Mobility Action Group

Session Three

May 25, 2017 12:00-1:00 pm EDT

Audio available by call-back feature OR by dialing:

Teleconference Line: 1-800-832-0736 Conference Room Number: *8713107#

Participant Access Code: 052517#

Welcome

Isaac Burrows, MPH Laura Maynard, M.Div. Learning and Diffusion Group CJR Learning System Team

Center for Medicare & Medicaid The Lewin Group Innovation

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Faculty

Dr. Sharon Inouye, MD, MPH Harvard Medical School, Beth Israel Deaconess Medical Center

and Hebrew SeniorLife

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Introduction to Adobe Connect

To Enlarge Presentation

Closed Captioning

Download Available Resources

To Ask Questions

or Send Messages

To View the Video

To Dial In via

Telephone

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Introduction to Adobe Connect (Cont.)

• Use the Chat pod to submit any questions or comments

• Please use “@” if your question/comment is directed to a specific presenter

• Submit your question/comment by clicking the chat bubble icon

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Agenda

• Welcome & Logistics • Mobility Action Group Prework Survey Data

• Measurement Matters • Q&A on Measures • Participant Presentation and Q&A • Summary and Next Steps • Announcements & Reminders

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Participating Organizations by CMMI Model Affiliation and Bed Size

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Count of Tactics Chosen in Prework (N=110)

*

Note: Each hospital could select more than one tactic. *Includes health systems noting that they will be deferring to their specific organizations,

organizations who plan to assess readiness/current implementation status, and organizations that already have a robust mobility program.

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Measures

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Measures: Change Tactics

Strategy → Change Concept → Tactics

• You may be adding some of these tactics to your existing mobility program

• You may be initiating a program with some of these tactics

• You may choose not to consider most of these

• We recommend adding or initiating a few at a time

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Measures: Change Tactics (Cont.)

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Measures: Organizational Readiness

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Questions?

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Chat

Please type into the chat box the tactics your organization will be testing or implementing.

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PIH Health-Whittier Presentation

Casey Bailey, PT Administrative Director of Rehabilitation Services and

Wound Healing Center

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Organizational Culture Change: Implementation of a Nurse Driven

Mobility Program

PIH Health-Whittier 12401 Washington Blvd, Whittier CA 90602

Presenter: Casey Bailey, PT, Administrative Director Rehabilitation and Wound Healing Services Sarah Merkle, MSN,RN, AOCNS Clinical Nurse Specialist Renata Jones, DNP, RN, Director of Patient Safety Lynze Ruvalcaba, BSN, RN, Clinical Director Oncology Unit Pippin Ashton, BSN, RN, Clinical Director Surgical Telemetry Unit Gail Martin, PT III

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PIH Health

PIH Whittier is a 546 bed hospital, which is part of a California regional nonprofit healthcare delivery network that serves more than 2.1 million residents in Los Angeles County, Orange County and San Gabriel Valley.

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Problem Statement

Clinically unnecessary inactivity and prolonged bed rest are associated with unfavorable patient outcomes. Mobility is largely left to Physical Therapy and standardized mobility assessment is lacking.

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Program Goals

• Implement a mobility program to promote patient health and safety in the acute hospital setting at PIH Health in order to decrease the consequences of immobility

• Decrease cost by eliminating Physical Therapy referrals for routine mobility needs

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Baseline Metrics • Of 2,919 discharges on one of our medical-surgical units,

440 (15%) had at least one strict bedrest order. Absence of an activity order is perceived to be the same as a bedrestorder

• Of 2,825 discharges on this floor, 1932 (68%) had fewerthan 2 documented mobilization events per day

• Of 94 randomly selected PT orders, 22% did not meetcriteria for clinical appropriateness (by CMS guidelines)

• Hospital-wide nursing survey results (N=104): • 90% of nurses at PIH believe mobility will improve outcomes for their

patients • 54% believe that leadership has provided sufficient resources,

time/support

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~~ PIH HEALTH

Creating a Culture of Mobility:Program Name and Logo

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~"1. PIH HEALTH

BEDSIDE MOBILITY ASSE SSMENT T OOL

Assessment Level 2-Stretch and Point

1. With patient in sealed position at the side d the bed, ha'oN! patient dace bodl feet on 1he floor (or stool) with knees no ligher than hP5.

~- Ask patient lo 5Rtch one leg and stradlten the knee. then bend the ant lellle:x and pont the toes. If~. repeat With the Olher

Assessment Level 3-Stand

1. Ask patient to elevate of tM bed or chair (seated 10 sta'ldini:i'I using an asss1J...e device •:came oedrail t

' Patient should be aole 10 ra'Se Dlllttocks crff oe and hold 'or a count of five May repeat once

Assessment Level 4-Walk

1. Ask paent lo man:h in place ill bedside.

2. Then a~ 1o ac1vance sll!p and return each foot.

'There an! medical condibons thal may render a pilbenl unable ID step backward; use ~ best clnical iucilmert-

PASS= P;rtie.nt io ; b'.le to com e to ;; :;.e;;::ed

positicon.. m ':ilint ;;i n core

otren,i;th.. r. • - · • """-'•<! b<;f ;uu'• wh~e rexhi11;: ;;;aoss midlin.e.

MD\-e on to Azessme r: t l.e¥el 2.

f All..: Patient un;;;ble to

perform t ;;:;;b r p;1':ient l!.i MOBIUlY ln'El 1

PASS= P;rtie;llt io ; b'.le t o demoratr-te ;;;;ppropri;;;te QIJ•<I otren,i;th on ir.tende d ......,;;tit be• rini;: limb(<). Move on.:o ~7nen:t

l.e¥el 3o f All..: P;rtie11~ un;;;'ble llo

com plete, ;;;,;k. P;rti.,,,~ i• ..... .... ~

P:1nen: m- - ~ns:

m r.din,i;: ,;t; bEty for ·~

le• :;t 5 .econ&. proceed ":a •z~:;m.e11it k-v tt .

f All..: P;;tien-:: urt.it'ble to

demoratr-te Z:;;;11d in;; m . Patient is

M061L Tf LEVEL 3 PMS= l?;rtie.nt

demomtr.tes: b ;;l; :noe while sliiftini; ,.,.,;i;trt ;;;:nd ·~ llo <tep, '3e• indepemGe r.t rtep~ doe!:O

not'""" ;zZtive devfce p;; ':ie:n-:: i:;; MOBIUTY LE\'El 4 fail= 1P-.':ie11~ not ; l>..ie t o

com plete to.sk> 05I

req..1ires w:e: of 3.zi:mv.e devfce. i>;;;llieMis M061UTf UVEL 3

Nursing Training:Banner Mobility Assessment Tool (BMAT)

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Mobility Interventions

• Level 1: Bed activities

• Level 2: Seated activities

• Level 3: Standing activities

• Level 4: Walking activities

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Examples of Change Tactics

1. Strategy: Provide Early Mobilization a) Trained all staff in safe mobility

1) Gained physician and nursing buy-in

2) Nurses and aides trained in assessing and providing mobility

b) Appropriate assistive devices available for every patient 1) Walker and gait belt in every room

2) Next day replacement through central supply

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Examples of Change Tactics (Cont.)

2. Strategy: Enhance Function and Mobility a) Mobilization included in every patient care plan

1) Mobility interventions at set frequencies

2) Physical therapy orders limited to appropriate criteria

3) Mobility champions identified

b) Regular mobility provided 1) Default/pre-checked order “activity per nursing assessment”

2) Expiration of bed rest orders in 24 hrs.

3) Documentation of mobility in standard location

4) Standardized whiteboard communication

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Month

January

February

March

April

May

~~ PIH HEALTH

Activity

• Mobility Steering Committee formed • Educator and mobility champion training

• Comprehensive training of all RN's and CNAs • Creation of mobility order sets and EHR customization • Purchase of gait equipment

• Completed bedside competencies; program launch

• Preliminary chart audits, Refinement of HER

• Additional CNA training, • Installation of hallway distance markers • Ongoing QI process with iterative feedback

Timeline Table 2017

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Questions/Feedback

Contact Information: • Phone (562) 698 0811 ext. 12496

• email: casey.bailey@pihhealth.org

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Faculty Comments

• Heidi Wierman, MD, Maine Medical Center

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Questions, Reactions & Insights

Tell us using Chat! • What questions do you have?

• Are you using similar approaches?

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Summary and Lessons Learned

• Measurement: For the monthly measures, wewill track your change tactics over time and your organizational readiness

• Participant Presenter (PIH Whittier, Casey Baileyand team): – Effective approaches to create culture change—

creating a culture of mobility – Practical examples of: limiting bedrest orders;

assuring equipment available; engaging, trainingand communicating with nurses and aides

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Overall Guidance

Where you should be now: – Target population/unit identified

– Team identified and meeting regularly

– Change tactics selected (2-3+ to start)

– Collecting all measures (establishing baseline)

– Training staff in mobility—engaging and communicating

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Next Steps

• Where you want to get… – Move forward with your change tactics – Identify what you want to do next: Select additional

tactics – Build teamwork and confidence – Continuous quality improvement

• Please share what you are doing with each other on Connect and on the webinars; would love to hear from you!

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Mobility Action Group on ILS Connect

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Upcoming Mobility Action Group Sessions

If you have any questions, please send an email to Mobility@Lewin.com.

Please take a few minutes to respond to the Post-Event Survey.

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