Abstract TP311: A Safe Early Mobility Protocol for Stroke Patients
Background: Early mobilization of medical and critical care patients benefits outcome, length of stay, and patient satisfaction. There is limited data regarding safety of early mobilization of stroke patients, because concern for falls or neurologic deterioration due to positional hypoperfusion has led to promoting bed rest during the acute phase of care. The study evaluated the ability of nursing staff to safely assess and mobilize stroke patients at an appropriate level within 24 hours of admit.
Methods: A Stroke Mobility Protocol was developed to assess the clinical readiness of patients to be mobilized. The protocol was implemented in January 2011 for all stroke patients in our neurosciences unit. Protocol safety was evaluated by the number of persistent clinical deteriorations, falls occurring due to the protocol and the overall fall rate. Nurses were to monitor for clinical decline and report any changes not resolving after repositioning. Falls in patients with a stroke diagnosis were tracked using unusual occurrence reports. Fall rates were calculated as number of falls per 1,000 patient days. Post-implementation fall rate from 2011 was compared to pre-implementation falls rate from 2010. Our 2011 fall rate was also compared to 2011 fall rate of an affiliated hospital not using the protocol. Fall rates were compared using the Wilcoxon Rank Sum Test.
Results: There were no reports of persistent neurologic deterioration. The post-implementation fall rate per 1,000 patient days was lower (1.4 falls, mean rank=408.00, n=436) compared to the pre-implementation rate (6.3 falls, mean rank=405.21, n=376) although these differences were not statistically significant (p=.38). The 2011 fall rate at the comparable hospital (5.1 falls, n=590) was also higher compared to the protocol hospital, although not statistically significant (mean ranks: 516.31 versus 509.69, respectively, p=.11). No falls occurred as a result of the protocol.
Conclusions: Initial data indicate that early mobilization does not lead to prolonged neurologic deterioration or more falls. The Stroke Mobility protocol enables nurses to safely evaluate patients’ function, allowing earlier mobilization.
- © 2012 by American Heart Association, Inc.