Mobility Minute: Teresa Boynton on mobility assessment and technology interventions
Today we speak with Teresa Boynton MS, OTR, CSPHP.
Teresa is currently an independent Safe Patient Handling Mobility (SPHM) and Bedside Mobility Assessment Tool (BMAT) consultant. She previously worked for Hill-Rom as a Clinical Consultant assisting healthcare facilities across the U.S. to build and sustain SPHM programs with a focus on improving patient outcomes while increasing caregiver safety using a standardized assessment linked to SPHM interventions.
Prior to this, she worked for Banner Health for over 26 years. In 2001, she became the Banner Health “Ergonomics and Injury Prevention Specialist.” In 2003 with the goal of establishing SPHM programs system-wide, she began work on what became the Banner “Bedside Mobility Assessment Tool” (BMAT) – a validated nurse-driven tool for assessing current mobility status based on objective findings. From 2011 through 2015, she led the Banner Health combined “Safe Patient Handling and Falls Prevention Team.”
Other projects include using the HFMEA model to develop algorithms, a standardized care path, and appropriate equipment bundle for patients-of-size; standardizing workers’ compensation injury coding, tracking and trending for effective injury prevention action planning; reviewing FDA medical device adverse events reports related to sling and lift safety issues, and participating with a team that wrote the “Healthcare Recipient Sling and Lift Hanger Bar Compatibility Guidelines.” Teresa is certified by the Association of Safe Patient Handling Professionals (ASPHP) and recently was awarded the prestigious NBCOT Innovation Award in 2020.
“My passion for mobility was focused initially on doing something about nursing and CNA injuries, and then I really became aware that we could have much better patient outcomes if we were focused on a standardized early progressive mobility program for all patients.”
Listen to the full podcast here.
Note: Podcast transcript below is generated using a combination of speech recognition software and human transcribers, and may contain errors. Please check the corresponding audio before quoting in print.
Thanks for talking with us today, Teresa. Right off the bat, let’s unpack how you first got into this. Where did your passion for mobility first start?
I’m an occupational therapist. I started working in an occupational rehab clinic for over 15 years including treating injured nurses and aids who worked for the hospital associated with the clinic. Then in 2003, the risk manager asked me to take on a new role as ergonomics and injury prevention specialist and to take on the lead for the Safe Patient Handling and Mobility Program. In taking over that program, it became apparent to me that we needed an effective assessment and a standardized approach to using our patient mechanical lifts and safely moving patients both in bed, transfers and when walking.
Around that time, I began sitting on Fall Prevention teams and early on saw the overlap between staff injuries and patient falls that were associated with complications of immobility. Patients were becoming weak and deconditioned from spending too much time in bed and caregivers were getting injured trying to move patients.
There was real breakthrough when a manager on a med/tele unit (who was noticing these issues with her team) agreed to do a trial of an early version of what became the Bedside Mobility Assessment Tool (BMAT). We asked, “What if we did a quick bedside assessment looking a patients’ mobility status?” I felt that if the nurses were empowered to do a quick check-in with their patients and then use their SPHM equipment appropriately, we really could have an impact.
We had positive results from this trial. It went a long way to change practice across the whole Banner Health system. It became apparent that there was a real need for this type of tool, not only in the Banner Health system but throughout hospitals.
My passion for mobility was focused initially on doing something about nursing and CNA injuries, and then I really became aware that we could have much better patient outcomes if we were focused on a standardized early progressive mobility program for all patients.
Obviously collaboration is a big part of mobility, especially when you’re trying to standardize a multi-disciplinary approach to mobility, right? Making sure that everyone’s on the same page on who’s able to help move patients and to assess when they’re ready to do so. Can you explain why collaboration is so important in order to really understand where the patient’s at and if they’re ready to mobilize?
It’s critical. You have to have collaboration. Too often what I’ve found is mobility programs are viewed as the sole responsibility of rehab departments, especially physical therapists. Often PTs are over-resourced, and there aren’t enough therapists or they don’t get a referral until just before discharge. They could have been spending their time with a patient who really needed them.
PTs and OTs usually only see a patient once a shift if they’re lucky, and they may not be able to do their initial evaluation until after the patient has spent several days in bed. Getting out of bed, weight bearing and doing range-of-motion and strengthening exercises for a few reps once every 24 hours just isn’t enough to impact the negative effects of bedrest.
Nurses and CNAs who are with the patient 24/7 have an enormous impact when they fully support mobilizing the patients early and often. Rehab, PT and OT still need to be involved to share their expertise and promote empowering nurses to take the lead for mobilizing.
Frankly, if a mobility program is not embraced as a nursing practice supported and sustained by a multi-disciplinary team, the hospital will not reach the goals that they set for the program such as decreasing falls, decreasing pressure injury rates, decreasing length of stay, decreasing hospital-acquired condition fines or whatever current initiatives are important to the administration.
Right. And staying on the same page about where the patient’s at and what type of mobility they’re able to perform is also important. How do you see technology as a way to support mobility assessment, where you are able to determine a patient’s readiness to mobilize?
You need data to hold people accountable. It’s too easy to say “I know I need to mobilize my patient,” and then you get involved with so many other projects. If you’re tracking mobility data, (you can understand) how often the patient is getting up and how often they’re being moved or if goals are being met.
If you don’t have a way of holding people accountable, it’s just not as effective. Nurses and healthcare workers intend to do the right thing, they really do, but it’s too easy to get off track and lose focus on that (mobility). That’s why I think a lot of early progressive mobility programs really aren’t as effective as they could be. You need a way to hold people accountable.
I’ve had nurse managers tell me that they track the data and really look at what’s important to them because they want their staff to be held accountable. They share that information, and they’re going to call people out if they’re not providing the standardized quality of care that everyone knows is going to lead to the best patient outcomes.
Accountability and also getting credit for mobility when you normally wouldn’t get credit as the bedside caregiver. It’s important to get that credit because you mobilize that patient and you know it’s helping them improve and quicken their recovery, but you don’t necessarily get the validation that it happened.
You’re absolutely right. The nurses that really appreciate when data is being tracked, it’s because it’s a good record that we are doing what we intended to do and what we’ve been instructed to do. We do these programs, we roll them out and educate folks but when they start doing the right thing, they need to be recognized for that.
That data can absolutely provide positive feedback.
What is it about a hospital patient that puts them so at risk when they become bedbound? What are some of the complications of immobility, and why is it so important to get these patients up?
It is challenging to get patients out of bed for a variety of reasons. That can include not having enough unit specific safe patient handling equipment. They might not be tracking the right data and may not know if they’re having an impact or not.
Nurses tend to state that they don’t have enough time or frankly they’re afraid they might get hurt. We know that patient handling-related injuries continue to be at a high rate for nurses. They want to do the right thing for the patient but it’s difficult. For instance a patient of size, one that is 6’2’’ and weighs 300 pounds. They know they need to get them up and moving but if they feel like they don’t have the right enough equipment or time, it’s just not going to happen.
Patients tend to attribute their lack of mobility to debilitating symptoms such as pain or being weak. Think about after you’ve had the flu and you’ve been in bed for a day or two how weak you feel when you first get up. Patients may be tethered (to the bed) from IV lines and when they sit up and get light headed, they get fearful which can lead to something called ‘bedrest dependency’ and their absolute refusal to get up.
Physicians may attribute a lack of mobility to a lack of patient motivation. We just haven’t motivated them enough. This indicates that we need to do a better job of educating patients and family members on why it’s so important to mobilize patients and what we’re trying to avoid.
In the hospital setting, better preparation can help reduce anxiety for both the patient and the caregiver. Having the right equipment can make the process of mobilizing patients more efficient and much safer.
One thing I noticed when looking over the BMAT was an acronym that you use. A.C.T. - what does it mean to empower caregivers to ACT in your opinion?
For me it really means that you have to give them the reason and rationale behind ‘why.’ Why are you asking me to do this new assessment? What’s in it for me or my patient?
We just didn’t come up with this because we thought you didn’t have enough to do during your shift. Getting those nurses success stories and making sure they hear them is important.
It’s one of the reasons a lot of the education I do with hospitals (is about) the background. Giving specific case scenarios with real patients helps do this and explaining to nurses what’s in it for them. Setting expectations regarding mobilizing patients and having these programs be fully supported by nursing leadership is essential.
In a whitepaper, “The Case for Mobility in Hospitalized Older Adults,” a case study of a 75-year-old man who was admitted to a hospital for syncope found that the value of discharge planning begins the day of admission. The lack of a coordinated system and culture oriented towards mobility resulted in a day of discharge surprise. The predictable loss of mobility in a seriously ill hospitalized older adult was not recognized and mobility status was not identified as an important outcome of hospital care.
If the hospital team had prioritized a mobility assessment and provided appropriate interventions, (the patient) might have gone home rather than to a sub-acute rehab center.
These types of scenarios are playing out every single day in hospitals.
ABOUT THE AUTHOR
DREW MARTIN
Drew works as marketing manager and takes care of digital and content marketing efforts for Recovery Force Health. He enjoys learning about and discussing newer medical technologies and adopting them into everyday marketing practices.