Joints just say no. Muscles grow weak.
We all know the body’s ability to do the mind’s bidding often falters later in life. But the effects of age on function can be especially unforgiving when you’re hospitalized. Knee replacements, hip replacement, arthritis, rotator cuff, spinal fusions, laminectomies, osteotomies…all common surgical procedures happening in Winnipeg everyday.
Lying in a hospital bed day after day can quickly undermine one’s mobility. Even though most of the hospital data comes from the USA; our nurses, doctors, hospital staff are experiencing the same trends in healthcare as the Boomers come into their 60s.
Hospitals get it. Care plans are developed for patients that prescribe exercise when appropriate. Doctors put in orders for physical therapists to help patients walk and otherwise preserve their mobility.
Nurses and assistants often are expected to help patients move, even if it’s just from bed to chair for their dinner.
But that doesn’t mean it always happens. When hospital units become swamped with particularly sick patients, preserving mobility can easily slip down the priority list, hospital administrators say.
“There’s the ideal world, and then the practical world,” said Liz Ericson-Macke, a nurse, social worker and case-management supervisor with the Franklin County Senior Options Program.
“Sometimes just getting people up and walking them may not happen as much as we would like it to.”
Michele Weber acknowledges that. While working on her doctorate, the clinical nurse specialist at Ohio State University’s Wexner Medical Center evaluated how well nurses stuck to the mobility guideline for intensive- and critical-care patients.
It took persuading, but physicians bought into the guideline that took effect in 2009. They issued a blanket order giving registered nurses greater power to decide when exercise and physical therapy were appropriate during stays in the ICU, which average 5.5 days. A physician’s order is still required for physical therapy, however.
In late 2010 and early 2011, Weber examined the care provided to 207 patients — 41 percent of whom were older than 60 — to see whether the guideline was being followed.
“We were following protocol 30 to 40 percent of the time,” she said.
There were several barriers to improving compliance, including factors beyond the nurses’ control. Some patients refused to exercise. Many hospital rooms are small, with constrained layouts that didn’t lend themselves to the right kind of chair.
In some cases, nurses didn’t have the right supportive devices — walkers, canes, gait belts — close at hand. Some equipment didn’t have battery backup so that IVs could remain hooked up to patients when they were up and about.
And inadequate staffing levels sometimes hurt compliance.
Today, audits show compliance is better, typically between 50 and 60 percent, Weber said. The hospital added the mobility guideline to the orientation process for new critical-care nurses, provided better equipment and balanced staffing.
Mount Carmel Health System declined to share similar compliance data. A spokesman for OhioHealth said the hospital system doesn’t have such data.
Efforts to get patients moving might seem at odds with another hospital priority: fall prevention. But Weber said there were no adverse outcomes during the OSU research project.
The benefits of getting a patient moving early have become more widely recognized, said Dr. Larry Swanner, vice president of medical affairs at Mount Carmel West.
“In the past several years, we have increased our focus on physical therapy,” he said.
For patients who have had hips or knees replaced, early exercise leads to quicker recovery times. For surgical patients, walking encourages deep breaths and coughing, which reduces the risk of pneumonia.
Meanwhile, patients who have undergone abdominal surgery might find that walking stimulates the return of their intestinal function.
If a physician orders physical therapy in the morning, it should take place that same day, Swanner said. If it’s ordered late in the afternoon, it should happen the next morning.
OhioHealth has been assessing many protocols, including for mobility, through a process-improvement group focused on geriatrics, said Michele Stokes, director of senior health services at the Gerlach Center for Senior Health.
“We really have a lot of opportunity across the system to be aware and do more for our elderly patients,” she said.