For nearly as long as there have been hospitals, doctors who practice in them have included those words in their standard patient orders.

 

But is prescribing immobility for those who are capable of more really the best medicine? Our expertise and experience said otherwise, so, 18 months ago, nursing implemented a comprehensive, interdisciplinary “mobility program” at Memorial Regional Hospital that’s benefitting more than just the individuals receiving care.

 

The list of potential problems for immobile patients is long and significant, including, but certainly not limited to, hospital-acquired deep vein thrombosis, pulmonary embolisms, and pressure ulcers. Often overlooked, however, are musculoskeletal injuries that can have lifelong ramifications when suffered by caregivers trying to get patients up and out of bed. There was also the productivity and morale-related issue of the hospital not having its nurses and physical therapists practice at the top of their licenses if they were constantly being called on to lift patients.

 

Our mobility team is made up of 10-12 young adults interested in healthcare careers that have been empowered with training, patient information, equipment, and tools that log, track, and audit mobility activities. They also have the support of hospital staff and patient families, who have come to understand that individuals that get out of bed quicker are more likely to leave the hospital sooner. 

 

Here’s how we go about making that happen:

• Training is provided to mobility team members on how to use proper body mechanics and lift equipment to get patients moving.

• Triggers within a patient’s electronic medical records automatically alert the team of anyone at risk of declining due to inactivity. No further orders are required to have members, who usually round in groups of two, begin visiting patient rooms to mobilize them.

• “Heels for Meals” is a program nurse leaders monitor that requires patients able to get out of bed to eat do that. By putting heels on the ground, patients experience improved mobility, cognition, well-being, and digestion. 

• Family participation is encouraged and loved ones are requested to bring sneakers or comfortable shoes from home and to actively participate in a walking plan that is scheduled and charted the same way as with medicine.

• Tracking progress is now easier with the placement of hallway markers that denote distance, which is recorded in a journal, giving patients something to do and increasing accountability to the program.

 

Not to be overlooked is the mobility team’s use of fun to incentivize patients to take control of this aspect of their recovery. One elderly patient wanted to be sung to, and serenaded she was, as a motivator to do something hard and potentially uncomfortable.

 

Leslie Pollart, DON, reported that while two years of comparison data (which we don’t yet have) are required to draw a statistical picture of the decrease of patient-related immobility issues, we can report that musculoskeletal problems (such as pain in the caregiver’s backs) have decreased by 77%. The program has also increased employee engagement, resulting in a staff, especially nurses and PTs, that feels well cared for. We also continue to challenge doctors to justify recommendations of bed rest when not necessary.

 

Lastly, our mobility team members benefit from real-world, on-site training, potentially providing them future employment within Memorial Healthcare System and giving us a pipeline to those who have already proven their commitment to the patient and family-centered care we pride ourselves on.