By Eileen Casey, PT
It’s not that we’re inhospitable, but here at Brattleboro Memorial Hospital we get our patients up, moving, and out the door as soon as they’re ready and able.
That’s because now more than ever we realize that movement promotes recovery from illness and injury.
We once believed that extended bed rest and limiting activity were the keys to recovering from an illness or surgery. However, recent research suggest that prolonged periods of immobility in hospitalized patients can have a serious and long-lasting negative effects.
When extended periods of immobility result in a decline in functional abilities, patients are more likely to have their hospital stay extended. Or they may be discharged to long-term care. Functional decline can happen in as little as two days. A 2008 study shows that for every day an older adult spends in bed it takes an average of 3.8 days to return to their pre-hospitalization level of functioning.
Extended immobility can negatively impacts our cardiac, circulatory, nervous, and musculoskeletal systems. It also challenges our psychological and emotional wellbeing. Patients confined to bed for long periods often experience higher rates of depression, anxiety, forgetfulness, and confusion. These issues can raise concerns about their ability to function safely and independently at home.
BMH Rehab/Physical Therapy Services has instituted a robust new initiative that promotes getting all our patients up and moving as quickly as possible, unless otherwise ordered by their physician. The Ambulation Pride Program (APP) counteracts the negative impact of immobility and helps patients get back to optimum functioning as quickly and safely as possible. Regaining independence and returning home are top priorities for many of our patients. By getting them up and moving, we reduce the incidence of blood clots, muscle atrophy, infections, pneumonia, dehydration, and many other complications that can extend hospital stays or cause patients to be discharged to a nursing home.
Under the new APP initiative, all patients admitted to BMH, with the exception of the Birthing Center, now have a default order for ambulation, unless otherwise ordered by a physician. Patients excluded from the protocol include those who are dependent on ventilators, those admitted with blood clots, acute stroke, acute fractures or spine fracture and other conditions in which ambulation might pose a health or safety risk.
Patients’ resting heart rates, blood pressure, blood sugar, and other factors are assessed before ambulation begins. And their readiness for ambulation is re-assessed by a nurse each morning of their hospital stay. We’ve designed a series of magnets to affix to each patient’s door. They make it immediately visible to all staff when a patient has been cleared to ambulate.
It also indicates how many times that day they’ve ambulated, and how many more sessions they have left in their day. These visual cues mean nursing staff no longer has to refer to a patient’s chart to see their ambulation activity. Their daily goals and activity are right there.
Our expectation is that all of our patients will be supported to ambulate at the highest degree of their functioning possible. That means getting up and walking in the hallways at least three times a day. It also includes getting up and out of bed for meals and sitting up for rounds and other visits. We’ve learned a lot of valuable lessons from the field of cardiac rehabilitation over the years. We used to think the best way to recover from a heart attack was to rest and limit activities. Now we know movement promotes the recovery of heart patients, who do better (as do most of our patients) when they’re up and about as soon as possible.
Instituting such a pro-active protocol requires more than declaring ambulation a priority, though. Upon admission to the hospital, every patient is now assessed for mobility and an individualized plan for ambulation entered in their record. BMH nursing and physical therapy staffs work in partnership to ensure that patients and their families are educated about the importance of ambulation.
And physical therapy staff are present regularly on the inpatient units to provide “curbside consults” to nursing staff about how to effectively and safely get their patients up and moving. We measure patients’ ambulation distances are and enter them into their record. This allows nursing staff to evaluate their progress and ensure they meet their daily ambulation goals.
Ambulation benefits patients of every age. But it’s particularly important for our older patients who value their independence and wish to maintain an active lifestyle. The ability to return home to mow your lawn might not be everyone’s cup of tea. But regaining independence is a key motivator for many patients. Should you find yourself receiving inpatient care at BMH, you can expect we’ll be planning your personalized ambulation program from the minute you are admitted.
Your nursing and rehab team will support you in reaching your ambulation goals. We want you to rest and recover; but we also want you to know that movement promotes recovery. We will help you get up and move so you can return home to your regular activities as soon as possible.
Eileen Casey, PT is Director of Rehab Services at Brattleboro Memorial Hospital. She can be reached by calling 802-257-8255.