Page 6 - Christiana Care Focus

The Christiana Care Way |
The 4Ms and more:
To come
Patient mobility heads in a new direction
By To come
Jennifer A. Thomas, MBA, MS, CCC-SLP, vice president, Rehabilitation Services, and Denise Lyons, DNP, APRN, AGCNS-BC, LSSBB, WISH program manager
As we are curious and continuously look for ways to innovate, we are launching an initiative called Activity and Mobility Promotion (AMP) at our hospitals aimed at getting our inpatients moving each day. The initiative will be piloted on six patient care units this fall, with the goal of rolling it out systemwide next year. Even though change can be challenging, our multidisciplinary teams will be working together to reshape the culture around mobility.
This initiative is a departure from the long-standing tendency to not mobilize hospital patients out of fear of falls and other potential negative consequences. Data suggest that hospital patients spend more than 95% of their time in bed.
Research also shows that bedrest places patients at a higher risk
for negative outcomes such as muscle atrophy and weakness, joint contractures, thromboembolic disease, pressure ulcers and respi- ratory complications. In-hospital immobility can also contribute to “post-hospital syndrome,” a transient state of heightened vulnera- bility following hospitalization associated with an increased risk of functional decline, medical adverse events and hospital readmission.
Promoting mobility in the hospital may help to prevent falls and injuries, while increasing the rate of patients being discharged to home rather than a skilled nursing facility. According to research published in The Journal of the American Medical Association, supervised daily walking and a balance assessment program were associated with an increased rate of being discharged home rather than to a skilled nursing facility.
Moving forward with innovative tools
A daily mobility calculator will help determine movement goals that are appropriate for each patient including range-of-motion exercises, walking down the hall and sitting in a chair or on the side of the bed. Each day, our caregivers will record the activities that our inpatients do, and patients and their care teams will strive to progress to the next activity on the scale over time.
Mobility is also part of a pilot program in our Acute Care for the Elderly (ACE) Units at both Christiana Hospital and Wilmington Hospital, as well as some of our primary care practices. The effort involves tracking four high level interventions considered the essential, initial elements for health systems to ensure that older adults receive the best care possible.
This framework is known as the “4Ms” which stands for: • What Matters to the patient and family.
• Medication.
• Mentation.
• Mobility.
The 4Ms were developed as part of an Age-Friendly Health Systems initiative led by The John A. Hartford Foundation and the Institute for Healthcare Improvement in partnership with the American Hospital Association and the Catholic Health Association of the United States. The goal is to spread the 4Ms framework to 20% of U.S. hospitals and medical practices by next year.
By using the 4Ms, caregivers are better able to provide reliable, evidence-based care to elderly patients who have multiple chronic conditions and take multiple medications.
You’ll likely hear from our champions who will work across disciplines to effectively teach and implement all aspects of these initiatives as we prepare to apply the learning of our pilot initiatives across the health system.
Through our commitment to serving together, we are helping our patients get more mobile on their journey to optimal health. 
Through AMP at Christiana Care, we’re also striving to use our resources more wisely. This involves reducing unnecessary physical and occupational therapy consultations and better directing rehabilitation resources to inpatients with greatest needs.
More mobility, fewer falls
AMP at Christiana Care kicked off with an evaluation by a team from Johns Hopkins Activity and Mobility Promotion which has developed structured quality improvement processes to promote a hospital culture of activity and mobility. During a year-long project, their team doubled the number of patients ambulating daily without any increase in falls.
The Johns Hopkins team recommended staff training, updates to the electronic medical health record and setting daily movement goals for our inpatients. A new algorithm focusing on mobility and activity also will help identify the most appropriate post-acute therapy options.
Starting July 1, six units at Christiana Hospital started education and training on using the innovative tools provided by Johns Hopkins.
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