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Beyond TEDS and Meds:

Beyond TEDS and Meds:. Mobility Strategies for Prevention of Post-Stroke DVT and Other Complications Dori Tooke, MHA, PT, CSCS Aurora St. Luke’s Medical Center Milwaukee, Wisconsin. Objectives:. At the end of the lecture, the listener will:

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Beyond TEDS and Meds:

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  1. Beyond TEDS and Meds: Mobility Strategies for Prevention of Post-Stroke DVT and Other Complications Dori Tooke, MHA, PT, CSCS Aurora St. Luke’s Medical Center Milwaukee, Wisconsin

  2. Objectives: • At the end of the lecture, the listener will: • Have an increased awareness of the importance of patient mobility post-stroke in the prevention of common complications • Recognize the need to approach patient mobility from a medical and rehabilitative team perspective • Describe at least two cost effective and time efficient strategies to incorporate patient mobility into an acute care setting

  3. Common Post-Stroke Complications • As a result of impaired mobility, post-stroke survivors can encounter: • DVT/VTE • Pneumonia • Depression • Falls • Decubiti • Contracture • UTI • Delirium

  4. DVT Prevention Literature Search • 196 abstract reviews: • Medications: effective • External compression devices: effective • Mobility: absent from the literature except to acknowledge immobility is a prognosticator of complications One study did cite early mobility after DVT as having no increased risk of consequences if proper secondary prophylaxis applied

  5. Early Mobility of Post Stroke Patients • Literature does support early mobility as a means to improve rehabilitative outcomes (short and long term) • Mobility benefits include prevention of complications, maximizing outcomes, and prediction of appropriate post-stroke service needs • Quality indicator for rehabilitation plan and DVT prophylaxis

  6. Mobility Barriers • Medically unstable patients • Severely impaired patients • Lack of expertise and / or comfort with patient mobility • Time perception

  7. Mobility Solutions • Lift equipment for severe impairments; or use the space you’ve got for positioning and PROM • Utilization of mobility experts; partnership with therapies • Incorporate strategies into the day

  8. Therapy Partnership • Provision of recommendations for mobility or activity • Training for carryover of mobility • Recommendations for maximal safety • PT, OT, ST, and Physiatry

  9. Severely Impaired Patients • Lifting equipment • P-AAROM to affected limbs • AROM for unaffected limbs • Activity schedules • Positioning techniques (example: shoulder approximation and wrist elevation of affected arm; with finger extension) • Optimize stimulation in the environment • Therapy goals may be pre-ADL or pre-gait activities

  10. Moderately Impaired Patients • As per severely impaired • Considerations for cognitive issues and safety • Pivot transfers if safe • Up in chair for meal times • Use commodes; avoid bedpans and catheters • Have therapy train staff for the best/easiest transfer technique

  11. Minimally Impaired Patients • Walk each shift • Watch for equipment needs (communication strategy with therapy!) • Up in chair for all meals • Use the bathroom or commode • Encourage active motions • Encourage leisure interests (example: knitting, word puzzles - with caution)

  12. Mobile Patients • Normalize function • Independent in room; clear with therapy • Ensure post-stroke resources for rehab are ordered (for all patients) • Watch for high-level cognitive deficits that are subtle

  13. Communication Strategies • White boards (activity section) • Posters (examples: swallow precautions, swallow strategies, activity schedules, positioning cards, equipment lists, etc.) • Education sheets • Plan of care rounding

  14. Activity Specialists Programs • Model that adds FTE(s) whose purpose is to ensure activity occurs- • Nursing works on medical needs • Therapists work on skilled therapy components • Activity specialist carries out routine and/or supportive therapeutic mobility • Ambulation teams • Therapy extension programs

  15. How Does a Hospital Pay for an Activity Specialist? • Generally entry level or slightly higher pay (similar to CNAs) • Compare with the costs of a single complication that can be prevented: • Cost of a fall with injury: $6,437 • Fall with significant injury: upwards of $60,000 • Cost of a pressure ulcer: $7,310 Data from 2005 to 2007, conservative estimates

  16. Activity Specialist Training • Would be jointly nursing and therapy trained • Could be unit specific • Would be supervised by nursing • Could incorporate leisure and social skills, as well

  17. Patient Activity: • Prevents complications • Minimizes decline • Ensures team commitment to the patient • Maximizes outcomes • Provides for highest quality care

  18. Contact me: Dori Tooke Aurora St. Luke’s Medical Center 414-649-5541 dori.tooke@aurora.org

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