Transcript Beyond TEDS and Meds:

Beyond TEDS and Meds:
Mobility Strategies for Prevention
of Post-Stroke DVT and Other
Complications
Dori Tooke, MHA, PT, CSCS
Aurora St. Luke’s Medical Center
Milwaukee, Wisconsin
Objectives:
• At the end of the lecture, the listener will:
- Have an increased awareness of the importance of
patient mobility post-stroke in the prevention of common
complications
- Recognize the need to approach patient mobility from a
medical and rehabilitative team perspective
- Describe at least two cost effective and time efficient
strategies to incorporate patient mobility into an acute
care setting
Common Post-Stroke Complications
• As a result of impaired mobility, post-stroke
survivors can encounter:
-
DVT/VTE
Pneumonia
Depression
Falls
Decubiti
Contracture
UTI
Delirium
DVT Prevention Literature Search
• 196 abstract reviews:
- Medications: effective
- External compression devices: effective
- Mobility: absent from the literature except to
acknowledge immobility is a prognosticator of
complications
One study did cite early mobility after DVT as having
no increased risk of consequences if proper
secondary prophylaxis applied
Early Mobility of Post Stroke Patients
• Literature does support early mobility as a means
to improve rehabilitative outcomes (short and long
term)
• Mobility benefits include prevention of
complications, maximizing outcomes, and
prediction of appropriate post-stroke service needs
• Quality indicator for rehabilitation plan and DVT
prophylaxis
Mobility Barriers
• Medically unstable patients
• Severely impaired patients
• Lack of expertise and / or comfort with patient
mobility
• Time perception
Mobility Solutions
• Lift equipment for severe impairments; or
use the space you’ve got for positioning
and PROM
• Utilization of mobility experts; partnership
with therapies
• Incorporate strategies into the day
Therapy Partnership
• Provision of recommendations for mobility or
activity
• Training for carryover of mobility
• Recommendations for maximal safety
• PT, OT, ST, and Physiatry
Severely Impaired Patients
• Lifting equipment
• P-AAROM to affected limbs
• AROM for unaffected limbs
• Activity schedules
• Positioning techniques (example: shoulder
approximation and wrist elevation of affected arm;
with finger extension)
• Optimize stimulation in the environment
• Therapy goals may be pre-ADL or pre-gait
activities
Moderately Impaired Patients
• As per severely impaired
• Considerations for cognitive issues and safety
• Pivot transfers if safe
• Up in chair for meal times
• Use commodes; avoid bedpans and catheters
• Have therapy train staff for the best/easiest
transfer technique
Minimally Impaired Patients
• Walk each shift
• Watch for equipment needs
•
•
•
•
(communication strategy with therapy!)
Up in chair for all meals
Use the bathroom or commode
Encourage active motions
Encourage leisure interests (example:
knitting, word puzzles - with caution)
Mobile Patients
• Normalize function
• Independent in room; clear with therapy
• Ensure post-stroke resources for rehab are
ordered (for all patients)
• Watch for high-level cognitive deficits that
are subtle
Communication Strategies
• White boards (activity section)
• Posters (examples: swallow precautions,
swallow strategies, activity schedules,
positioning cards, equipment lists, etc.)
• Education sheets
• Plan of care rounding
Activity Specialists Programs
• Model that adds FTE(s) whose purpose is
to ensure activity occurs- Nursing works on medical needs
- Therapists work on skilled therapy components
- Activity specialist carries out routine and/or
supportive therapeutic mobility
• Ambulation teams
• Therapy extension programs
How Does a Hospital Pay for an Activity
Specialist?
• Generally entry level or slightly higher pay
(similar to CNAs)
• Compare with the costs of a single
complication that can be prevented:
- Cost of a fall with injury: $6,437
- Fall with significant injury: upwards of $60,000
- Cost of a pressure ulcer: $7,310
Data from 2005 to 2007, conservative estimates
Activity Specialist Training
• Would be jointly nursing and therapy
trained
• Could be unit specific
• Would be supervised by nursing
• Could incorporate leisure and social skills,
as well
Patient Activity:
• Prevents complications
• Minimizes decline
• Ensures team commitment to the patient
• Maximizes outcomes
• Provides for highest quality care
Contact me:
Dori Tooke
Aurora St. Luke’s Medical Center
414-649-5541
[email protected]