Real-life hypothetical.

What if a bedside caregiver could walk into any patient room and instead of reviewing a chart or asking the patient to recall how much they’ve moved today, they could look at the patient’s digital movement tracker and view up to a 48-hour history of objective data (bed-chair-steps) to answer that question? Would access to this patient data make it easier for hospital caregivers (nurses, patient techs, therapy services, etc.) to coordinate and execute mobility goals for patients? Could that data better guide clinical decisions relating to mobility progression for the caregiver or possibly even assist in transfer or discharge decisions?

The call to “Implement mobility early and often,” is used quite frequently - but what does that mean? Many organizations have made good attempts at developing mobility programs and protocols to answer this question, but we need good standards of practice to reference as these protocols and programs are being developed. We are off to a good start with efforts to improve healthcare outcomes through mobility and movement, however, I believe we are just at the beginning and have an exceedingly long way to go as we develop and implement these valuable and much-needed practices.

Let us consider some of the critical elements to include as we construct a mobility program. If it is to be a standardized part of care delivery, which disciplines will be responsible for leading the program? How will mobility orders be written into the care plan? Are there detailed descriptions for physicians to include in their orders? Which provider will be writing the orders for mobility, or might it be a hospitalist who determines what is required? Who is responsible for overseeing the execution of these mobility orders?

[pauses for breath]

A lot to consider, right?

Every program will need to begin with an assessment of the individual patient. From there, assessments will need to continue and evolve as the patient’s condition progresses. Patient-centered goals with objective metrics are critical to engagement, progress, and recovery. Acutely ill patient safety will need to be a key consideration - but a conservative view of safety should not in any way hinder the benefits achievable from getting a patient moving.

Technology can play a key role in facilitating mobilization. The selection of appropriate technology will help standardize practice and manage risk to both the patient and caregiver when engaged in early mobilization activities.

 When does early mobilization begin and end? I would say it begins as soon as the patient is placed in a hospital bed. With surface technology and other available medical devices, early in-bed mobilization can begin immediately. We will need to begin with what is thought to be the best prescription for the individual patient, but it will be important to measure what is taking place so that we can establish an evidence base on which to make prescriptions. Data collection capabilities are being built into medical devices and expanding the use of sensor technology in the healthcare environment. This allows us to now capture this crucial mobility data and drive clinical decisions. In my opinion, early mobilization shouldn’t end until the patient is back to their pre-hospitalization baseline, which means that there are several patients that will likely need prescriptive mobility even after going home.

 This is just the very start of what needs to be considered - but we need to start somewhere. As we progress, it will be especially important to have a broad multidisciplinary perspective - but there’s no doubt that in today’s healthcare world, the synergy between technology and clinical practice will drive future improvement.   

ABOUT THE AUTHOR

Dr. Guy Fragala Ph.D., PE, CSP, CSPHP

Dr. Fragala has many years of experience as a healthcare professional and is recognized as one of the pioneers of Safe Patient Handling and Mobility efforts in the United States. He has lectured throughout the world and is a recognized international expert in the application of ergonomics to the healthcare setting.  Currently, he helps and supports a number of organizations, vendors, and facilities with their safe patient handling and mobility efforts.  In 2012 he was awarded the National Advocacy Award for Improved Caregiver Safety and in 2017 awarded the Bernice Owen Safe Patient Handling and Mobility Research Award.  His book entitled, Ergonomics: How to Contain On-the-Job Injuries in Healthcare, published by the Joint Commission on Accreditation of Healthcare Organizations, has influenced much of the work today related to healthcare ergonomics and safe patient handling and mobility programs.