1. C. Bennett, E. Nicholl, S. Serna, Supervisor: Dr Owen
Rise and Shine:
The importance of patient mobilisation
C. Bennett, E. Nicholl, S. Serna,
Supervisor: Dr Owen
At least ½ of elderly acute fractured neck of femur patients per week experience delayed mobilisation after their operation. This increases loss of independence and risk of death in these already vulnerable members of our community.
Where does the problem lie?
Problem
During our time working on orthopaedic wards within the hospital, we have observed inconsistencies in the mobilisation of patients following surgery for fractured neck of femurs. One patient only got out of bed three times in a three month stay!
This problem occurs on a daily basis across the three orthopaedic wards in Kettering General Hospital. 1.
Patient Falls
Fractured Neck Of Femur Diagnosed
Operation
Weight-bearing Status Documented
1. Physiotherapy Assessment Day 1 Post-op
Mobilisation Status Determined
2. Nursing Staff Mobilise Patient
Patient Out of Bed
Patient Discharged
Initial data collection showed that 50% of patients were appropriately mobilised on day 1 post-op.
Discussion with the physiotherapy team and the results of our screening questionnaire highlighted that the problem may lie from day 5 onwards.
Number Of Patients
Out Of Bed?
Evidence 2.
Our second baseline measure highlighted patients were only being mobilised with the physiotherapists i.e. every other day.
This also showed that there was a fundamental lack of knowledge with regards to when it is safe to mobilise.
No local evidence or guidelines regarding mobilisation of patients
Qualitatively, all members of the MDT concerned about mobilisation
Published evidence relating to the associated risks of staying in bed. (Mudge, O’Rourke & Denaro, 2010).
The British Orthopaedic Association states that one of the 8 aspects of good care is prompt mobilisation.
(1=no, 2=yes)
Out of Bed:
Goal
Objectives
Plan of action
100% of all fractured neck of femur patients aged 60 or above to be out of bed for 80% of their post-operative rehabilitation on Barnwell B ward by 16/3/15.
To increase the number of days fractured neck of femur patients are out of bed during their post-operative rehabilitation.
To increase awareness of the importance of post-operative mobilisation amongst the MDT.
To improve documentation about post-operative mobilisation
Prospective data collection
Four PDSA interventions : Verbal Prompt, Teaching, Mobilisation Algorithm, Shine Chart
Six days of data collection: Patients days 5-10 post-op (up to 5 patients)
All members of MDT involved
PLAN
Teaching: Importance of Mobilisation DO
MDT teaching session
STUDY
Mobilisation data for day 5-10 post-op
ACT
Unclear when to mobilise, develop algorithm
Verbal prompts to encourage mobilisation
Daily verbal prompts to MDT
New PDSA -formal teaching
FAILED - STOP: NEW CYCLE
PDSA Cycles
Shine Chart
Chart included in all notes
Continue and expand solution
Mobilisation Algorithm
Algorithm included in all notes
Continue, included signing sheet
IMPROVEMENT:
NEW IDEAS
SUCCESS: CONTINUE
Days out of bed
Patients
Run Chart: Is this working?
Include a SHORT attention grabbing title
Include your name – add a photo of you and your team if you wish
Add your hospital LOGO
Summary
Obstacles
Disinterested senior staff
Defensive nursing staff
IIntroduction of “yet more paperwork”
Staff shortages, bank staff not familiar with routine
Lack of motivation to “make a change”
We identified that patients were not being mobilised because the nursing staff did not know when it is safe to mobilise and they felt that it was not their role.
Verbal prompting and formal teaching did not seem to improve our outcome.
Although, staff were against the use of the “Shine Chart” – on the day of implementation 95% of patients were mobilised. This has been sustained and the Rise and Shine Campaign has become talk of the orthopaedic wards.
We recommend that Shine Charts and Mobilisation Algorithms are incorporated into the nursing records for all fractured neck of femur patients.