SAFEMOB: Difference between revisions
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== How to Mobilize and Progress == | == How to Mobilize and Progress == | ||
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! scope="col" width="400" style="background: #E6FFB3;" | Step 1: Prepare | |||
! scope="col" width="400" style="background: #E6FFB3;" | Step 2: Safety First | |||
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*Note obstacles or challenges related to the patient and environment and plan appropriately (e.g. set up equipment – chairs, transfer belt, mobility aids, length of leads/lines) | |||
*Determine whether the benefits outweigh the risk | |||
*Ensure pre-medication as indicated (analgesia, bronchodilators, oxygen) | |||
*Obtain baseline vital signs (heart rate, blood pressure, oxygen saturation) | |||
*Have objective end-points such as limits of blood pressure, heart rate, oxygen saturation and level of exertion pre-determined before mobilization | |||
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*Use proper body mechanics during transfer and allow gradual change from lying to upright position; Encourage circulation exercises i.e. foot and ankle, knee flexion/extension before commencing more demanding mobilization procedures | |||
*If postural hypotension is suspected, monitor BP and ask patient about lightheadedness at each phase of the mobilization i.e. sitting on edge of bed, standing, walking a few paces | |||
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! scope="col" width="400" style="background: #E6FFB3;" | Step 3: When to Quite While You are Still Ahead | |||
! scope="col" width="400" style="background: #E6FFB3;" | Step 4: Monitor and Progress | |||
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*Monitor closely. Watch for signs of fatigue, pain, diaphoresis and intolerance during activity; Frequently ask patient how he/she feels | |||
*Evaluate patient’s status at each progression to determine whether to continue or stop | |||
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*Determine the limiting factor of the mobilization and any undesirable response(s) | |||
*Use objective outcome measures to monitor progress e.g., ease of transfer, sitting duration, walking distance, HR, RR, oxygen saturation, Borg scales, and pain scales | |||
*After mobilization, monitor patient until vital signs have returned to pre-activity level | |||
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== References == | == References == |
Revision as of 06:44, 8 January 2014
Developed by the SAFEMOB Task Force:
Dr. Elizabeth Dean, Dr. Darlene Reid, Frank Chung, Simone Gruenig, Rosalyn Jones, Jocelyn Ross, Maylinda Urbina, Alison Hoens.
SAFE PRESCRIPTION OF MOBILIZING PATIENTS IN ACUTE CARE SETTINGS[edit | edit source]
What to Assess, What to Monitor, When not to Mobilize, and How to Mobilize and Progress
Purpose, Scope, & Disclaimer[edit | edit source]
The purpose of this document is to provide physical therapists with guidance on safe mobilization of the patient in acute care settings. This decision-making guide is evidence informed and where there is insufficient evidence, expert informed. It is not intended to replace the clinician’s clinical reasoning skills and interprofessional collaboration. Mobilization, for the purposes of this document, has been defined as “To work towards the functional task of locomotion”.
What to Assess[edit | edit source]
The Chart | The Patient, Family, and Team Member |
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When to Consider Not Mobilizing[edit | edit source]
Cardiovascular Status | Respiratory Status |
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Neurological Status | Other |
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- Please note: The cited values are not absolute criteria for withholding mobilization but are within the range of concern that could benefit from team discussion.
What to Consider During Mobilization[edit | edit source]
Subjective | Objective |
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How to Mobilize and Progress[edit | edit source]
Step 1: Prepare | Step 2: Safety First |
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Step 3: When to Quite While You are Still Ahead | Step 4: Monitor and Progress |
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References[edit | edit source]
1. Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Critical Care Medicine, 2008; 36:2238-43. 2. Stiller, K. Safety issues that should be considered when mobilizing critically ill patients. Crit Care Clin 2007; 23, 35-53. 3. Schweickert WD, Pohlman MC, Pohlman NS Nigos C, Pawlik AJ, Esbrook CL et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: an RCT. Lancet. 2009; 373:1874-82. 4. ACSM Guidelines for Exercise Testing and Prescription. 8th edition. Lippincott Williams & Wilkins. Philadelphia 2010 pp.209-10. 5. Timmerman, RA. A mobility protocol for critically ill adults. [DIMENS CRIT CARE NURS. 2007; 26(5):175-9. 6. Singh C, Fletcher R, Cunningham K, and Szlivka M. Mobilization with a Deep Vein Thrombosis. Clinical Practice Guideline (DRAFT in process). Fraser Health Authority. 2009. 7. Reid WD, Chung F. Clinical management notes and case histories in cardiopulmonary physical therapy. New Jersey: Slack; 2004. 8. Chung F, Fletcher R, Lavoie K, Parrent L, Perret D, Roy L, Urbina,M. Members of the physiotherapy professional practice council critical care practice stream for the Fraser Health Authority. Canada. Forthcoming. 2009. 9. Bailey P, Thomsen GE, Spuhler VJ, Blair R, Jewkes J, Bezdjian L, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007; 35:139-45. 10. Collard HR, Saint S, Matthay MA. Prevention of ventilator-associated pneumonia: an evidence-based systematic review. Ann Intern Med. 2003;138:494-501. 11. Dodek P, Keenan S, Cook D, MD, Heyland D, Jacka M, Hand L et al. Evidence-based clinical practice guideline for the prevention of ventilator associated pneumonia. Ann Intern Med. 2004; 141:305-13. 12. Needham D. Mobilizing patients in the intensive care unit: improving neuromuscular weakness and physical function. JAMA. 2008; 300:1685-90. 13. Perme C, Chandrashekar R. Early mobility and walking program for patients in intensive care units: creating a standard of care. Am J Crit Care. 2009; 18:212-21. 14. Sessler CN, Gosnell M, Grap MJ, Brophy GT, O'Neal PV, Keane KA et al. The Richmond Agitation-Sedation Scale: validity and reliability. Am J Respir Crit Care Med 2002; 166:1338-44.