SAFEMOB: Difference between revisions
Evan Thomas (talk | contribs) No edit summary |
Evan Thomas (talk | contribs) mNo edit summary |
||
Line 326: | Line 326: | ||
Q2H = Every 2 Hours; HOB = Head of Bed; BID = Twice daily; TID = Three times daily; OD = Once daily | Q2H = Every 2 Hours; HOB = Head of Bed; BID = Twice daily; TID = Three times daily; OD = Once daily | ||
<br> | |||
== Richmond Agitation Sedation Scale (RASS)<ref name="Sessler 2002">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.</ref> == | == Richmond Agitation Sedation Scale (RASS)<ref name="Sessler 2002">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.</ref> == |
Revision as of 06:08, 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 |
---|---|
|
|
When to Consider Not Mobilizing[1][2][3][4][5][6][edit | edit source]
Cardiovascular Status | Respiratory Status |
---|---|
|
|
Neurological Status | Other |
|
|
- 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 |
---|---|
|
|
How to Mobilize and Progress[7][edit | edit source]
Step 1: Prepare | Step 2: Safety First |
---|---|
|
|
Step 3: When to Quite While You are Still Ahead | Step 4: Monitor and Progress |
|
|
How to Progress[1][3][8][9][10][11][12][13][edit | edit source]
Continue to monitor vitals to guide progression
Level I[1] | |
---|---|
Target Level of Consciousness (RASS)[14] | Strength Criteria for Entering this Level |
|
|
Turning & Bed Mobility | Positioning & Devices |
|
|
Exercise Program | Mobilization |
|
|
Level II[1] | |
---|---|
Target Level of Consciousness (RASS)[14] | Strength Criteria for Entering this Level |
|
|
Turning & Bed Mobility | Positioning & Devices |
|
|
Exercise Program | Mobilization |
|
|
Level III[1] | |
---|---|
Target Level of Consciousness (RASS)[14] | Strength Criteria for Entering this Level |
|
|
Turning & Bed Mobility | Positioning & Devices |
|
|
Exercise Program | Mobilization |
|
|
Level IV[1] | |
---|---|
Target Level of Consciousness (RASS)[14] | Strength Criteria for Entering this Level |
|
|
Turning & Bed Mobility | Positioning & Devices |
|
|
Exercise Program | Mobilization |
|
|
Q2H = Every 2 Hours; HOB = Head of Bed; BID = Twice daily; TID = Three times daily; OD = Once daily
Richmond Agitation Sedation Scale (RASS)[14][edit | edit source]
+4 | Combative; violent, immediate danger to staff |
+3 | Very agitated; pulls or removes tubes/lines; aggressive |
+2 | Agitated; frequent non-purposeful movement, fights ventilator |
+1 | Restless; anxious but movement not aggressive or vigorous |
0 | Alert and calm |
-1 | Drowsy; not fully alert, sustained wakening (eye-opening/contact) to voice >10 sec |
-2 | Light sedation; briefly awakens with eye contact to voice <10 sec |
-3 | Moderate sedation; Movement or eye opening to voice but no eye contact |
-4 | Deep sedation; No response to voice but movement or eye opening to physical stimulation |
-5 | Unarousable; No response to voice or physical stimulation |
References[edit | edit source]
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 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 3.14 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;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.
- ↑ 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.
- ↑ 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.
- ↑ Collard HR, Saint S, Matthay MA. Prevention of ventilator-associated pneumonia: an evidence based systematic review. Ann Intern Med. 2003;138:494-501.
- ↑ 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.
- ↑ Needham D. Mobilizing patients in the intensive care unit: improving neuromuscular weakness and physical function. JAMA. 2008; 300:1685-90.
- ↑ 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.
- ↑ 14.0 14.1 14.2 14.3 14.4 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.