Integrating a Standardized Mobility Program and Safe Patient Handling

Postoperative Mobilization Protocol in Lumbar Laminectomy Patients

There are often misconceptions associated with early mobilization in postoperative spine surgery patients related to initiating mobility and staff responsibilities. Nursing staff and nursing certified technicians are responsible for ambulating patients after lumbar laminectomy surgery, resulting in improvement in clinical outcomes (Rupich et al., 2018). Lack of early mobilization in postoperative lumbar laminectomy patients may result in complications such as hospital-acquired weakness, infection, and increased length of hospital stay (Fiasconaro et al., 2020). The purpose of this quality improvement (QI) project was to increase mobilization at 24 and 48 hours in postoperative lumbar laminectomy patients as evidenced by improved electronic medical record (EMR) documentation. The Plan-Do-Check-Act (PDCA) model was used to frame the project, which took place on a neurological focused care unit in a Midwest tertiary care center. A retrospective chart audit indicated that documentation of mobility in the postoperative lumbar laminectomy patients was lacking. Staff education, using a self-paced module, was initiated related to the benefits of mobility in postoperative lumbar laminectomy patients and the importance of documentation in the EMR. The use of the John Hopkins Highest Level of Mobility scale and 6-clicks scale was discussed. A secondary chart review over 4 weeks posteducation showed results of improved documentation of early mobilized patients. This QI project demonstrated the impact of staff education on promoting mobility and appropriate documentation in the postoperative laminectomy patient. Future retrospective chart reviews will be undertaken to determine the effectiveness of a one-time education workshop on the impact of early ambulation over time.

Can an early mobilisation programme prevent hospital-acquired pressure injures in an intensive care unit?: A systematic review and meta-analysis

A systematic review and meta-analysis were conducted to clarify the effect of an early mobilisation programme on the prevention of hospital-acquired pressure injuries in an intensive care unit as opposed to standard care. We searched a total of 11 databases until 1 May 2020 and included seven studies (n = 7.520) related to the effect of early mobilisation protocol in the prevention of hospital-acquired pressure injuries (five quasi-experimental and two random comparative). The five quasi-experimental studies were significantly heterogeneous (P = .02 for Q test and 66% for I² ), and the odds ratio was 0.97 (95% CI: 0.49-1.91) with a non-significant statistical difference between both groups (P = .93). Our study shows inconclusive outcomes related to the effect of the implementation of an early mobility programme in the prevention of pressure injuries in critical patients. Future research is needed considering the small number of articles on the topic.

A novel early mobility bundle improves length of stay and rates of readmission among hospitalized general medicine patients

Inpatient early mobility initiatives are effective therapeutic interventions for improving patient outcomes and decreasing use of hospital resources among adult ICU and general medicine patients. To establish and demonstrate guidelines for early patient ambulation, we developed and implemented a novel multidisciplinary mobility bundle utilizing the JH-HLM (Johns Hopkins Highest Level of Mobility) scale for mobility classification, on a single adult general medicine unit of a community hospital. Our results show that patients admitted to the unit after implementation of the mobility bundle had improved mobility scores, reduced rates of 30-day hospital readmission, and a shortened length of hospital stay. This study emphasizes the importance of measuring mobility using a systematic method, easing workflow among unit practitioners, and allowing mobility initiatives to be jointly driven by nursing, physical therapy, and physicians.

Person transfer assist systems: a literature review

OBJECTIVE

Novel developments in the robotics field have produced systems that can support person wheelchair transfers, maximize safety and reduce caregiver burden. The purpose of this study was to identify and describe these systems, their usability (or satisfaction), the context for which they have been or can be used and how they have been evaluated to determine evidence for their effectiveness.

METHOD

Available research on Person Transfer Assist Systems (PTAS) was systematically gathered using similar standards to the PRISMA guidelines. The search terms were derived from common terms and via exploring similar review articles. Initial search terms displayed 1330 articles and by using the inclusion/exclusion criteria 96 articles were selected for abstract review. After full- text reviewing 48 articles were included.

RESULTS

29 articles concerned research in robotic transfer systems, 10 articles used both ceiling and floor-mounted lifts and 9 articles used only floor-mounted lifts as an intervention/control group. The results of this analysis identified a few usability evaluations for robotic transfer prototypes, especially ones comparing prototypes to existing marketed devices.

CONCLUSION

Robotic device research is a recent development within assistive technology. Whilst usability evaluations provided evidence that a robotic device will provide better service to the user, the sample number of subjects used are minimal in comparison to any of the intervention/control group articles. Experimental studies between PTASs are required to support technological advancements. Caregiver injury risk has been the focus for most of the comparison articles; however, few articles focus on the implications to the person.IMPLICATIONS FOR REHABILITATIONCeiling mounted lifts are preferred over floor-based lifts due to lower injury rates.Many robotic transfer systems have been developed; however, there is a paucity of quantitative and qualitative studies.Based on the results of this review, rehabilitation settings are recommended to use ceiling over floor assist systems, and it is recommended to provide training on using devices to assist with patient transfers to lower the risk of injuries.