Statewide System Approach has Positive Impact on Stroke Care

Mobility of Patients with Stroke: Neuro Care Unit and Rehabilitation Interdisciplinary Bedside Scientist Grant Kamila Frederick PT, MPT; Laura Norton RN, MSN, CNRN; Laurie Neely PT, DPT; Rachel Friscia RN Abstract

Nursing staff inservice provided by Physical Therapist on safe transferring of patients to and from chair based on common neurological impairments seen post CVA. Completed with return demonstration from staff.

Research has shown that many patients are inactive for a majority of the day while in an acute care hospital. It is important to have a multidisciplinary team approach to increase physical activity of patients. The purpose of this study is to determine if increasing staff education, implementing safe mobilization techniques, and utilizing a variety of therapeutic activities to stimulate physical function can improve mobility rates for stroke patients, positively impact the Neuro Care Unit’s fall rates and improve communication between nursing, patient care technicians and rehabilitation staff.

Portion of skills day dedicated to safe positioning, transferring, and use of Wii for patients status post acute CVA. Completed with quiz. Implementation of a new circulation/mobility section in the nursing staff doc flowsheets which made it easier for staff to document a patient’s mobility status. *Occurred concurrently but not part of grant proposal.

Background In 2011 72% of all stroke patients at AAMC were not ambulatory by hospital day two. Of those, 39% had no documentation of ambulatory status regardless of the patient’s ability to ambulate (GWTG Stroke PMT database). An observational research study of patients in acute stroke units showed that patients are inactive for a majority of their day with 53-60% of their day spent resting in bed and only 12.8% of the day engaged in moderate or high physical activity.1

Nursing Survey Results


Major Conclusion Pre and Post Intervention

Stroke Patients Ambulatory by Day 2 after Admission

Limitations and Next Steps

Stroke Patients Level of Ability of Ambulation : Discharge

60% 60% 50% 50% 47%



40% 37%

2012 through september (n=454)

30% 54%

2013 through September (n=443)


32% 2012 through Septembe (n=448)

45% 20%

Patient outcomes and rehabilitation is greatly influenced by the initiation of early, sustained activity and ambulation. Early ambulation impacts rehabilitation potential and affects risk for development of complications related to immobility including, venous thromboembolism, skin breakdown, pneumonia, contractures, and depression.2

Early mobility in a dedicated stroke unit with education of staff, patients and families is important for successful recovery from stroke. In a randomized control study, a team approach to nursing and rehabilitation for acute stroke patients resulted in more patients discharged home, improved functional outcomes, decreased need for institutional care and decrease in early mortality.3 RESEARCH POSTER PRESENTATION DESIGN © 2011

10% 16%

26% 20%




1% 0%

0% Ambulating

Not ambulating

Same cohort of nursing staff may not have been surveyed post intervention as all surveys were anonymous. Implementation of new circulation/mobility doc flowsheet may have improved documentation scores rather than the education intervention alone. Lack of time for nursing staff to use Wii and other interactive games with patients status post acute stroke. Currently working with auxiliary office to find a dedicated volunteer to play Wii and interactive games with the patients in the Neuro Care Unit.

2013 through september (n=443)

20% 29%

Nursing and PCT staff survey was completed pre and post intervention to assess comfort level with activity, mobility, and positioning. Results showed an increase in the number of staff members that stated “always” to the following questions post intervention: • Do you feel comfortable transferring a patient out of bed • Do you seek out rehabilitation staff to determine what activities the patient should do in between therapy sessions

No Documentation

* Based on nursing and PCT documentation

1. More patients had evidence of ambulatory status by day 2 post intervention 2. Compliance with documentation of ambulatory status by day 2 improved. The patients who had “no documentation” was reduced by 28% 3. Neuro Unit falls did not show any improvement (total falls per 1,000 patient days FY 2012 = 3.98; 1st 3 quarters of FY 2013 = 4.14)


References 1. Bernhardt J, Dewey H, Thrift A, Donnan, G. Inactive and alone: physical activity within the first 14 days of acute stroke unit care. Stroke. 2004; 35:1005-1009 2. Miller E, Murray L, Richards L, Zorowitz R, Bakas T, Clark R, Billinger S. Comprehensive Overview of Nursing and Interdisciplinary Rehabilitation Care of the Stroke Patient: A scientific Statement from the American Heart Association. Stroke. 2010 3. Indredavik B, Bakke F, Slordahl S, Rokseth R, Haheim L, Holme I. Benefits of a stroke unit: a randomized controlled trial. Stroke. 1991; 22:1026-1031 4. Brosnan S. The Potential of Wii-Rehabilitation for Persons Recovering From Acute Stroke. Physical Disabilities Special Interest Section Quarterly. 2009; 32:1-3


Statewide System Approach has Positive Impact on Stroke Care

Mobility of Patients with Stroke: Neuro Care Unit and Rehabilitation Interdisciplinary Bedside Scientist Grant Kamila Frederick PT, MPT; Laura Norton ...

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