Research shows that a hospital stay can lead to profound functional loss for patients – caused by immobility rather than illness. That decline can begin as soon as two days after admission.
Nursing supervisor Sharon Fogarty, B.S.N., R.N., and physical therapist Stephanie Smith, D.P.T., CCS, of Texas Health Presbyterian Hospital Dallas recently introduced a way to help nurses get patients walking sooner.
“The primary focus of nurses on med-surg units is treating the patients’ illness, not mobility,” said Sharon, who works in Hamon 2 North, a surgical unit. “Patients quickly become weaker, and if they’re elderly, they may have to go to a skilled nursing unit (SNU). About 30 to 35 percent of these people never get to go home again.
“So that just sparks our passion to get people up and moving.”
Confidence booster needed
This project built off a previous yellow belt effort Stephanie completed that led to Walking to Wellness, a nurse-driven initiative to get nurses mobilizing patients more and walking in the hallways three times a day. The program was adopted systemwide, “but it had a ‘failure to launch.'”
“We realized that nurses were expected to get patients up and walking, but they weren’t always able to assess whether a patient could,” Stephanie said. “You can’t expect a nurse to feel confident about getting a patient out of bed if they don’t have a way to assess whether they can do that.”
Last spring, the two earned a fellowship through Texas Christian University’s Center for Collaborative Practice to improve patient mobility at the hospital. The fellowships bridge research and practice by implementing evidence-based practices in a real-world environment.
Simple assessment tool
Sharon and Stephanie researched best practices and learned about the Banner Mobility Assessment Tool (BMAT), developed by Banner Health in Arizona. The tool is designed to help nurses assess mobility and determine what assistive equipment a patient needs. It assigns patients different levels based on their performance of simple tasks. (To see the Texas Health version of the tool, scroll to the bottom of the article.)
“It’s already been proven to be effective, so we wanted to incorporate that into our hospital,” Sharon said.
They started with three units at Texas Health Dallas, finding three to four champions in each unit to help.
“They did a pre-assessment, and then we did education, showed them the research and taught them how to do the BMAT assessment,” Sharon said. “Then for three months after that, whenever they were working they would use the tool and hand it in to us.”
Kimbra Saunders, an analyst with Decision Support and formerly a Performance Improvement coach, helped crunch the numbers.
“After our pilot was complete, the data showed that we had a significant increase in people getting up out of bed,” Sharon said. “Ambulation increased by about 40 percent.”
Adopted by RCB
While the project was going on, Texas Health Resources was working to update the Reliable Care Blueprinting(TM)(RCB) module on ambulation.
“The system was planning to roll out the updated module right after we finished our project,” Stephanie said. “Sharon was on the committee, so we suggested they use the BMAT.”
Based on the success of the Texas Health Dallas project, the RCB design team developed a process for implementing BMAT (renamed the Bedside Mobility Assessment Tool) systemwide. The tool is part of the RCB update that rolled out in April.
“The RCB design process is aided greatly when a pilot with complete data is presented to the design team,” said Stephen Allen, director of System Transformation. “We love when our clinicians can give us useful data and ideas to help all our hospitals provide better care for our patients.”
Using the BMAT took some getting used to.
“It’s a complete 180 in our culture,” Stephanie said. “We used to be a culture of fear to move people because of the risk of falls.
“But really, you’re doing more harm if you leave someone in bed.”
By Robin P. Loveman • Posted May 9, 2019
