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 Features

• 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

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

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

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

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