Early Patient Mobility and the SPH Medical RoWalker
Categoriesearly mobility

Advancements in Early Mobility

As the years go by, more and more patient care programs and trends are making their way into the mainstream. One area that has received a plethora of focus in recent years is the advancements in early mobility benefits for those in the ICU and critical care units. If your hospital doesn’t currently have a formal early patient mobility program, it’s time to consider implementing one.

The Biggest Problems With Bedridden Patients

Any nurse that has ever spent time on the floor can tell you that bedridden patients experience numerous health issues beyond their current diagnosis. A big one is muscle deconditioning or weakness that occurs when the muscles aren’t adequately used. Some other notable issues patients experience include delirium and depression.

Fighting These Problems With Early Mobilization

A major solution that has helped to greatly reduce and even eliminate some of these unhealthy conditions in patients is the implementation of early mobilization. Both patients in the ICUs and critical care units have been noted to enhance all of the following:

  • Functional Recovery
  • Walking Distance
  • Reduced Length of Stay
  • Respiratory Function
  • Cardiac Health
  • Muscular Function

While the benefits of early mobilization can have any nurse or PT excited about being able to help their patients even more, implementing this type of program at your hospital requires some planning and clinical input. Not only do you need to convince staff members and patients alike that early mobilization is the key to their best and fastest recovery, but you need to have the right equipment to get the job done.

The SPH Medical RoWalker Platform Walker Providing Advancements in Early Mobility

This acute care ambulation walker is the product of more than ten years worth of collaboration with physical therapists, interdisciplinary nurses, cardiothoracic surgeons, and respiratory therapists. It’s ergonomically designed and provides patients with optimal physical security so that they’re more confident when getting out of bed for the first time. In many cases patients are afraid to get out of bed and stand for the first time. They don’t trust their own legs to support them and also don’t trust the nurse or therapist to prevent them from falling.

Optimal Patient Security

The RoWalker provides an optimal level of patient security with adjustable hand grips, optional support belt, and other unique features. Now you can support early patient mobility with fewer staff members without compromising patient safety. The RoWalker will be sure to fit perfectly into your safe patient handling program, and you’ll be confident knowing that your patients can ambulate with a proven device that has been used in many evidence based mobility programs across the country.

This helpful device utilizes an optional ambulation belt that can be used to assist a low-functioning during walking for fall prevention. This is a great add on to a device that already has everything. With adjustable height levels, the RoWalker can support patients of all heights and sizes. It features two convenient hand grips complemented by padded arm rests to offer optimal patient support.

Additionally, and perhaps most importantly, there are seat flaps that flip up and can also be rotated outwards 180 degrees so that the RoWalker can be brought right up to the bedside so that patients can feel more comfortable standing and taking their first steps.

The seat flaps go a long way in preventing unwanted falls and providing opportunities for rest for both the patient and your staff members alike. Now with the built in seat flaps you don’t have to drag a wheelchair behind the patient during ambulation and fewer staff are required when ambulating ICU patients.

The SPH Medical RoWalker supports IV and Oxygen

Designed With Patient Needs in Mind

The SPH Medical RoWalker is designed with various components that can easily house patient necessities to ensure that they’re under optimal care throughout their mobilization program. The RoWaker has an integrated IV pole, a convenient oxygen tank holder, and a large front basket that can support a portable ventilator or cardiac monitor. You’ll find adequate room for all of the assistive devices that your patients need.

Advancements in early mobility are becoming more and more prominent as its many benefits for the body continually become cited by medical facilities and practitioners. The SPH Medical RoWalker can be the perfect assistive device to help patients in your ICU and critical care units get up and move sooner. With so much evidence supporting the use of early patient mobilization in hospitals, you simply can’t afford not to integrate this program into your facility.

The SPH Medical Rowalker supports Early and Progressive Mobility
Categoriesearly mobility

Early and Progressive Mobility Essentials

Although there are cases where a patient leaving bed is not possible for a variety of reasons, in the majority of cases, encouraging a patient to become mobile is beneficial. Early and progressive mobility essentials are beneficial for both the patient’s physical healing and mental well-being.

Getting patients out of bed early in the healing process reduces:

  • The length of time a patient must be mechanically ventilated
  • The overall length of stay in the intensive-care unit
  • Short-term complications
  • Long-term physical and mental disabilities

Patients also won’t need as many sedatives when they ambulate, and any sedatives they need, for whatever reason, will not be at high dosages. Too, helping a patient be mobile is a bonding process between not only the patient and the staff but also between staff members, which can only improve the level of care. Such improvement is not limited to that of the patient in question, either, as the bonding between the various staff members will affect every patient who is under their care.

In 2015, the Journal of the American Medical Association Internal Medicine published Hodgson et al., a study on the positive impact of early mobility on elderly patients who had been mechanically ventilated. The mobilized patients exhibited higher scores on the Medical Research Council Dyspnea Scale than those who were not mobile. They also lived longer post-discharge than those who could not become mobile.

Some other evidence based benefits of early mobility on patients after discharge include the following:

  • More than a third of patients avoided ICU-Acquired Weakness.
  • If a patient experienced ICU-Acquired Delirium, the duration of such delirium was 50% shorter than in those patients who were not mobile.
  • Patients required 10% less time on a ventilator.
  • More than 50% of patients were independently functional post-discharge.
  • One in eight patients who would have otherwise died survived.

Progressive Mobility Essentials For New Patient Mobility Strategies

Aside from the multidisciplinary approach, there are other strategies for hospital staff regarding early patient mobility. They must assess each patient individually and realize that not every patient will be able to be mobile. Even if a patient cannot get out of bed, for example, there are things that the patient can do with a nurse or physical therapist while remaining in bed. Exercises, turning to different positions to avoid bedsores, and just sitting up can work wonders.

Safety is also obviously a concern. A patient might be willing, but the parameters of the case might make it impossible for the person to be safely mobile. Also, even though you might adopt general safety criteria, each case requires well-reasoned decision making regarding mobility. This highlights the great strength of the multidisciplinary strategy. Throughout the team, there will be enough experience and expertise to make the right decisions regarding early patient mobility.

The Banner Mobility Assessment Tool, or BMAT, as is is now known, is a common tool that is used to asses the mobility level of a patient by going through some simple functional tests. The test are fairly simple but yield validated results. The nurse will have the patient sit and shake, stretch and point, stand, then walk. After going through the BMAT assessment the patient is given a BMAT level, 1, 2, 3, or 4. If after the level 3 standing test the patient can bear weight but if any assistive device (cane, walker, crutches) is needed, patient is determined to be Mobility Level 3, and the appropriate assistive tool should be selected. A validated Nursing mobility assessment is often the cornerstone of a sustainable program. As part of California’s AB1136 (CA LC 6403.5) legislative requirements, a validated patient mobility assessment tool provides valuable documentation about patient mobility status and communication between staff.The Banner Mobility Assessment tool provides validated results

The RoWalker for Early and Progressive Mobility Essentials

After assessing the patients’ mobility level, one of the best ways to get a patient up and moving as part of a safe patient handling program is to use a sturdy and stable platform walker, such as the SPH Medical RoWalker. This kind of walker is the best choice because it has wheels with directional casters and brakes on the wheels. With these features,
the nurse or therapist can safely get a patient standing at bedside with the brakes on, or walk the length of a hallway without drifting from side to side, a key benefit of the directional casters.

Additionally, having a rolling walker with the proper attachments makes it a snap to attach IV bags, various monitors, and even an oxygen tank to it. That way, the patient can get all the benefits of mobility without having to leave vital devices behind. A SPH Medical RoWalker also has a basket attached to the front so that some of this critical care equipment can go with the patient as they progress, move further away from bedside, and take steps towards recovery.

References:

https://www.ahrq.gov/hai/tools/mvp/modules/technical/intro-early-mobility-fac-guide.html
https://www.medtronic.com/covidien/en-us/clinical-solutions/icu-early-mobility/about.html
https://ccforum.biomedcentral.com/articles/10.1186/s13054-021-03741-z

Categoriesearly mobility

Benefits of Early Patient Mobility Revealed

Benefits of Early Patient Mobility in the ICU

The human body is designed to move regularly and stay active as much as possible. Failure to ambulate can leave you battling several health complications. That is why we see benefits of early patient mobility and it’s continued encouragement even amongst ICU patients. In this article, we have talked about the benefits of early mobility in patients as well as what ICU nurses and physical therapists need to do to make sure it is done safely without exposing patients to injuries.

Why Early Patient Mobility is Important

A study carried out by the Johns Hopkins University School of Medicine states why early patient mobility is important. This evidence based study goes further to demonstrate how the program can significantly improve patient outcomes. Dale M. Needham, M.D., Ph.D., the lead researcher of the university, says, in the study, that patients who get out of bed as soon as possible are less likely to suffer from mental illness, physical impairment or muscle weakness compared to patients who stay in bed a bit too long.

The National Institutes of Health also published another study discussing why early mobilization in patients is important. According to the study, patients who spend less time in bed are less likely to suffer from blood clots, UTIs (urinary tract infections), pneumonia, and bedsores, which are also referred to as pressure ulcers.

An evidence based article written on April 14, 2021, shows that patients who get out of bed sooner are also more likely to enjoy lots of emotional benefits than their counterparts who take a little longer to stay in their hospital beds. The article notes that early mobilization can actually stimulate the mental well-being of patients. It also points out that it can massively improve their emotional well-being. And this, in turn, improves the quality of their lives, while, at the same time, reducing overall recovery time as well as decreasing the serious risk of delirium.

Steps Hospitals Are Taking to Promote Early Mobilization in Patients

Although it is easy to say that patients can enjoy all these benefits simply by starting to ambulate as soon as possible, one thing we must note is that ambulation in patients who have been in their hospital beds for quite some time is not so straightforward. Well, this is where a safe patient handling program comes into play. Under this program, nurse leaders, ICU nurses, or physical therapists help mobilize patients and help them get back to their feet, literally. An early patient mobility program is a specialized program that falls under Safe Patient Handling where a multidisciplinary team of doctors, nurses, therapists, and respiratory therapists collaborate to get patients up and out of bed.

They use assistive mobility devices or rely on trained medical teams to achieve this. This could mean repositioning, lifting, or transferring patients from one bed to another surface like a stretcher, cardiac chair or wheel chair. It might also mean helping patients exercise. Well, patients who exercise have a greater chance of avoiding the health issues discussed early on in this post.

Using SPH Medical RoWalker to Promote Early Mobility in Patients

When it comes to assistive mobility devices, the SPH Medical RoWalker is highly recommended. Yes, there are lots of assistive mobility devices out there. However, the RoWalker is preferred because it carries just about everything a complex patient might need while using it. These include an IV pole, an oxygen tank, and it has a front basket that can carry a portable ventilator or a cardiac monitor.

All of these accessories make the mobility device incredibly convenient to use. Still, on convenience; this ambulation device has innovative features such as soft knee pads that support patients when standing and, when walking, give them much-needed protection. The most innovative feature of the RoWalker are the seat flaps. The seat flaps flip up and rotate outwards so the Rowalker can be brought right up to the bedside to help a patient to stand for the first time. Then the seat flaps can fold down and rotate into position during ambulation so that patient falls are avoided. The seat flaps also eliminate the need for a 2nd nurse or therapist to follow behind with a wheelchair! The several attachment options for oxygen tanks are worth mentioning too. They make RoWalker very easy to use. Moreover, the small footprint allows nurses and physical therapists to effortlessly fit this platform walker in any patient room.

Conclusion

Early patient mobility comes with plenty of benefits that health practitioners can simply not ignore. These include improved muscle mass, improved cardiac function, reduction in the risk of delirium, and improved respiratory function, among others. However, it is not easy to execute. That is why ICU nurses, nurse leaders, and physical therapists are advised to consider the SPH Medical RoWalker.

Mobilize Patients Early with SPH Medical's RoWalker
Categoriesearly mobility

Early Patient Mobility Trends

In the past, hospital personnel followed safe patient handling guidelines that primarily focused on the safe movement and transfer of patients with staff assistance from surface to surface or from bed to chair for example. Most safe patient handling programs that were implemented really focused on staff injury prevention. And as we all know today the majority of staff injuries come from repositioning patients up in bed and lateral transfers between bed and gurney or bed to table. In the past, keeping a patient in bed just seemed to make sense as patients getting out by themselves or when manually handled by staff were often at risk of falling. Today however, early patient mobility is now a trending practice across the nation. Professional opinions about this topic have changed drastically in recent years as more doctors, nurses and physical therapists have taken an approach that’s evidence based rather than stuck on traditional practices and norms.

Consider the following evidence and ways early patient mobility benefits both patients and staff:

  • Muscle Atrophy or Deconditioning Isn’t Allowed to Set In

    Many immobilized patients quickly lose muscle mass, strength and tone. The old saying “If you don’t use it, you lose it” definitely applies to recovering patients. Certain biological processes kick in during immobilization that reduce muscle mass. Movement can help prevent and reverse these processes. Patients who have difficulty with standing and walking can benefit from care out of bed that involves any type of movement. They don’t need to rely on physical help from hospital personnel alone. Several types of assistive tools exist, such as the SPH Medical RoWalker, that can help with this type of safe patient handling program to make it easier for patients to move around and stop muscle wasting as quickly as possible.

  • Prevention of Cardiovascular and Respiratory Events

    As the Centers for Disease Control and Prevention notes on its website, immobilized patients are at high risk of experiencing blood clots that can lead to heart and lung problems and strokes. Movement reduces clots by improving circulation. Increased blood flow can improve oxygen levels and respiration. Patients who have suffered a critical illness might also need an oxygen tank to breath when walking. Many assistive tools like the SPH Medical RoWalker have built-in features that make it easier for patients with cardiovascular, respiratory and critical needs to ambulate, such as a telescoping IV pole, a basket that can carry a cardiac monitor or small ventilator, an oxygen tank holder, hand grips and a built-in seat for breaks.

  • Reduction of Hospital and Overall Medical Bills

    Hospitals that implement early patient mobility can actually help patients reduce their medical debt burden. It might seem counterintuitive for any type of business to find ways to stop billing customers, but many patients who can’t pay their immediate medical bills are unable to pay them at all as time passes. Growing medical debt then often forces them to put off preventative care, which adversely impacts hospitals when those same patients seek ER care for emergencies they could have prevented in prior weeks, months and years. Additionally, early mobility during an inpatient stay can prevent costly followup ER visits by reducing the risk of related muscular and cardiovascular events. For example, it can reduce the number and length of physical therapy appointments and in-home exercises required for a full recovery, which decreases the patient’s medical debt burden from recovery treatment and the risk of more debt from an emergency atrophy-related muscle strain.

  • Additional Hospital and Staff Benefits

    The adoption of early mobility in an ICU and other hospital settings can open up beds faster. If patients are capable of getting up and moving around, they’re not going to need to remain in the ICU for long. Movement can even help staff determine if the patient is strong enough to leave the ICU and breathe without assistance. A safe handling plan that includes assistive and supportive equipment means that staff members won’t have to rush around or experience accidents to retrieve items they need while helping patients. If they’re using a sturdy, durable walking system like the SPH Medical RoWalker, they also won’t need to catch falling patients by hand. They can use the equipment to support the patient’s weight. Lastly, early mobility can help improve patient sleep and mental health, which can reduce ER surges and dangers to staff related to a growing national mental health crisis.

Early Patient Mobility improves outcomes
Categoriesearly mobility

Safety Platform Walkers

A Practical Solution for Early Mobility in the Acute Care Setting

By Amber Perez MHA, CSPHP

 

The benefits of early and progressive mobility programs are well-established in the acute care setting. Greater than a decade of published research validates the positive patient outcomes associated with implementing an early mobility (ICU-Based) and progressive mobility (acute care inpatient) program as an essential part of the patients plan of care. Marra and Ely of Vanderbilt University published the groundbreaking research establishing an intensive care patient protocol the ABCDE (now the ABCDEFG) method for reducing the risk of Delirium in ICU patients.  Delirium, once under-diagnosed and rarely treated, is now recognized as a primary indicator for mortality and identified early in most ICU’s in the United States. Vanderbilt University’s groundbreaking results contributed to drastic improvements in the quality of life and mortality rates of an immeasurable number of patients as a result of widespread adoption of the methods and tools published in the protocol. One of the key components of the ABCDE method is the ‘E’ or Early Mobility intervention. Subsequent research further identifies benefits of mobility (early and progressive) to include reduced risk of hospital acquired pressure injuries, ventilator acquired pneumonias, patient falls, hospital readmissions, and length of stay. In addition, patients experience an improved discharge disposition1.

Hospitals all over the world are prescribing mobility as a standard component of patient care. While mobility programs offer exciting and promising outcomes and quality improvements for patients, it is not without challenges and risk. Without proper planning and integration with a facility Safe Patient Handling & Mobility (SPHM) program, risk for patient handling injury and patient falls risk increase.

In an independent survey of ICU and Hospital nursing leaders – the barriers reported with early mobility protocol implementation include: lack of caregiver resources, increased risk of patient falls, and risk of patient handling injury. In addition, nursing leaders reported greatest concern with “out of bed activities” specifically, “standing and ambulation”. Many leaders reported having advanced ICU beds capable of assisting with many tasks of the early mobility protocols- including, tilt table/ hemodynamic training, sitting, edge of bed, and early weight bearing. The greatest concerns for staff and caregiver safety emerged around patient standing and walking. Of the nursing leaders surveyed, the equipment used to assist in standing and walking patients ranked as most preferred for mobility activities as follows:

  1. ICU/Inpatient Safety Walkers 66%
  2. Ceiling lift with walking sling 24%
  3. Mobile lift with walking sling 8%
  4. Mechanical stand aid with removable footplate 2%

The following are comments captured on the survey related to each category:

ICU/ inpatient Safety walkers:
“Safest option available”, “Fits well in crowded rooms”, “Allows us to walk patients out of the room”, “Staff prefer this option”, “Intuitive, easy to operate”, “O2, IV and devices have a place to go on the walker”

Ceiling lift with walking sling:
“Not all rooms have ceiling lifts”, “Only works well with a XY ceiling track”, “We do not have dedicated walking slings” “Great option if we can find the walking slings” “limited to in room activity”

Mobile lift with walking sling:
“Mobile lifts are too big and bulky in the ICU room” “Cumbersome”, “No place to put O2 or devices”, “Improved safety, prevents falls”

Mechanical stand aid with removable footplate:
“Footplate not removable on our device”, “Not a good option for an unsteady patient”, “no place to put oxygen or IV”

Based on the majority of feedback, utilizing a safety platform walker is the preferred equipment for accessibility, safety, function, and efficiency.

Below is a decision table to help you identify which safety platform walker is right for you.   

  • Walker
  • Features
  • Patient specific recommendations

RoWalker FeaturesMobilize Patients Early and Safely

  • 400lb weight capacity
  • Fixed seats that rotate and flip
  • Directional locking castors
  • Accessory basket
  • O2 tank and IV pole holder
  • Manual height adjustment
  • Width adjustable platform

RoWalker – Patient specific recommendations

  • Ideal for patients able to come to a standing position independently
  • Consider when sling management is a barrier
  • Simple and intuitive
  • Higher weight capacity
  • Conducive to therapy activities
  • Consider for patients with sternal precautions

Rise & Go Platform Walker Features

  • 330lb weight capacity
  • Safety sling with hygiene strap
  • Accessory basket
  • O2 tank and IV pole holder
  • Power stand assist
  • Directional locking castor available
  • Extra-wide adjustable platform
  • Swing away shin pads
  • Splash/water resistant design

Rise & Go Platform Walker – Patient specific recommendations

  • Ideal for deconditioned ICU level early mobility – power stand assist
  • Hygiene strap on sling allows OT’s to work with patient on ADL’s- water resistant design allows bathing therapy sessions with limited water spray
  • Swing away shin pads allow for progression in ambulation
  • Ideal for taller and smaller patients, longest stroke length on actuator
  • Small footprint for easy storage

XL Platform Walker Features

  • 500lb weight capacity
  • Extra wide frame adjustments
  • O2 tank and IV Pole holder
  • Accessory basket
  • Shin pad accessory- removable
  • Extra wide adjustable platform

XL Platform Walker – Patient specific recommendations

  • Ideal for ambulatory bariatric patients
  • Power rise assists with sit to stand
  • Ideal for patients who are not a high fall risk
  • Patients with O2 and IV’s may be useful with therapy.

References:

  1. Winkleman C, Johnson K, Hejal R, et al. Examining the positive effects of exercise in intubated adults in the ICU: a prospective repeated measure clinical study. Intensive Critical Care Nursing. 2012

 

  1. Vollman K. Early progressive mobility: strategies for successful and safe achievement to impact short and long-term outcomes. 

 

  1. Roberts M, Johnson LA, Lalonde TL. Early mobility in the intensive care unit: Standard equipment vs a mobility platform. American Journal of Critical Care.

 

  1. Marra A, Frimpong K, Ely EW. The ABCDEF Implementation Bundle. Korean Journal of Critical Care Medicine (2383-4870). 2016

 

  1. Pottenger BC, Pronovost PJ, Kreif J, et.al. Towards improving hospital workflows; an evaluation of resources to mobilize patients. Journal of Nursing Management. 2019
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