Qi Group 7 Presentation
Qi Group 7 Presentation
Qi Group 7 Presentation
Mobility / Ambulation
in Medical Patients
Mayu Hoang, Julie Mayo, Kristin Schmitt,
Shana Vazquez, Susan Castillejos
Day 2
Loss of
muscle
strength,
blood flow
Day 3 Plasma
Volume
CV workload
(HR, SV,
CO)
orthostatic
hypotension
Day 5
microvascular
dysfunctions
By Day 8
Bone degradation
begins and
continues as long
as bed rest occurs
Day 7
Visible weakness
Ca+ in urine
10% in postural
muscle strength
Deep Vein
Thrombosis/
Pulmonary
Embolism
2011 National
2011 National
Example in Numbers
Patient Safety
Patient Safety
> Population Aged > 65yr in U.S. = 12.5% or 35 million
Indicator:
> 45 medical patients
> 65yr able to walk in 2Indicator:
weeks prior to hospitalization
> Wireless accelerometers attached to patient thigh for first 7 days
hospitalization
> Mean length of stay: 5.1 days
> Generated: 2,592 hours data
> 35 patients or 77.8%
were
willing
and able to
walk aper
short
distance
10.74
per
1,000
8.14
1,000
independently
> 83% of measured hospital stay was spent lying in bed
> Median time any one patient spent standing or walking a day:
43 minutes
(Brown, 2009)
> Study that Shows Positive Outcomes Related to Early Ambulation/Mobility in the Hospital Setting :
Study #2
Journal: Chest (American College of Chest Physicians)
Study: Early mobilization of patients hospitalized with community-acquired pneumonia performed in 1997-1998
Participants: General Medical Patients with CAP
Measure: Early Mobility (EM) was defined as sitting or ambulating out of bed for >20 min in first 24 hours of admission
Results: Hospital length of stay for EM vs usual care was significantly less (mean, 5.8 vs 6.9 days; adjusted absolute difference, 1.1 days; 95% confidence
interval, 0.0 to 2.2 days). There were no differences in adverse events or other secondary outcomes between treatment groups (Mundy, 2003).
QI Tools
Recommendations
-Initiate mobility within 24 hours after
admission
-Initiate PT and OT therapy along with ROM
-Educate nurses and staff about Early
Mobility Program
References
Bailey, P., Thomsen, G., Spuhler, V., Blair, R., Jewkes, J., Bezdjian, L., ... Hopkins, R. (2007). Early activity is feasible and safe in respiratory failure patients.
Critical Care Medicine, 35(1), 139-145. Retrieved February 20, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/17133183
Basses, R., Vollman, K., Brandwene, L., Murray, M. (2011). Integrating a multidisciplinary mobility programme into intensive care practice (IMMPTP): A
multicentre collaborative. Intensive and Critical Care Nursing, 28 (2), 88-97. Retrieved February 22, 2015, from
http://www.sciencedirect.com.ezproxy.library.kapiolani.hawaii.edu:8080/science/article/pii/S0964339711001303?np=y
Developing and Implementing a QI Plan. (n.d.). Retrieved February 22, 2015, from
http://www.hrsa.gov/quality/toolbox/methodology/developingandimplementingaqiplan/part4.html
Brahmbhatt, N., Murugan, R., & Milbrandt, E. (2010). Early Mobilization Improves Functional Outcomes In Critically Ill Patients. Critical Care, 321-321.
Brown, C., Redden, D., Flood, K., & Allman, R. (2009). The underrecognized epidemic of low mobility during hospitalization of older adults. Journal of the
American Geriatrics Society, 57(9), 1660-1665. Retrieved February 21, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/19682121
Engel, H., Needham, D., Morris, P., & Gropper, M. (2013). ICU Early Mobilization.Critical Care Medicine, S69-S80.
Fact Sheet on Inpatient Quality Indicators. (2013). Retrieved February 21, 2015, from
http://www.ahrq.gov/professionals/systems/hospital/qitoolkit/complete_qitoolkit.pdf
Gallagher, S., Kumpar, D., Harrington, S., Wilson, K., & Zock, R. (n.d.). Advancing the Science and Technology of Progressive Mobility. Retrieved February
22, 2015, from
http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Work-Environment/SafePatient/Advancing-the-Science-and-Technology-of-Progre
ssive-Mobility.PDF
King, L. (2012). Developing a progressive Mobility Activity protocol. Orthopaedic Nursing, October 2012, Volume 31, 253-262.
Mundy, L. (2003). Early Mobilization Of Patients Hospitalized With Community-Acquired Pneumonia. Chest, 124(3), 883-889. Retrieved February 21, 2015,
from http://www.ncbi.nlm.nih.gov/pubmed/12970012
Perme, C., & Chandrashekar, R. (2009). Early Mobility And Walking Program For Patients In Intensive Care Units: Creating A Standard Of Care. American
Journal of Critical Care, 18, 212-221.