Protocol Poster
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Progressive Mobility® Program
BREATHE
TILT
SIT
STAND
MOVE
Initial Patient Assessment Assess patient’s mobility levels within 8 hours of admission to the ICU and reassess at least every shift.
Level 1: Breathe
Level 2: Tilt
Level 3: SIT
Level 4: STAND
Level 5: MOVE
Patient Assessment: RASS –5 to –3; SAS 1-2
Patient Assessment: RASS >–3; SAS >3
Patient Assessment: RASS >–1; SAS >3
Patient Assessment: RASS >0; SAS >4
Patient Assessment: RASS >0; SAS >4
(eg, cannot participate)
(eg, opens eyes; may have profound weakness)
(eg, weak but may move arms/legs independently)
(eg, weak but may tolerate increased activity)
(eg, weak but may tolerate increased activity)
Activities
Activities
Activities
Activities
Activities
• Maintain HOB ≥30°
• Maintain HOB ≥30°
• Maintain HOB ≥30°
• Maintain HOB ≥30°
• Maintain HOB ≥30°
• q2hr turning
• q2hr turning
• q2hr turning (assisted)
• q2hr turning (self/assisted)
• q2hr turning (self/assisted)
• Consider continuous lateral rotation therapy (CLRT), see protocol
• Passive/active ROM | 3 times/day
• Active ROM | 3 times/day
• Active ROM | 3 times/day
• Active ROM | 3 times/day
• Up to 20° Reverse Trendelenburg/ Tilt Table with lower extremity exercises/retracting footboard Min 15 mins/Max 60 mins | 3 times/day
• Encourage activities of daily living As tolerated
• Encourage activities of daily living As tolerated
• Encourage activities of daily living As tolerated
• Full chair position (footboard on) 60 mins | 3 times/day
• Full chair position (footboard off/feet on the floor) | 3 times/day
• Patient stands/bears weight >1 min 3 times/day
• Dangling, if patient can move arm against gravity As tolerated
• Stand attempts, if patient can move leg against gravity (use a sit-to-stand lift) 3 times/day
• Patient marches in place | 3 times/day
• PT/ Occupational Therapy (OT) actively involved | 1 time/day
• Pivot to chair, if tolerates partial weight bearing | 2 times/day
Start at level 1 if the patient meets any of these criteria or skip to level 2.
Pa02/Fi02
<250
Positive End-Expiratory Pressure (PEEP)
≥10 cm H2O
02 Saturation
<90%
Respiratory Rate (RR)
Not within 10-30 per minute
Cardiac Arrhythmias or Ischemia
New Onset
<60 or >120 beats per minute
Heart Rate (HR)
<90 or >180 mm Hg
Systolic Blood Pressure (SBP)
New or increasing
Richmond Agitation Sedation Scale (RASS)
Riker Sedation-Agitation Scale (SAS)
Assessed to Level 1 or 2 ©2013 Hill-Rom Services, Inc. ALL RIGHTS RESERVED. ORDER NUMBER 182485 rev 2 10/03/2013 ENG – US Zinc Number US-AC-0313-0123f
• Up to 20° Reverse Trendelenburg/Tilt Table with lower extremity exercises/ retracting footboard Min 15 mins/Max 60 mins | 1 time/day
• Legs dependent 15-20 mins | 3 times/day • Physical therapist (PT) consultation 1 time/day
<55 or >140 mm Hg
Mean Arterial Pressure (MAP)
Vasopressor Infusion
• Passive range of motion (ROM) 2 times/day
<-3
• PT/OT actively involved | 1 time/day
Move to Level 2 When the Patient…
Move to Level 3 When the Patient…
Move to Level 4 When the Patient…
Move to Level 5 When the Patient…
• Has acceptable oxygenation/ hemodynamics
• Tolerates active-assistance exercises 2 times/day
• Tolerates increasing active exercise in bed
• Can successfully comply with all activities
• Tolerates q2hr turning
• Tolerates lower extremity exercises against footboard/Up to 20° Reverse Trendelenburg
• Tolerates HOB >30° or up to 20° Reverse Trendelenburg
• Actively assists with q2hr turning or turns independently • Tolerates full chair position 3 times/day
• Tolerates legs dependent / HOB 45°
Level 2
Progress to
Level 3
• PT/OT actively involved | 1 time/day
Continue to ambulate progressively longer distances as tolerated until patient consistently participates and moves independently
• Tolerates partial weight-bearing stand and pivots to chair
<3
Progress to
• Tolerates trial periods of full chair position (footboard off/feet on the floor) 3 times/day
• Ambulate to bedside chair to achieve “out-of-bed” (use a patient lift) 3 times/day
Progress to
Level 4
Progress to
Level 5
End
Protocol
This tool is provided for education and discussion only. Each facility is responsible for the development, adoption and implementation of its own protocols. Follow protocols and rules adopted by your facility.