Integrating a multi-disciplinary mobility program into a Long-Term Care Practice: A quality initiative to improve value

Abstract

Background: The majority of patients living in a Long-Term Care Unit (LTCU) have limited mobility.1 Prolonged immobilization results in functional decline and increases the risk of other complications.2 It was observed that there is a lack of a structured, evidence-based mobility program using mobility protocols and guidelines. As per a 6-weeks baseline data collection, out of the 36 patients in Rumailah Hospital's LTCU-2, 40% were bedbound and only 60% of them were engaged in any kind of “Out Of Bed Therapeutic Activities” (OOBTA) as of November 2020.The project aimed to increase patients’ participation in OOBTA from 60% to 80% by December 2021. Methods: A Mobility Task Force (MTF) was formed from a Multi-disciplinary Team (MDT). The Institute for Healthcare Improvement (IHI) Model of Improvement was utilized. A Cause and Effect Diagram with multi-disciplinary input identified potential causes limiting mobility and supported possible solutions for testing in a series of Plan-Do-Study-Act (PDSA) cycles (Figure 1). Each specialty evaluated and provided appropriate OOBTA based on their level of care. Results: This project helped the unit to promote a culture3 of early and safe patient mobility as shown by increased participation in OOBTA and zero falls, no pressure injuries, etc. As a result, it helped the unit to attain more than 80% of patient participation in OOBTA during their hospital stay (Figure 2). The team observed good multidisciplinary collaboration and engagement in developing this mobility program. Conclusion: Promoting early mobility is a cultural change that improved patients’ participation in OOBTA from 60% to 80% from July 2021, five months ahead of our target date and despite the COVID-19 pandemic situation.