least four times, two for each foot) with or Staffing (registered nurse, physical therapist, Desaturation (02 sat <85% or if intervention required without assistance respiratory therapist) unavailable throughout [i.e., increase in Fi02]) the day Cardiac arrest requiring cardiopulmonary resuscitation Walking: walking away from the bed/chair by at New arrhythmia (excludes sinus tachycardia, premature least four steps (two for each foot) assisted by a Patient declined mobilization throughout the ventricular contractions (PVC), or pre-existing person/people or gait aid, or unassisted day arrhythmia that did not worsen during mobilization) Unknown: it is unknown regarding what Patient is too weak to progress to higher level Fall WITH staff assisting in lowering patient activity, if any, occurred of mobility Fall WITHOUT staff assisting in lowering patient Other barrier not listed above Unknown barrier Other Instructions for Daily Early Mobility Data Collection Tool Please complete this form once a day, every day. If possible, complete it around the same time each day, hopefully during patient rounds. Patients are considered mechanically ventilated on a specific day if they were mechanically ventilated at the time of observation. All of the contraindications are listed at the end of the data collection tool. Please print the data collection sheet with the contraindications on the back for ease of data collection. **This tool may also be used for patients who are not mechanically ventilated.** DATA FIELD DIRECTIONS Enter the name of your hospital. Hospital Enter the name of your unit. Date Enter today’s date as MM/DD/YYYY format (e.g., 01/31/2014). Bed # Enter all the bed numbers on the form, regardless of whether the patient is on mechanical ventilation. Include empty beds.
least four times, two for each foot) with or without assistance Walking: walking away from the bed/chair by at least four steps (two for each foot) assisted by a person/people or gait aid, or unassisted Unknown: it is unknown regarding what activity, if any, occurred Staffing (registered nurse, physical therapist, respiratory therapist) unavailable throughout the day Patient declined mobilization throughout the day Patient is too weak to progress to higher level of mobility Other barrier not listed above Unknown barrier Desaturation (02 sat <85% or if intervention required [i.e., increase in Fi02]) Cardiac arrest requiring cardiopulmonary resuscitation New arrhythmia (excludes sinus tachycardia, premature ventricular contractions (PVC), or pre-existing arrhythmia that did not worsen during mobilization) Fall WITH staff assisting in lowering patient Fall WITHOUT staff assisting in lowering patient Other Instructions for Daily Early Mobility Data Collection Tool Please complete this form once a day, every day. If possible, complete it around the same time each day, hopefully during patient rounds. Patients are considered mechanically ventilated on a specific day if they were mechanically ventilated at the time of observation. All of the contraindications are listed at the end of the data collection tool. Please print the data collection sheet with the contraindications on the back for ease of data collection. **This tool may also be used for patients who are not mechanically ventilated.** DATA FIELD DIRECTIONS Hospital Enter the name of your hospital. Enter the name of your unit. Date Enter today’s date as MM/DD/YYYY format (e.g., 01/31/2014). Bed # Enter all the bed numbers on the form, regardless of whether the patient is on mechanical ventilation. Include empty beds.
early-mobility-tool.docx