Download Early Mobilization at Sunnybrook Health Sciences Center

Early Mobilization at
Sunnybrook Health Sciences
Center - A Quality Improvement
Initiative
Jocelyn Denomme, PT
Mobility Lead, Senior Friendly
Strategy
For if the whole body is rested much more than is usual, there
is no immediate increase in strength. In fact, should a long
period of inactivity be followed by a sudden return to exercise
there will be an obvious deterioration.
-Hippocrates
Chadwick J, Mann Wm. The Medical Works of Hippocrates. Oxford, UK:
Blackwell, 1950 p. 140.
Outline
•
•
•
•
•
Background/evidence
Our Standard of Care for Mobility
Indicator monitoring and results
QI activities
Early Mobilization in Emergency
Ontario’s Action Plan for Seniors
Responding to the Needs of Seniors is Imperative.
1/3 of our seniors will develop a new disability as a
result of deleterious hospital processes
Sunnybrook Numbers:
SHSC discharges11,000 patients / year over the age of 65 - 3300 will
experience functional
decline that will threaten ability to:
• Return home
• Resume former functioning
• Resume caregiver, companion roles
7
RGP Senior Friendly Hospital Framework
O rganizational Support
There is leadership and support in place to make senior friendly care an organizational priority. When hospital
leadership is committed to senior friendly care, it empowers the development of human resources, policies and
procedures, care-giving processes, and physical spaces that are sensitive to the needs of frail patients.
P rocesses of Care
The provision of hospital care is founded on evidence and best practices that acknowledge the physiology,
pathology, and social science of aging and frailty. Care is delivered in a manner that ensures continuity within
the health care system and with the community, so that the independence of seniors is preserved.
Emotional and Behavioural Environment
The hospital delivers care and service in a manner that is free of ageism and respects the unique needs of
patients and their caregivers, thereby maximizing satisfaction and the quality of the hospital experience.
E thics in Clinical Care and Research
Care provision and research are conducted in a hospital environment that possesses the resources and
capacity to address unique ethical situations as they arise, thereby protecting the autonomy of patients and
the interests of the most vulnerable.
P hysical Environment
The hospital’s structures, spaces, equipment, and facilities provide an environment that minimizes the
vulnerabilities of frail patients, thereby promoting safety, independence, and functional well-being.
8
Senior Friendly Hospital Strategy 2011/2012
 11 acute care units
 Holland Centre site
 Veterans Centre site
Integrate a mobility
standard of care
400 new staff orientation
 102 IP mobility champions
850 interprofessional staff
 300 mobility
volunteers educated
OUTCOMES
• Integrate a language of mobility
• Mobilize patient 3 times daily
• Embed mobility in unit processes
9
The Mobility Standard of Care
1. Daily assessment ( within 24 hours of admission) and
documentation of mobility status
2. Members of the inter-professional team work with
patients and/or their families to design a plan of care to
optimize mobility and functional status that is consistent
with the patient’s wishes and treatment plan
3. Participation and documentation of minimum three
mobility activities per day (activities expected are based
on the patients mobility status)
Simplified Algorithm
Mobility Standard of Practice
Performance Indicators
Monitoring
16
Visual Audit - Out of Bed
Overall Hospital Performance
60%
50%
40%
30%
SBK
Target
20%
10%
0%
Q1 Avg
Q2 Avg
Q3 Avg
2013-2014
Q4 Avg
Meeting the Standard - 3x daily mobilization
Overall Hospital Performance
90%
80%
70%
60%
50%
SBK
40%
Target
30%
20%
10%
0%
Apr
May
Jun
Jul
Aug
Sep
Oct
2013-2014
Nov
Dec
Jan
Feb
March
Documentation of the Mobility Level
Overall Hospital Performance
100%
95%
90%
85%
SBK
Target
80%
75%
70%
Apr
May
Jun
Jul
Aug
Sep
Oct
2013-2014
Nov
Dec
Jan
Feb
March
3x Daily Mobilization all units
Results
Primary Outcomes:
 3x daily mobilization 75%
 Mobility level 93%
 Visual audits 51%
Secondary Outcomes (August 2013)
 5%  in # of patients discharged home without supports
 Rate of injurious falls has remained stable over time
 Combined average length of stay for all units has remained stable over
time
Quality Improvement Activities
Patient-related
Treatment-related
Illness severity, comorbidity,
Activity order, devices,
medications
pain, delirium
Barriers to
Mobilization
Institution-related
Attitudinal factors
Staffing, time constraints,
equipment
Patient or staff,
expectations, concern
falling
Brown, C et al J Hosp Med 2007;2:305
General Medicine
% of Sampled Charts Meeting the Standard: 3 x Daily Mobilization (Target = 64%)
Aim Statement
D4 will improve the percentage of patients meeting the 3x daily
Mobilization Standard from 40% to 64% by November 2013
D4 will improve the percentage of patients who are out of bed at
the time of visual audit by 15% to 50% out of bed by November
2013.
Why are we struggling to meet our
targets?
Small Tests of Change
Results
D4
% of Sampled Charts Meeting the Standard: 3 x Daily Mobilization (Target = 64%)
D2
% of Sampled Charts Meeting the Standard: 3 x Daily Mobilization (Target = 64%)
Educating Patients and families
Mobility Volunteers: Acute Care
Small tests of change
D2 out of bed Lunch time audit
80
PDSA 1
70
60
50
40
30
20
10
0
PDSA 2
PDSA 3
Early Mobilization in Emergency
• Falls are the leading cause of injury
hospitalizations for seniors across the
• country, contributing to 9% of all emergency
department visits by seniors.
Early Mobilization in Emergency
Small group discussion:
 What opportunities/advantages are there to
implementing an early mobilization strategy in
emergency?
 What are the potential barriers to implementing
an early mobility strategy?
 Would this enhance care for seniors? How?
What are the next steps you will take when you go
back your organization to promote early
mobilization in the ED?
Senior
ThankFriendly
you ….