Background
The Practice Guideline Advisory Task Force of the Physiotherapy Association of BC identified in June 2009 the need for some form of guidance for BC PT clinicians with respect to the safe mobilization of acute medical and post-surgical patients.
In order to meet the need to provide guidance in this practice area, a group of content experts (Drs Dean & Reid from UBC Dept of PT and 3 clinicians – Frank Chung, Rosalyn Jones and Simone Gruenig) was convened in October 2009 to produce a tool to guide clinical decision-making for safe prescription of mobilization in the acutely ill patient. Jocelyn Ross and Maylinda Urbina joined the group in 2010 to assist in the dissemination phase of the project.
Objective
To develop a concise tool which guides physiotherapy clinicians in evidence-informed-decision-making (EIDM) relevant to the safe mobilization of patients in acute-care settings.
Note: Given the spectrum of conditions and severity of patients in acute-care settings, this tool cannot adequately address the effectiveness of various intervention strategies.
The tool was designed to meet the following criteria:
- Be appropriate across acute care settings (ICU, Critical Care, Step-Down Unit, ward), based on the patient’s status rather than location of the patient. This is in recognition that allocation of patients to various locations is often dependant upon available resources and expertise rather than universal clinical criteria.
- Be limited – Will not include direction for the unique requirements of special high risk populations as the acute head injury, spinal cord injury or burn patient.
- Be supported by knowledge translation strategies
Format
This 2-3 page document is comprised of the following sections:
- (1) What to Assess – what to look for in the chart, what to assess in the patient, what to monitor during mobilization
- (2) When to consider not to mobilize
- (3) How to mobilize and progress mobilization
The SAFEMOB clinical decision-making tool was distributed through PABC, the Public Practice Distribution list and is posted on the UBC Dept of PT and PABC websites. In addition, the team presented a webinar through PABC, which was subsequently recorded explaining how the tool is to be used. The recording is available on the PABC website.
Since distribution of SAFEMOB in November 2010, the SAFEMOB team has received excellent feedback about the usefulness of the tool. It has been adopted widely and used by nursing in addition to physical therapy. The Continuing Education Committee of the Canadian Physiotherapy Association requested that the team present a special session at CPA Congress 2011 on the SAFEMOB tool in order to facilitate its use throughout Canada.
*Please note that another successful project has grown from the seeds of the SAFEMOB project – Safe & Effective Exercise Prescription in Acute Exacerbation of COPD (AECOPD).