Mobility Intervention Tools - THCA



MobilityEnhancing and maintaining mobility as a part of daily care helps to maintain a person’s function as well as physical and psychological well-being. Working on this goal will help nursing home staff address mobility and related issues including range of motion, bed mobility, transferring, walking, eliminating physical restraints, wheelchair mobility, and reducing fall risk. Residents’ health and quality of life will improve with added freedom of movement and increased activity.This tracking tool calculates several outcomes based on MDS items you are already familiar with. For your quality improvement project, however, a mobility assessment should be completed for each resident you are following every month. A printable worksheet with just the mobility items you need for this workbook is included in the tab 'MobilityAssessmentForm.' The calculated outcomes are displayed on the 'DataforWebsiteEntry' tab.A set of 8 mobility items is used to construct 2 composite scores for each resident: Personal Movement Score, and Life Space Mobility Score. Additionally, a change score is calculated for those residents who have a current mobility assessment AND an assessment within the previous 30 days. The percent improving (among those not already with the highest possible score) and remaining stable (among those not at the lowest possible score) is also calculated.The Personal Movement Score is the sum of scores for Bed Mobility, Transfer, Walk in Room, Walk in Corridor, Upper Extremity Function and Lower Extremity Function. The Life Space Mobility Score is the sum of scores for Bed Mobility, Locomotion On Unit and Locomotion Off Unit. Each goal has: Data gathering or tracking toolA series of fact sheets to inform:Consumers Staff Leadership “Probing questions” – examples of the types of questions NHs might ask as they do their root-cause analysisLinks to useful resources781050190500Create Improvement (resources)Mobility Intervention ToolsAll Resident Levels left0Where Does Balance Come From?Introductory explanation of roles of vision, vestibular and proprioceptive functions and recommendations to improve balance by encouraging walking, even with device. left0The Falls Management ProgramComprehensive, interdisciplinary falls management program for long term care with several toolkits and videos. Useful for setting up a fall prevention program. left0National Center for Patient Safety 2004 Falls ToolkitComprehensive falls management program developed by the VA for both long term and acute care facilities. Includes multiple fall reduction tools addressing clinical interventions, equipment, and environment. Recommendations for hip protector use should be re-evaluated based on latest evidence. left0American Geriatrics Society Guideline for the Prevention of Falls in Older AdultsClinical guidelines for the reduction of fall risk in nursing home residents. Useful as background information which summarizes the evidence for and against fall prevention interventions in nursing homes. left0Centers for Disease Control and Prevention: Falls in Nursing HomesWebsite with a variety of background information for nursing home staff, residents, and families. left0Improving Patient Safety in Long-Term Care Facilities Training Modules: Falls PreventionOne of three self directed training modules with an instructor's guide and detailed content for educating staff on reducing falls risk. INSTRUCTOR'S GUIDE.The Falls Management Program Treatment Risk FactorsWe found the following treatment risk factors to be associated with greater likelihood of falls:Cardiac and analgesic drugs: residents taking digoxin, type IA antiarrhythmic, or opioid medications.Diuretic medications.Vasodilator.Multiple medications; residents taking more than three or four medications.Medication side effects.Treatment To Reduce RiskWe found the following treatments to reduce the risk of falls:Vitamin D supplements (1,000 IU/day).Use of toileting schedules.Mental DomainResident Risk FactorsWe found the following resident risk factors to be associated with greater likelihood of falls:Dementia, cognitive impairment.Depression.Agitated behaviors.Low Folstein Mini Mental Status Exam score.Treatment Risk FactorsWe found the following treatment risk factors to be associated with greater likelihood of falls:Central nervous system (CNS)-active medications, including benzodiazepines (both short- and long-acting), antidepressants, anticonvulsants, and narcotics (opioids).Psychotropic medications.Treatment To Reduce RiskWe found the following treatments to reduce the risk of falls:Structured multifactorial general medical assessment and additional specific fall risk evaluation tool that included attention to medications, including psychotropics.Functional DomainResident Risk FactorsWe found the following resident risk factors to be associated with greater likelihood of falls:History of falls.Abnormal postural sway, proprioception.Gait dysfunction.Low hand grip strength scores/hand dynamometry.Gait and balance instability.Lower extremity joint function limitations.Mobility limitations/challenges.Age-related changes in muscle and bone.Physiologic systems (somatosensory, vestibular, and visual).Low instrumental activities of daily living scores.Poor physical condition of resident.Treatment Risk FactorsWe found the following treatment risk factors to be associated with greater likelihood of falls:Walking aids: walkers and canes.Wheelchair use.Specific physical activities.Treatment To Reduce RiskWe found the following treatments to reduce the risk of falls:Exercise programs; moderate intensity group exercise; regular exercise.Gait and balance training.Muscle strengthening exercises.Tai Chi group exercise.Environmental DomainResident Risk FactorsWe found the following resident risk factors to be associated with greater likelihood of falls:Pieces of furniture.Poor lighting.Treatment Risk FactorsWe found the following treatment risk factors to be associated with greater likelihood of falls:Restraint reduction.Assistive and protective aids.Treatment To Reduce RiskWe found the following treatments to reduce the risk of falls:Daily 5- to 10-minute exposure to Nolwenn Leroy CD for 1 month.Staff education regarding fall prevention, implementation of prevention strategies.Use of hip protectors.Visual way to identify residents at risk of falling, such as bracelet or color-coded charts.High nurse aide-to-resident ratio.Facilitywide multidisciplinary team responsible for implementation and evaluation of fall prevention activities.Multifactorial Treatments To Reduce FallsFlowchart to improve documentation of fall risk factors and characteristics of fall episodes; supports referrals to geriatrician.Menu-driven incident reporting system for falls.Multifactorial fall risk assessment and prevention program.Fall management program.Postfall assessment tools.Probing Questions: Why are our mobility rates low? Are our observations borne out by changes to MDS scores on mobility? Which groups are affected? Are we getting more individuals moving in who weren’t ambulating before? Were they using walkers and wheelchairs already? What kinds of people aren’t going to activities anymore? Have there been changes in the staffing and scheduling of meals or bathing? Are we seeing more residents with diminished capacity? Is this problem occurring throughout the home or is it in just one unit, hallway or floor? Are the declines in mobility seen where we have new staff assigned? Are we seeing patterns related to time of day or shift? Have there been changes in who’s ambulating and how? Has the decline we’ve noticed been in a certain type of residents – for example, residents whose restorative programs were recently stopped? Is what we’re seeing related to family pressure to keep relatives “safe” from falls and hence not up and about? Do we tend to put residents in wheelchairs because it is faster to transport them? Processes and Resources to Consider What assistive devices are we using? Are residents getting the correct assistance device - for example, canes are adjusted to the correct height? Are assistive devices in good working condition? Are there gait belts routinely available or does each resident have a gait belt? How do we monitor mobility? Is there a structured way for staff to communicate with each other about a resident’s mobility status? Is there a process in place that alerts staff members to a change in the mobility status of a resident? Do we have any specific tools we’re using to help in our observations about mobility? Has there been some sort of external change that has impacted mobility – for example, it is the middle of winter? What techniques are we using to support maximum mobility? Are we allowing enough time for personal mobility? Are our ambulation programs sufficient to maintain/promote mobility? Are we encouraging our residents to ambulate? Could lighting be playing a role in our problem? Is there a place outside the nursing home where residents can go and is it easy for them to access it? Are there places along the hallways where residents can sit? How do we know if a person has lost their shoes? Are residents getting proper foot care? Are residents moved to a chair and out of their wheelchair during meals and activities? Is mobility an organizational priority? Are we making it a priority to help get all residents to activities? Do staff feel a sense of responsibility for maintaining mobility? Are staff held accountable for supporting mobility? Who is responsible for mobility? Is mobility seen as being primarily the responsibility of the therapy department? What is the role and expectation of front-line staff in improving and maintaining mobility? What type of education are we providing to support staff? Do we emphasize the importance of mobility in our training for caregivers? Are staff educated on how to assist residents? \s\s ................
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