Assign Roles and Responsibilities 

Once you have set your goals, next step is to assign your team, and define roles and responsibilities. Getting buy in form your key stakeholders up front will save you a lot of time and energy later. 

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More than 70 strategies are available to overcome barriers to early mobility3*

Guide to effective team meetings

A sample agenda is available in the program toolkit.  This can help keep your meetings on track and ensure that you are addressing key issues for continued forward momentum

Action Planning sets your goals into action

Review action plans and timeframes at regular meetings to address areas that need addressed to get you to the next level.  Review your goals and current state analysis documents often.  

Multidisciplinary Roles

Can be MD, PT, RN, OT or a combination of disciplines.

It is most important that the team lead(s) for the Early Mobility program have strong leadership skills, and ability to work across multiple disciplines. For sustainable Early Mobility programs, a strong multi-disciplinary team is needed. The leader needs to understand workflow of the various disciplines, facilitate interdisciplinary education and training, identify inter-disciplinary differences and barriers to a team approach to mobility. Team lead will run monthly meetings, work with leadership to ensure sufficient resources for the program, and perform program audits to ensure ongoing success through accountability and continuous program improvement. 

Nurses are with the patients 24/7 and are aware of how the patient is responding to all the interventions including mobility.

Nursing staff take care of the patients’ physical and hygiene needs, including all patient movement required to achieve these needs, such as repositioning or turning in bed, assisting to the bathroom, dressing, feeding, and bathing. There are many opportunities for mobility throughout these care tasks. Nursing can facilitate increased patient participation and highest level of mobility throughout all care tasks to promote patient activity. Nursing can follow through with specific mobility activities as recommended by physical and occupational therapists to help patients overcome specific deficits identified by these professionals. Nursing can also help promote the team approach to early and continuous mobility by assisting with cross discipline education about nursing priorities, and how to help ensure that  therapies and mobility have high priority in the care of each patient.

Physical therapists evaluate patient mobility in more depth, evaluating the underlying causes of impaired mobility, and designing a specific plan of care to address these structural or functional problems in order to restore independent mobility to the patient.

 Examples include neurological problems, pain, physiological responses to movement, strength, range of motion (ROM), balance, patients’ ability to sense and feel movement, to be aware of their body position, patient ability to understand and follow directions, and patients’ ability to put movements together in a sequence that results in meaningful movement. PT are also skilled at identifying the appropriate assistive devices that patients need to help them successfully achieve meaningful movement. Therapists will also assess the patient response to exercise and mobility in order to prescribe the correct dosage of exercise or mobility for the condition of their patient.  Dosage includes intensity, duration and frequency of exercise and mobility. PTs assist with planning for patient discharge, and providing input

Occupational Therapy uses everyday life activities (occupations) to promote participation in roles, habits, and routines in home, school, workplace, community, and other settings.

 OTs evaluate body functions and structures, values, beliefs, and spirituality, as well as skills needed by the patient for successful participation. These include motor skills, ability to process including cognition, visual spacial awareness, and social interaction.  OTs are skilled at identifying needs for adaptive equipment the patient may need to be able to complete tasks successfully, and are also skilled at evaluating patient responses to interventions. OTs are also integral in discharge planning, by providing input about patients’ level of care needed to transition from one level of care to another, including patients’ home environment. In Early Mobility programs, OTs are uniquely skilled to evaluate cognitive status and help patients with orientation to situation and unit. They can help with multidisciplinary team approach though sharing knowledge and recommendations with other disciplines, helping with education of other disciplines, and understanding the work flow of the unit to coordinate with other activities throughout the patients’ day. 

Respiratory therapists (RTs) interview and examine patients with breathing or cardiopulmonary disorders

They consult with physicians to develop patient treatment plans. Perform diagnostic tests, such as measuring lung capacity and manage the airway and gas exchange that is vital for muscle function. In Early Mobility programs, RTs provide support for ventilation to ensure the patients have sufficient oxygenation to perform the mobility activities. 

Respiratory therapists (RTs) interview and examine patients with breathing or cardiopulmonary disorders

Medical providers have a crucial role in ensuring that patients are mobilized appropriately for the medical condition of each patient. Contra-indications and precautions for mobility are identified and shared with the team, and importance of prioritizing mobility can be reinforced through expectations and follow through by the medical providers. Physicians assist in developing and approving mobility protocols and physiological parameters for starting, and stopping mobility. They can also help drive a culture of mobility through education of patients and families that mobility is good for them, through appropriate mobility orders and helping ensure that default bed rest orders are no longer in place, and that bed rest is only to be ordered for a specific medical reason, and then removed as soon as possible. Physicians are in a unique position to be able to ask if patients have met their mobility goals and lead the expectations that mobility goals are set and met for all patients.

1. *Achieved with physical therapist participation in mobility. Garzon-Serrano J, Ryan C, Waak K, Hirschberg R, et al. Early mobilization in critically ill patients: Patients’ mobilization level depends on health care provider’s profession. PM R. 2011;3(4):307–313. doi: 10.1016/j.pmrj.2010

2. *With early mobility therapy vs. standard care, where 35% of patients regained independent status. Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373:1874 – 1882.

3. *As identified in survey. Dubb R, Nydahl P, Hermes C, et al. Barriers and strategies for early mobilization of patients in intensive care units. Ann Am Thorac Soc. 2016;13(5):724 – 730.