SAFEMOB: Difference between revisions
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**Stretching exercises | **Stretching exercises | ||
**Balance/coordination exercises for head, neck, and trunk | **Balance/coordination exercises for head, neck, and trunk | ||
* | *Additional exercise/mobilization as per physio assessment | ||
| width="400" style="background: #CCECFF;" | | | width="400" style="background: #CCECFF;" | | ||
* | *High fowlers or cardiac chair position x 30-60 minutes TID | ||
*Mobilization may include tilt table, dangle or to chair with mechanical lift prn (use caution for patients at risk of hypotension) | |||
|} | |} | ||
<br> | |||
{| cellpadding="2" border="1" style="border: 1px solid darkgray;" | |||
|- | |||
! colspan="2" scope="row" style="background: #FFFF65;" | | |||
'''Level III'''''<br>'' | |||
|- | |||
! scope="col" width="400" style="background: #E6FFB3;" | Target Level of Consciousness (RASS) | |||
! scope="col" width="400" style="background: #FFE1FF;" | Strength Criteria for Entering this Level | |||
|- valign="top" | |||
| width="400" style="background: #E6FFB3;" | | |||
*RASS -1 to +1 | |||
| width="400" style="background: #FFE1FF;" | | |||
*Able to move arm against gravity | |||
|- | |||
! scope="col" width="400" style="background: #CCECFF;" | Turning & Bed Mobility | |||
! scope="col" width="400" style="background: #CCECFF;" | Positioning & Devices | |||
|- valign="top" | |||
| width="400" style="background: #CCECFF;" | | |||
*Q2H | |||
*Gradual withdrawal of assistance | |||
*Initiation of training to promote patient’s independence | |||
| width="400" style="background: #CCECFF;" | | |||
*Same as Level I | |||
*Assess for seating needs | |||
|- | |||
! scope="col" width="400" style="background: #CCECFF;" | Exercise Program | |||
! scope="col" width="400" style="background: #CCECFF;" | Mobilization | |||
|- valign="top" | |||
| width="400" style="background: #CCECFF;" | | |||
*Encourage pt assist with ROM with more active involvement | |||
*Breathing, stretching, and balance/coordination exercises as prior with more active involvement | |||
*Consider inclusion of arm ergometry | |||
*Additional exercise/mobilization as per physio assessment | |||
| width="400" style="background: #CCECFF;" | | |||
*Assist physio with dangle on side of bed - may need ceiling lift if patient is heavy | |||
*Sitting balance exercises with physio as appropriate, 5 to 10 minutes to start | |||
*Initially OD, progress to BID as patient tolerates | |||
*As per physio assessment of patient strength, assist physio with sit to stand, walking in place; +/- walker | |||
*Patients with neuro/ortho status precluding WB require individualized mobilization prescription | |||
|} | |||
<br> | |||
{| cellpadding="2" border="1" style="border: 1px solid darkgray;" | |||
|- | |||
! colspan="2" scope="row" style="background: #FFFF65;" | | |||
'''Level IV'''''<br>'' | |||
|- | |||
! scope="col" width="400" style="background: #E6FFB3;" | Target Level of Consciousness (RASS) | |||
! scope="col" width="400" style="background: #FFE1FF;" | Strength Criteria for Entering this Level | |||
|- valign="top" | |||
| width="400" style="background: #E6FFB3;" | | |||
*RASS -1 to +1 | |||
| width="400" style="background: #FFE1FF;" | | |||
*Able to move arm and leg against gravity | |||
|- | |||
! scope="col" width="400" style="background: #CCECFF;" | Turning & Bed Mobility | |||
! scope="col" width="400" style="background: #CCECFF;" | Positioning & Devices | |||
|- valign="top" | |||
| width="400" style="background: #CCECFF;" | | |||
*Q2H | |||
*Focus on training to promote pt’s independence | |||
| width="400" style="background: #CCECFF;" | | |||
*Same as Level III | |||
|- | |||
! scope="col" width="400" style="background: #CCECFF;" | Exercise Program | |||
! scope="col" width="400" style="background: #CCECFF;" | Mobilization | |||
|- valign="top" | |||
| width="400" style="background: #CCECFF;" | | |||
*Encourage active ROM as per Level III | |||
*Breathing, stretching, and balance/coordination exercises as well as arm ergometry as per Level III | |||
*Consider inclusion of weight-bearing/weight-shifting exercises | |||
*Additional exercise/mobilization as per physio assessment | |||
| width="400" style="background: #CCECFF;" | | |||
*If dangle and stand at bedside successful, physio assesses ability to weight shift, ability to transfer to chair | |||
*Initial time in chair 30 minutes, progress per OT/PT assessment | |||
*Initially OD, progress to BID as patient tolerates | |||
*If patient able to transfer to chair, tolerates well, physio assesses ambulation, begins walking practice with appropriate aids, increasing distance and frequency as patient tolerates | |||
|} | |||
<br> | |||
== References == | == References == | ||
<references /> | <references /> |
Revision as of 05:22, 20 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[1][2][3][4][5][6][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[7][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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How to Progress[edit | edit source]
Level I | |
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Target Level of Consciousness (RASS) | Strength Criteria for Entering this Level |
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Turning & Bed Mobility | Positioning & Devices |
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Exercise Program | Mobilization |
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Level II | |
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Target Level of Consciousness (RASS) | Strength Criteria for Entering this Level |
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Turning & Bed Mobility | Positioning & Devices |
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Exercise Program | Mobilization |
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Level III | |
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Target Level of Consciousness (RASS) | Strength Criteria for Entering this Level |
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Turning & Bed Mobility | Positioning & Devices |
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Exercise Program | Mobilization |
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Level IV | |
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Target Level of Consciousness (RASS) | Strength Criteria for Entering this Level |
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Turning & Bed Mobility | Positioning & Devices |
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Exercise Program | Mobilization |
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References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 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,fckLR2008; 36:2238-43. Cite error: Invalid
<ref>
tag; name "Morris 2008" defined multiple times with different content - ↑ 2.0 2.1 Stiller, K. Safety issues that should be considered when mobilizing critically ill patients. Crit Care Clin 2007; 23, 35-53.
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 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.
- ↑ 4.0 4.1 ACSM Guidelines for Exercise Testing and Prescription. 8th edition. Lippincott Williams &amp;amp; Wilkins. Philadelphia 2010 pp.209-10.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 Timmerman, RA. A mobility protocol for critically ill adults. [DIMENS CRIT CARE NURS. 2007; 26(5):175-9.
- ↑ 6.0 6.1 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.
- ↑ Reid WD, Chung F. Clinical management notes and case histories in cardiopulmonary physical therapy. New Jersey: Slack; 2004.