Jakubas, Zara A, BSN, RN

Mills, Katrina, BSN, RN

Weinsteiger, Toni Lynn, BSN, RN

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingImplementing a Nurse-Driven MobilityAssessment Tool to Facilitate Earlier PatientMobilizationZara A. Jakubas BSN, RNLehigh Valley Health Network, Zara.Jakubas@lvhn.orgKatrina Mills BSN, RNLehigh Valley Health Network, Katrina.Mills@lvhn.orgToni Lynn Weinsteiger BSN, RNLehigh Valley Health Network, Toni.LynnWeinsteiger@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/patient-care-services-nursingThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtJakubas, Z. Mills, K. Weinsteiger, TL. (2018, November 30). Implementing a Nurse-Driven Mobility Assessment Tool to Facilitate EarlierPatient Mobilization. Poster presented at: LVHN Vizient/AACN Nurse Residency Program Graduation, Lehigh Valley HealthNetwork, Allentown, PA.© 2014 Lehigh Valley Health NetworkLehigh Valley Health Network, Allentown, PennsylvaniaImplementing a  Nurse-Driven Mobility Assessment Tool to Facilitate Earlier Patient MobilizationIn newly admitted patients, does implementing a nurse-driven mobility assessment tool get patients out of bed sooner in comparison to waiting for physical therapy assessments?P: Newly admitted patients within 24 hours with an active mobility order who have not yet been assessed by PT I: Nurse-driven mobility assessment tool (BMAT)C: Waiting to mobilize after PT consultsO: Earlier patient mobilization• A lack of confidence often prevents RNs from ambulating patients without a PT consult• Increase in falls and pressure injuries on both units• Pre-implementation secret-shopper audit completed over 5 days of RNs on 5A/7A to gauge whether nurses are getting patients out of bed without a nurse-driven mobility assessment tool• In-person BMAT education provided to RNs over a 2 week period during the shift or change-of-shift– Educated 33 RNs and 11 TPs• Assess RNs using BMAT on units upon admissions—worked alongside RNs in implementation process• Pocket tool BMAT reference guide was developed for RNs for reference and posted around unit– Reference guide provides instruction on what types of assistive devices to utilize• Patients eligible for inclusion on 5A TTU and 7A  Neuroscience units are those admitted within 24 hours with an active mobility order who have not yet been seen by PT • Post-implementation secret-shopper audit completed over 5 days to measure whether nurses mobilized patients before PT worked with the patients• The Banner Mobility Assessment Tool (BMAT) is a standardized mobility tool used by nurses that is comprised of four tasks by which to assess and categorize patients based on functional mobility level.– Provides ease of use to staff and does not take time away from other aspects of patient care (Boynton, Kelly, & Perez, 2014)• There is a major need for a nurse-driven mobility assessment tool, based on/in order to: (Laine, 2016)– Increased patient falls– Increased staff injuries– Increased length of stay– More RNs feeling uncomfortable  mobilizing patients– Decrease contractures/muscle atrophy– Maintain patients’ baseline mobility level– DVT Prevention– Aid in GI mobility & bowel regimen– Prevent skin breakdown– Communication barriers with patients • One study involved integrating the BMAT across multiple specialties (medical-surgical, ICU, progressive care) to determine content/construct validity– Construct validity P<0.001 indicated BMAT was successful in discriminating between different patient populations (Boynton, Kelly, Perez, Miller, An, etc., 2014)– Survey of those involved on 342-bed unit proved that BMAT increased patient & staff satisfactionPre-BMATAuditPost-BMAT AuditPatients Admitted in 24-hour Period56 45Patients not yet “Out of Bed”36 19Zara Jakubas BSN, RN, Katrina Mills BSN, RN, and Toni Lynn Weinsteiger BSN, RNPICO QuestionBackgroundEvidenceImplementation Results1. Boynton, T., Kelly, L., Perez, A., Miller, M., An, Y. & Trudgen, C. (2014). Banner Mobility Assessment Tool for Nurses: Instrument Validation. American Journal of Safe Patient Handling & Mobility, 4(3). Retrieved from https://pdfs.semanticscholar.org/563c/e8542bd88b3ee6ded8ec6fee70b7b9a88da6.pdf2. Boynton, T. Kelly, L., Perez, A. (2014). Implementing a mobility assessment tool for nurses. American Nurse Today.3. Elsevier Inc. (2017). Clinical Practice Guideline: Inpatient Fall Risk. Elsevier CPG Spring Release 2017. 4. Laine, Kaylin C., “Educating Nurses on the Use of Bedside Mobility Assessment Tool (BMAT) to Create a Culture of Safety” (2016). Master’s Projects. Paper 348. 5. https://library.hill-rom.com/Global/Clinical-Programs/STAMP/English%20-%20UK/images/HR-STAMP-5EN180610-01%20-%20Mobility%20Assessment%20Customer%20Sample%20-%20THB.pngPre- and Post-Implementation AuditsConclusion• Utilizing the BMAT increased nursing confidence and facilitated earlier ambulation• 36% of patients were gotten OOB prior to BMAT implementation and 58% of patients were gotten out of bed after the BMAT was implementedNext Steps• Report results back to LVHN Safe Patient Handling Council• Trial the BMAT network-wide• 100% of patients who did not get out bed during final audit were scored as either a Level 1 or Level 2 on the BMAT• 64% of patients did not get out of bed before use of the BMAT• 42% of patients did not get out of bed after using the BMAT• Conversation with RNs after the second audit revealed that many felt “more comfortable in having something to use specifically for RNs, especially because PT is not able to assess many of the patients prior to admission to the floorWhen accounting for the total number of patients admitted within the 24-hour time period, we excluded those already seen by PT and those without activity orders.0102030405060Total Number of Admissions in 24-hour PeriodTotal Number of Patients Not Out of BedPre-BMAT Implementation Post-BMAT ImplementationComparing the Number of Patients Getting Out of Bed Before and After Implementing the BMAT Number of PatientsPocket cards posted around the unit for RNs to use upon admission. Associates level scoring to assistive devices appropriate for the patient. Falls 5A TTUFalls 7ANSU Pressure Injuries 5A TTU Pressure Injuries 7ANSUMay 2018 2 2 0 0June 2018 0 7 0 0July 2018 1 7 2 2August 2018 1 8 3 3

Implementing a Nurse-Driven Mobility Assessment Tool to Facilitate Earlier Patient Mobilization

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Implementing a Nurse-Driven Mobility Assessment Tool to Facilitate Earlier Patient Mobilization

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