Relationship Between Mobility and Falls in the Hospital Setting

Implementing an Activity and Mobility Promotion Approach to Improve Patient Mobility

BACKGROUND

A decline in patient mobility is a common occurrence following hospital admission, even with short, uncomplicated stays. Low mobility is known to result in a variety of adverse outcomes, including functional decline, especially for the vulnerable older population.

PURPOSE

Strategies to promote mobility in hospitalized patients are crucial to improving outcomes and reducing associated costs. The aim of this quality improvement project was to implement the Johns Hopkins Activity and Mobility Promotion (JH-AMP) program at a large safety-net hospital, assess the feasibility of implementing this program, and examine the preliminary impact of the program on patient mobility.

METHODS

A pre- and postimplementation design was used on medical and surgical units, and in ICUs. The JH-AMP program was implemented using eight key strategies based on the Translating Research into Practice implementation science framework. The intervention was designed to provide all patients with a daily mobility goal during their stay in the hospital and ensure that frontline staff utilized this goal as a metric to move patients every day. Measures of mobility capacity and performance, the Activity Measure for Post-Acute Care "6-Clicks" Short Form (AM-PAC) and the Johns Hopkins Highest Level of Mobility (JH-HLM) scale, were integrated into the electronic health record to facilitate generation of a mobility goal. An iterative process was used to improve the thematic analysis of qualitative focus group discussions. Within-group comparisons of JH-HLM scores were performed for all units before and after implementation of the JH-AMP program using Mann-Whitney U tests.

RESULTS

Following program implementation, the frequency of patients scoring 4 (transfer to a chair) or higher on the JH-HLM scale was significantly greater compared to baseline (z = 2.02, P = 0.043). Similarly, all units demonstrated a significant decrease in the proportion of patients scoring 1 (lying in bed) compared to baseline (z = 2.03, P = 0.031).

CONCLUSION

Large-scale, hospital-wide implementation of an activity and mobility promotion program is feasible when performed systematically and can significantly reduce hospital immobility.

Exploring the influence of hospital context on acute care physical therapy fall prevention practice: A qualitative study

BACKGROUND

Falls are a significant concern for hospitals and patients. The risk of falls is particularly heightened around the period of hospitalization. Physical therapy (PT) is commonly consulted for hospitalized patients at-risk for falls, yet it is unknown how the hospital context influences fall prevention practice among physical therapists.

PURPOSE

To explore the perspectives of acute care physical therapists on fall prevention practices within hospital settings and examine how specific contextual factors influence their practice patterns and the effectiveness ofPT interventions.

METHODS

A prospective qualitative study using collaborative qualitative data analysis was conducted through semi-structured interviews with acute care physical therapists nationwide. Interviews focused on therapists' perceptions of fall prevention practices, PT intervention effectiveness, and the influence of hospital context.

RESULTS

We derived three primary themes and ten subthemes. First, mobility promotion was identified as central to fall prevention, requiring a system-wide culture involving multidisciplinary teams, particularly nursing staff. Second, systemic factors, such as time constraints, institutional priorities, high patient volumes, staff availability, equipment availability, and the physical environment, were found to limit optimal PT practice for fall prevention. Third, the effectiveness of PT interventions was context-dependent, with therapists adapting their practices to maximize impact within systemic constraints. Notably, clinical experience seemed to mitigate some practice limitations.

CONCLUSIONS

Despite the acknowledged benefits of PT, systemic factors often prevent therapists from implementing effective fall prevention interventions. Addressing these contextual barriers and developing standards of practice may enhance patient safety and the overall success of fall prevention efforts in hospitals.

Deconditioning in Hospitalized Patients with Cancer

OBJECTIVES

Provide an overview of hospital-associated deconditioning in hospitalized patients with cancer, including risk factors and trajectory of deconditioning. Discuss interdisciplinary roles in preventing deconditioning, best practices, and oncology nursing implications.

METHODS

A literature search was conducted in PubMed and on Google Scholar using search terms Hospital*, Mobility, Immobility, Deconditioning, Cancer, and Oncology. Peer-reviewed research studies, review articles, and websites of professional organizations were reviewed to provide an overview on mobility concerns in hospitalized patients with cancer.

RESULTS

Thirty-eight references were included in this overview of hospital-associated deconditioning (HAD) in patients with cancer. HAD is a widespread phenomenon with grave consequences. Patients with cancer are particularly vulnerable to HAD due to their cancer diagnosis and treatment effects. Physical activity in hospitalized patients is one of the most important practices to prevent HAD and is achieved through standardized mobility assessment and interdisciplinary collaboration.

CONCLUSIONS

Promoting mobility in hospitalized patients with cancer is essential to prevent the complications of HAD.

IMPLICATIONS FOR NURSING PRACTICE

Nurses are leaders of the interdisciplinary approach to enhance inpatient mobility. As they are most often at the bedside, nurses assess patients' level of mobility, recognize risk factors for HAD, and implement safe mobility interventions. Nurses experience barriers to promoting mobility including workforce shortages, high workloads, and competing priorities.