Empowering Nurses to Assess Mobility in Joint Replacement Patients

Because research clearly links delayed mobility after joint replacement to poor clinical outcomes, Orthopedic Nurse Navigator Lydia Sapien, MSN, RN, ONC, CMSRN, took note when, in the summer of 2021, she found that only 79% of knee replacement patients and 54% of hip replacement patients were ambulating within two hours of their arrival to the Ortho-Neuro-Spine (ONS) unit.

Sapien recognized that such mobility delays have the potential to cause loss of muscle strength, falls, declines in activities of daily living and longer hospital stays.

Sapien shared the data with key stakeholders from the Med-Surg and Rehabilitation Unit Practice Councils (UPCs). Nurses, occupational therapists and physical therapists on these councils reached consensus regarding the need to improve early mobility and reduce length of stay for joint replacement patients. That consensus led to the formation of an interprofessional task force that included Med-Surg UPC advisor Elvie (Aquino) Delfin, BSN, RN, CMSRN, ONC; Med-Surg UPC member Maybelle Peters, BSN, RN, CMSRN; Rehab Council Co-Chair Stephanie Sterner, MS, OTR/L; Elizabeth Schuler, OTR/L; Brian Wong, PT; and Lydia. Director of Med-Surg Agnes Lalata, MSN, RN, CMSRN, CNML, provided support and guidance.

The team began by searching current literature and found ample evidence of mobility loss being linked to a variety of poor outcomes such as loss of muscle strength, falls, declines in activities of daily living and longer hospital stays. Despite this, effective processes to assess and intervene to enhance mobility for patients recuperating at the hospital are lacking. They also found that an overdependence on the Rehabilitation Department for mobility assessments and a lack of a reliable assessment tool for nurses to perform their own mobility assessments can lead to decreased mobility and patient decline.

Adopting the Bedside Mobility Assessment Tool

After additional research, the task force decided to adopt and teach nurses how to use the Bedside Mobility Assessment Tool (BMAT), which includes a two-minute functional assessment that categorizes patients into four mobility levels and provides guidance about appropriate equipment for safe patient mobilization at each of the four levels. In short, the BMAT empowers clinicians to ACT:

  • Assess mobility in a quick and safe way.
  • Coordinate strategies to build muscle strength.
  • Target the right equipment to assist staff in mobilizing patients earlier.

The team worked with the Informatics Department at the medical center to add a query in the electronic health record for documenting BMAT scores and made a plan for adding the scores to patient whiteboards. In addition, the team developed an e-learning assignment and on-unit training aimed at informing both nursing and rehabilitation staff about the new tool and how its use would promote a team approach to improve patient care and outcomes.

By January 2022, a pilot program was operational. ONS nurses completed the e-training module, while BMAT task force members took turns providing live on-unit training to ONS nurses, ONS nurse aides and rehabilitation staff. Staff were taught to write the patient’s BMAT score on the patient’s whiteboard. Task force members also posted laminated copies of a color-coded BMAT instructional tool with photos and descriptions of each level of mobility and appropriate safe patient handling equipment.

By February 2022, nurses were regularly initiating early mobilization of ONS patients using the BMAT tool and guidelines when rehabilitation therapists were not available. By the end of Q1 2022, 100% of hip replacement patients and 97% of knee replacement patients had been mobilized within two hours of arrival to ONS, leading to a significant reduction in the mean monthly length of stay.

Infographic of Ortho-Neuro-Spine Reduced Mean Monthly Length of Stay

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