SAFEMOB: Difference between revisions
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! colspan="2" scope="row" style="background: #FFFF65;" | | |||
'''Level 1'''''<br>'' | |||
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! scope="col" width="400" style="background: #E6FFB3;" | Target Level of Consciousness (RASS) | ! scope="col" width="400" style="background: #E6FFB3;" | Target Level of Consciousness (RASS) | ||
! scope="col" width="400" style="background: # | ! scope="col" width="400" style="background: #FFE1FF;" | Strength Criteria for Entering this Level | ||
|- valign="top" | |- valign="top" | ||
| width="400" style="background: #E6FFB3;" | | | width="400" style="background: #E6FFB3;" | | ||
*RASS -5 to -2 | *RASS -5 to -2 | ||
| width="400" style="background: # | | width="400" style="background: #FFE1FF;" | | ||
|- | |- | ||
! scope="col" width="400" style="background: # | ! scope="col" width="400" style="background: #CCECFF;" | Turning & Bed Mobility | ||
! scope="col" width="400" style="background: # | ! scope="col" width="400" style="background: #CCECFF;" | Positioning & Devices | ||
|- valign="top" | |- valign="top" | ||
| width="400" style="background: # | | width="400" style="background: #CCECFF;" | | ||
*Q2H | *Q2H | ||
*Patient to assist as able | *Patient to assist as able | ||
| width="400" style="background: # | | width="400" style="background: #CCECFF;" | | ||
*Keep HOB >30° | *Keep HOB >30° | ||
*Apply splints, other positioning devices as per OT/PT instructions | *Apply splints, other positioning devices as per OT/PT instructions | ||
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! scope="col" width="400" style="background: # | ! scope="col" width="400" style="background: #CCECFF;" | Exercise Program | ||
! scope="col" width="400" style="background: # | ! scope="col" width="400" style="background: #CCECFF;" | Mobilization | ||
|- valign="top" | |- valign="top" | ||
| width="400" style="background: # | | width="400" style="background: #CCECFF;" | | ||
*PROM ex to incorporate into patient care (e.g. during washing, turns) | *PROM ex to incorporate into patient care (e.g. during washing, turns) | ||
*Additional exercise/mobilization as per physio assessment | *Additional exercise/mobilization as per physio assessment | ||
| width="400" style="background: # | | width="400" style="background: #CCECFF;" | | ||
*HOB >45° x 30-60 minutes BID, support to achieve midline head and trunk position | *HOB >45° x 30-60 minutes BID, support to achieve midline head and trunk position | ||
Revision as of 00:10, 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 1 | |
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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.