Question: Can an individualized nurse led exercise/mobility program in hospitalized elderly, age 75 and older prevent functional decline, decrease LOS and prevent institutionalization to SNF?
Hypothesis: Current practice is one mobility champion for 3 or 4 inpatient medical surgical units to ambulate or mobilize patients in a 262/300 bed hospital (NWH/CSH). No formal exercise program is in place unless there is an order for PT. This current practice leaves elderly age 75 and older at risk for functional decline and adverse outcomes. It was hypothesized that a nurse driven mobility program in the patients care plan for mobile, non- mobile and bed bound patients can help maintain the patient’s pre admission level of function and decrease the incidence of functional decline that leads to increased LOS and /or discharge to SNF.
Methods: Patients age 75 or older included in the intervention group would receive mobility/exercised according to their level of function during hospitalization. Ambulatory Patients: Ambulation with/without assistive devices, with or without PCT or Nurse assist to occur twice a day. Increase distance as the patient tolerates. Sitting up in a chair or at the bedside unassisted for all meals (propping with pillows in a chair is allowed). Use of a bedside commode or bathroom for all bowel and bladder output (no bed pans). Non Ambulatory Patients: Use of the Stand Aid to do a series exercises with increasing repetitions and time as the patient tolerates. Use of the Stand Aid to do a series exercises with increasing repetitions and time as the patient tolerates. Standing in place. Sit to stands. Marching in place. Sitting in a chair at the side of the bed if no contraindications for all meals (propping is allowed if necessary). Assisted transfers to a bedside commode for all bowel and bladder output if not contraindicated (Use of stand aid or mechanical transfer aids allowed). Bed Bound/Unstable Patient: Knee bends. Leg lifts. Heel slides. Assisted sitting at the side of the bed or in a chair if not contraindication to increase trunk strength (propping is allowed if necessary).
Results: There have discussions to implement this intervention on a short term unit at CSH and to use retrospective chart review to compare LOS and transfer to SNF with patients age 75 or older. We have identified opportunities to expand the role and use of mobility champions. Opportunities to decrease the incidence of physical deconditioning and cognitive decline using individualized exercise programs in the patient’s treatment plan tailored to their needs have been identified as well.
Implications: Decreased incidence of adverse events during acute hospitalizations including morbidity and mortality may be avoided and maintaining preadmission level of function may decrease LOS, institutionalization, and transfer to SNF. Utilizing the 6 click mobility score may help in preventing functional decline. The literature suggests that acute hospitalizations are a major contributor to functional decline and disability in the elderly population. Functional decline occurs in the elderly at a rapid pace leading to adverse outcomes and increased length of stay that put them at greater risk for morbidity and mortality. This EBP was created to try and find a way to overcome functional decline and decrease overall risk to this age group during hospitalization.
Schneider, Elizabeth; Koopman, Sarah; Sharp, Marissa; Dempsey, Victoria; Rudy, Elizabeth; Combs, Melissa; and Chapman, Dena, "Nurse Led Mobility/Exercise Program" (2023). Nursing Research and EBP Day 2023. 15.