU

- decrease over-sedation via prn vs. infusions

Topics in Stroke Rehab 2010;17:271-281

JHH Experience: FeasibilityDuring 4 month period (May – Aug 2007)

• 2 - 4x incr in PT & OT consult & Tx (vs prior yr)

• Of all PT and OT treatments– 68% while ventilated– 24% with ETT – 13% with femoral line

• New PM&R consults on weak patients

Archives of Physical Med & Rehab, 2010

MICU QI project D15

Walked 4 times:• Max dur’n 10 min• Max dist. 240 feet

(vs. 3 feet on QI day 1)

Our Experience with Feasibility

Removed for privacy purposes

Patient interviews & Video of ambulation process at:

www.hopkinsmedicine.org/OACIS

(OACIS = Outcomes After Critical Illness & Surgery)

JHH Experience: Safety

• 4 events (~1% of treatments)– feeding/rectal tubes dislodged

• also occurred with routine RN care

• Update from after the QI project….

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• JHH MICU over 2.5 years (June 2009 – Dec 2011)

• 1,110 admissions with >= 1 PT session

• 5,267 total PT tx (not individual activities)

– 66% of PT days: sitting at edge of bed or higher

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• JHH MICU over 2.5 years (June 2009 – Dec 2011)

• 34 potential safety events in 25 admissions

– 0.6% of PT sessions (i.e., 6 per 1,000 PT tx)• 80% of events = transient physiological (HR, BP, Sp02)

– 4 events required any Tx (8 per 10,000 PT tx)• 2 NG tube, 1 A-line, 1 fall with laceration & suture

Annals of ATS (2016)

Physical Therapy J (2013)

Cardiopulm PT (2015)

Journal of Critical Care (2013)

Back to QI project…Benefits: Sedation & Delirium

• Median RASS score (scale: 0 to -5): -3 to 0 (p<0.05)

• Median drug dose per day (pre-QI vs. QI):

– Morphine 71 vs. 24 mg per day (p=0.01)

– Midazolam 47 vs. 15 mg per day (p=0.09)

• Mean daily pain (scale: 0 -10): 0.6 vs. 0.6 (p=0.79)

• Doubled % of ICU days without delirium (21% to 53%, p=0.003)

Potential Benefits to HospitalWhy so many empty MICU beds?

Versus same 4-month period in 2006:

• 20% increase in MICU admissions• 10% reduction in hospital mortality• 30% (2.1 day) reduction in MICU LOS• 18% (3.1 day) reduction in hosp LOS

Acknowledgements• Dr. Landon King, Director PCCM for financial support• Dr. Jeff Palmer, Director PM&R for PT & OT support• Dr. Eddy Fan, MICU physician • Dr. Roy Brower, MICU Director • Drs. Radha Korupolu & Pranoti Pradhan, project coordinators

• Dr. Kashif Janjua & Mr. Victor Dinglas, project assistants• PT: Jen Zanni, Jessica Rossi, Janette Scardillo, Nancy Ciesla• OT: Ed Szetela, Kenroy Greenidge, Maggie Price, Aline Hauber, Chris Moghimi

• RN: Lauren Waleryszak, Didi Rosell-Missler & all MICU RNs• RT: Katie Mattare, Jaymie, Ally, Jon & all MICU RTs• Rehab physicians: Drs. David Pitts & Mohammad Yavari-Rad• Neurology physicians: Drs. Argye Hillis, David Cornblath

ConclusionsEarly mobility in ICU – very exciting & dynamic• safe & feasible• beneficial: evolving literature w/ issues (PICO):

– Patients: target population with most benefit– Intervention:

• type of rehab & by who (PT, OT, RN) • dose (intensity, frequency, duration)

– Co-interventions: sedation effect – Outcome: long-term benefits?

New research & clinical practice under way…

For more info…

www.hopkinsmedicine.org/OACIS

Removed for privacy purposes

Monthly ICU Rehab Email

• Update on latest research, videos, conferences & announcements

• Join via email request to:[email protected]

ICU Rehab Resources: www.bit.ly/icurehabsol

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The Future is Large-Scale Learning Networks & Collaborations

www.mobilization-network.org

Follow on Twitter: @icurehab

@DrDaleNeedham

Contribute to Twitter at: #icurehab

The ICU Recovery Network (IRN) (like a simple version of Facebook)

• To access & contribute to ICU Rehab content: – videos, documents, website links, and event information

• To interact w/ other ICU Rehab clinicians from world• Joining is simple (< 5 min.)

You receive invitation email with link to set up account

The web-based platform is provided, free-of-charge, by MedConcert.

Enter basic info into web form

To Join (only clinicians/researchers):

[email protected]

11th Int’l Mtg of PM&R in ICUTime: Sat. May 19, 2018 (~1.30 - 6.30pm)

Location: Univ California San Diego

Cost: Free

By Invitation Only [email protected]

Follow on Twitter: @icurehab @DrDaleNeedhamContribute to Twitter at: #icurehab

Pre-ATS Meeting

7th Annual Johns Hopkins Critical Care Rehabilitation Conference

Including a NEW one-day pre-conference:International ICU Diary Conference

November 1 - 3, 2018Johns Hopkins Hospital, Baltimore, MD

For more Conference info: [email protected] and bit.ly/icurehab

For ICU Rehab Solutions/Resources: bit.ly/icurehabsol

Follow Us on Twitter: @icurehab @DrDaleNeedham

Questions?

Developing our Culture of Mobility

A Journey by Franciscan Health Michigan City, Indiana

Presented by Brooke Nack, PTInpatient Therapy ManagerMobility Program Manager

Polling QuestionIn your hospital setting, who

“owns” mobility?For example: When your patient needs to do his or her

highest level of activity, Who do you call?

1. Nurses2. Nurses aides3. Therapists, physical or occupational4. Mobility Team/Lift Team5. Physicians6. Ghost Busters!

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Our Mobility Committee: “We Have an idea…”

Property of Brooke Nack, Inpatient Therapy Manager Franciscan Health Michigan City Not to be copied or reproduced without permission

Motivation to Move…Our Lit Review

“A study of 45 elderly patients on a general medical unit , who had neither delirium or dementia and were able to walk prior to

admission, found that they spent 20 out of every 24 hours in bed over the mean 5.1 days

they were in the hospital.”

Wood et al. A mobility program for an inpatient acute care medical unit. AJN. 2014; 114(10)34-40.

Property of Brooke Nack, Inpatient Therapy /Mobility Program Manager Franciscan Health Michigan City Not to be copied or reproduced without permission

What Does a Culture of Mobility Look Like?The Provider Approach

• All providers set patient/family expectations to MOVE

• Barriers to mobility are recognized and removed

• Providers hold each other accountable to achieve highest level of mobility

• Providers help each other mobilize patients

• All providers advocate for patient mobility

• Systematic use of mobility data and language

• Direct care providers know pre-admission and current mobility levels

• Medical and pharmacological management supports mobility

The Patient Experience

• Patients eat all meals in a chair unless they can’t

• Mobile patients walk out of their room every day, including day of admission

• Necessary mobility equipment is at every bedside

• Families participate in patient mobility

• Mobility status, precautions, and projected discharge date is visible at bedside

65Property of Brooke Nack, Inpatient Therapy/Mobility Program Manager Franciscan Health Michigan City

Not to be copied or reproduced without permission

Who Owns Mobility?

Physicians?

Patients?

Families?

Administration?

Therapists?

Nurses?

66Property of Brooke Nack, Inpatient Therapy /Mobility Program Manager Franciscan Health Michigan City


What a Team Approach to Mobility Looks Like

Patient performs highest mobility at least 3x/day with

assistance of appropriate

provider

Therapy Orders generated by

Mobility Reconciliation

Nurse Assesses Mobility



Rate Your Patient’s Mobility LevelLevel Zero (0):Vital signs unstable, patient may not be consciousLevel One (1): Needs two assist to sit patient on edge of bedLevel Two (2): Dangles on edge of the bed with assist x 1; holds at least one leg up, indicating strength to standLevel Three (3): Stands with assist or device for 2 minutes ORwalks in room with assist or deviceLevel Four (4): Walks in the hallway (”out the door” )with or without assistance or a device

Property of Brooke Nack, Inpatient Therapy/Mobility Program Manager Franciscan Health Michigan City Not to be copied or reproduced without permission

Franciscan Progressive Mobility Continuum


Mobility Baseline Data

Activity Level at Home Activity Level by Unit Staff



Num

ber o

f Pat

ient

s

Num

ber o

f Pat

ient

s

Care Map Trial Data

Activity Level at Home Activity Level using Care Map



Num

ber o

f Pat

ient

s

Num

ber o

f Pat

ient

s

Implementation Timeline

June July August September October November December FIRST QTR ‘16

10-1-15

MOBILITY TEAM GO-LIVE

Whole House Mobility Training and Stake-Holder Buy-In

Administrative Approval and Position Requests

Staff Surveys:

Mobility Needs and perceptions.

Analyze 4th Quarter 2015 Results

9-1-15

MOBILITY CARE MAP GO-LIVE

Culture of Mobility Mobility Team 1. Policies

2. Job Descriptions

3. Create Staff and patient Education Materials

Med Exec approval then

Announce and Interview for Positions

7-6-15

Patient Engage-ment Video Shoot

4-1-16

Assess performance



Cost Savings Through Reduced Adverse Events

Adverse Event Current Rate Target(every year for 5 years)

Cost per Event

Cost Savings

Pressure Ulcers

Per 1000 patients

↓ 10% Facility Specific

Hospital-Acquired pneumonia

Per 1000 patients


DVT Per 1000 patients


Falls Per 1000 patients


“If he has a bedsore, it’s generally not the fault of the disease, but of the nursing” -Florence Nightingale, 1859

Nightingale F. Notes on nursing . Philadelphia: Lippincott; p. 1859



Evidence-Based Goals for Mobility Program ROI

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Nursing Survey Results

Question 1 2 Neg Response 4 5 Pos. ResponseI always get enough information 3 11 14 20 4 24 Inadeq I have had enough training 0 10 10 18 10 28 Mobil I have enough equipment 2 15 17 16 6 22 Gait b I believe patients are more likely to fall 17 15 32 4 1 5I believe patients are resistant, so low satisfaction 17 16 33 5 1 6Mobility Masters = higher job satisfaction 0 3 3 15 17 32

Schedule 8-4:30 11-7:30 10-6:30 write in 9-5:30 later s 8 20 12 1 covers

Best result of Mobility Team: Job satisfaction Teamwork Pt satisfactionHealthcare OrgHope All of the above2 10 8 2 10 8



“Move Me”: Engaging our Peers and our Patients…https://www.youtube.com/embed/e6BOqd0JPwc?rel=0


https://www.youtube.com/embed/e6BOqd0JPwc?rel=0

Skills-Development for Progressive Mobility…Have a Little Fun



Idea to reality… Introducing our Mobility Team


Day One Results

Expectation Compliance

Mobility level reported in Interdisciplinary Care Rounds 96%

Mobility level written on communication board in room 53%

Mobility documentation by nursing matches reported levels 63%

Methods to Promote Compliance1. Feedback of performance provided to unit managers2. Transparency of performance across units3. Celebration of nurses with 100% compliance4. Leadership presence and rounding on the units5. Mobility Committee attends interdisciplinary rounds



Mobility Program Results


*Falls predominately unwitnessed unassisted, ages 45-65 years old, without injury

*See note

Mobility Program Survey ResultsQuestion NURSING STAFF NON-NURSING PROFESSIONALS

Agree/Strongly Agree(n = 38-41)

Disagree/ Strongly Disagree(n = 1-3)

Agree/Strongly Agree(n = 14-19)

Disagree/Strongly Disagree

Patients receive more opportunities to move since Mobility Team

100% 0% 100% 0%

My patients are satisfied with the Mobility Team

100% 0% 100% 0%

The Mobility Team safely mobilizes patients

97% 3% 100% 0%

Parts of my job are easier because we have a Mobility Team

95% 5% 100% 0%

The Mobility Team has contributed to my job satisfaction

92% 8% 100% 0%

The Mobility Team contributes positively to DC planning

93% 7% 100% 0%


Mobility Program Survey Results April 2016

I see so many more patients now up in chairs and walking the halls. Great job! I think as the Mobility Team continues to work with our patients the need will increase even more. It will become the norm which is wonderful. Great program! (CNA)

Early Mobilization and discharge… Patients do get better with early ambulation. (RN)

Best results are decreased decubiti, decreased aspiration and overall reduced LOS. Excellent idea. Well managed and standardized. Easy to follow process. One of my favorite projects that has helped my patients tremendously. (Hospitalist)


Conclusion

It is feasible and effective for both community and university based healthcare organizations to make great strides in developing a Culture of Mobility.

A systematic team approach to mobility is key to a sustainable value and values based approach to preventing hospital acquired conditions.

Franciscan Health Michigan City’s Mobility Program is recognized as the Innovation Award winner by the Indiana Hospital Association at the Safety Summit on June 6, 2017.

For further information on Franciscan’s Mobility Program, contactBrooke Nack, Inpatient Therapy Manager

[email protected]

Brooke will be presenting a more detailed description of the Franciscan Mobility Program, including program development, return on investment, and corporate-wide dissemination in the Indiana Hospital Association Webinar titled: “GET UP: Improving Mobility in Indiana 4 of 4” on Tuesday December 12th at 2:00 pm CST.


mailto:[email protected]

You have questions? We have answers

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BRING IT HOME

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Nerissa Legge, Program Manager| HRET

GET UP Resources• Mobility Assessments

– Get up and Go Test– Timed get up and go– BMAT: Banner Mobility Assessment Tool for Nurses

• Mobility Training Resources– "CAPTURE Falls" Mobility Training Videos

• Mobility Protocols– ICU Progressive Mobility Continuum– Med Surg Mobility Protocol

• Implementation Guide- ICU Liberation

• Early Mobility Resources- Early Mobility.com

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http://www.gericareonline.net/tools/eng/falls/attachments/Falls_Tool_2_Get_Up_and_Go_Test.pdf

http://www.cdc.gov/steadi/pdf/tug_test-a.pdf

http://www.hret-hiin.org/resources/display/bmat-banner-mobility-assessment-tool-for-nurses

http://www.hret-hiin.org/resources/display/progressive-mobility-continuum

http://www.hret-hiin.org/resources/display/medsurg-mobility-protocol

http://www.iculiberation.org/Pages/default.aspx

http://earlymobility.com/clinical-resources/

GET UP Resources

• UP Resource Page on HRET HIIN Website

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http://www.hret-hiin.org/engage/up-campaign.shtml

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Upcoming Events

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HRET HIIN Rural CAH Affinity Group Virtual EventTopic: Rural and Critical Access Hospitals (CAH) Webinar: November 27, 2017 1:00pm -2:00pm (CT)Register

Disparity exists in access to palliative services especially in the rural and frontier regions of our country. Register for the HRET HIIN Rural CAH Affinity Group Event on Monday, November 27th at 1pm CT to learn why this disparity exists and what rural communities are doing to address it. The event will feature Dr. Phil Lawson, an emergency room physician and palliative care director from Littleton Regional Hospital, a critical access hospital in New Hampshire. Dr. Lawson will dive into the patient, community and provider level drivers of disparity and offer strategies for organizations ready to fill the gap. We will then explore systems that support end of life conversations and advanced care planning for some practical next steps in addressing this important issue.

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Thank You!

Find more information on our website: www.hret-hiin.org

Questions or Comments: [email protected]

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