Why Aren’t My Patients Moving ? Shannon Boles MSN RN CCRN ACNP-BC GSLC Symposium 2016

OBJECTIVES 1. Identify barriers to patient mobility. 2. Discuss responsibility for patient mobility. 3. Discuss benefits of patient mobility.

“ Mobilization is the action of making something movable or capable of movement. -Oxford Dictionary

QUESTIONS ➤ Who can mobilize patients? ➤ What are the barriers to mobilizing your patients? ➤ Where does mobilizing your patient fall on your daily list of priorities?

PHYSIOLOGIC EFFECTS OF BEDREST ➤ In a healthy person, muscle strength decreases 20-30% in only ONE week of bed rest. ➤ Skeletal muscles are NOT only muscle suffer reconditioning. ➤ Within the first 3 days of bed rest, plasma volume is reduced 8-10%. ➤ Reduction in plasma volume results in increase in cardiovascular workload, elevation of resting heart rate approximately 10 beats per minute, decrease in stroke volume with reduction in cardiac output.

PHYSIOLOGY OF STANDING ➤ When a person stands up, baroreceptor reflexes are rapidly activated to restore arterial pressure and prevent drop in mean arterial pressure. ➤ Standing upright causes: ➤ increased systemic vascular resistance (sympathetic mediated) ➤ decreased venous compliance - due to sympathetic activation of veins ➤ decreased stroke volume- due to decreased preload ➤ increased heart rate- baroreceptor mediated tachycardia

EARLY MOBILIZATION ➤ intensification and early application of mobility ➤ bed mobility ➤ sitting on edge of bed ➤ transfers out of bed to chair ➤ gait training ➤ physical therapy

BARRIERS TO PATIENT MOBILITY ➤ Three categories ➤ Environmental ➤ Health care team ➤ Patient

HEALTH CARE TEAM CENTERED BARRIERS ➤ Concern for patient safety ➤ Hemodynamic stability ➤ Personnel & equipment resources ➤ Sedation practices ➤ Size of the patient ➤ Patient’s pain and discomfort ➤ Time ➤ Priority

PATIENT CENTERED BARRIERS ➤ Pain and discomfort ➤ Fear ➤ Cooperation ➤ Understanding

BENEFITS OF MOBILIZATION Decreased length of stay Improved patient outcomes ➤ decreased hospital acquired pneumonia ➤ decreased pressure ulcers ➤ decreased DVTs Better pain control Cost savings

ROLE OF PHYSICAL THERAPY & OCCUPATIONAL THERAPY ➤ diagnose and manage movement dysfunction and enhance physical and functional abilities. ➤ prevent onset, symptoms, and progression of impairments, functional limitations, and disabilities than may result from diseases, disorders, conditions, or injuries. ➤ assess functionality of activities of daily living.

QUESTIONS ➤ Who can mobilize patients? ➤ What are the barriers to mobilizing your patients? ➤ Where does mobilizing your patient fall on your daily list of priorities?

QUESTIONS &/OR CONCERNS?

REFERENCES ➤ Clark, D.E., Lowman, J.D., Griffin, R.L., Matthews, H.M., & Reiff, D.A. (2013). Effectiveness of an Early Mobilization Protocol in Trauma and Burns Intensive Care Unit: A Retrospective Cohort Study. Physical Therapy, 93(2) ➤ Hodgson, C.L., Berney, S., Harrold, M., Saxena, M., & Bellomo, R. (2013). Clinical review: Early patient mobilization in the ICU. Critical Care 2013, 17(207) 1-7. ➤ Hopkins, R.O., Miller, R.R., Rodriguez, L., Spuhler, V., & Thomsen, G.E. (2012). Physical Therapy on the Wards After Early Physical Activity and Mobility in the Intensive Care Unit. Physical Therapy, 92(12), ➤ Messer, A., Corner, L., & Forst, S. (2015). Implementation of a Progressive Mobilization Program in a Medical-Surgical Intensive Care Unit. Critical Care Nurse 35(5), ➤ Peterson, B., & Bogue, B. (2011). Patient Mobilization. Patient Safety & Quality Healthcare, 2(2), ➤ Robertson, D. (2008). The Pathophysiology and Diagnosis of Orthostatic Hypotension. Clinical Autonomic Research, 18(S1), 2-7. ➤ Vollman, K. M. (2010). Progressive Mobility in the Critically Ill. Critical Care Nurse 30(2), S3-5.