MOVE ON: Mobilization of Vulnerable Elders in Ontario: The Ottawa Hospital Experience
Mental Health and Geriatric Care
- Stakeholder engagement and unit leadership is crucial: having a direct link to Senior Management kept the project “in the spotlight”
- Having nurse educators leading the project led to better buy-in from front line nursing staff
- Sustainability and accountability need to be bulit in at the start; having several unit leaders whose performance metrics included mobility scores, drove success as did adding mobility to prevalence data collection
- Patient positioning and transfers need to be considered a basic nursing clinical skill and regularly evaluated.
- Communicating the importance of remaining active to patients and their caregivers facilitates getting out of bed and moving
- Recognizing staff who are “Mobility Champions” embeds mastery on clincial units
Functional decline is a common adverse outcome of hospitalized senior patients.(Lui, B et al)
There is a plethora of solid evidence that demonstrates the association between immobility and adverse consequences for any patient, but the impact on senior patients can be irreversible and life changing. Hospitalized seniors lose between 1-5% muscle strength /day; those seniors who were ambulatory 2 weeks prior to admission will spend on average 43mins/day standing or moving in hopsital. One third of hospitalised seniors develop a new disability in an ADL and half do not recover that lost function. In addition, ambulation and getting patients out of bed are 2 of the top patient-identified areas of missed nursing care (Kalish, 2013).
Addressing hospital-acquired functional led The Ottawa Hospital (TOH) to particiapte in 2 CAHO funded MOVE ON (Mobilization of Vulnerable Elderly in Ontario) pilot projects between October 2012 – December 2014. Additionally, as a Senior Friendly Hospital initiative, TOH secured funding from the Champlain LHIN and TAHAMO to extend the Move On Team at TOH. This resulted in an aggressive and innovative roll-out to 23 acute care units over 6 months.
The pilots and corporate rollout were guided by a Knowledge to Action Cycle involving focus groups, identifying barriers and facilitators to early mobilization from both front-line staff and patients/caregivers. Key messages were: determine mobility status within 24 hours of admission; mobilize patients 3 times/day in a scaled and progressive way; document/communicate mobility events; and mobilization is a team responsibility.
Improvements in length of stay, patient satisfaction, number of mobilty events and determination of mobilty status were achieved through the project period.