Mobility Recommendations: Facilitating Critical …...responsibility of patient safety and updating mobility recommendations. After two years in use, the mobility card is hardwired

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

2

4

6

8

10

12

14

16

18

2011 2012 2013 2014 2015

14

17

12

10

14

Team Member Injuries Mobilizing Patients

# injuries mobilizing pts.

Implementation in May

0

20

40

60

80

100

120

140

160

2011 2012 2013 2014 2015

150

160

143

119 122

42

62

41 41 38

Inpatient Falls and Falls with Injury

Falls Falls with injury

Implementation in May