Hill-Rom: Progressive mobility with continuous lateral rotation therapy

Helping patients quickly recover and return to their lives is the goal of caregivers around the world. Developing the techniques, protocols and tools that aid in that recovery is key to continuing to improve outcomes and Progressive Mobility is one concept that is leading to results.

Progressive Mobility is defined as a series of planned movements in a sequential manner beginning at a patient's current mobility status with a goal of returning to the patient's baseline (1). These movements  are administered  in a step wise fashion with  raising the head of the bed, passive range-of-motion, and  Continuous Lateral Rotation Therapy (CLRT) for the sickest patients. As the patient  tolerates, use of a 20 degree Tilt Table position can be  added to acclimate them to an upright position. As  next steps, Full Chair® position is included with progression to standing and  increased weight bearing, with ambulation as the final goal.

Mobility of the Critically Ill

Why move the critically ill patient? Many studies have confirmed the negative impact resulting from long-term immobility, including  pulmonary, cardiovascular,  musculo-skeletal, and skin complications, particularly in patients  who are intubated and on a ventilator. The majority of respiratory complications of the mechanically ventilated  may be related to stasis of secretions, which  can lead to an overall increase in atelectasis and  Ventilator  Associated Pneumonia(VAP). (2)

Evidence is growing in support of the practice of  early and progressive mobility  for the Intensive Care Unit (ICU) patient to combat some of these negative outcomes. One of the major challenges faced by the ICU nurse is determining how to consistently mobilize the most critically ill patients. Effective use of CLRT helps provide the answer.

Technology Solutions

Hill-Rom offers products that help deliver CLRT as well as other benefits that assist in safe mobility and recovery. The Hill-Rom® TotalCare SpO2RT® bed provides CLRT using cushion based rotation that maintains full body alignment while placing one lung above the other. Recent studies suggest that early rotation therapy can decrease the incidence of VAP, ICU and hospital length of stay, ventilator days, ICU readmission rates and overall costs. (3-6)

The TotalCare SpO2RT® bed can easily and safely assist the critical care nurse with  movements of Progressive Mobility as outlined  above;  One button places the patient in up to 20°of reverse Trendelenburg while the FlexAfoot ^TMmechanism extends and retracts the patient's legs for orthostatic training , passive range of motion and weight bearing exercises; The Full Chair® position, with the head fully upright  at 65 °and the legs dependent at 70°, can be achieved with one nurse and one button to provide a safe and easy way to comply with up in chair orders; Stand Assist helps stand the patient with one button while the nurse supports the patient to stand and bear weight - the bed is there to support a weak or unstable patient and decrease the risk of caregiver injury.

The TotalCare SpO2RT® surface is a weight-based pressure redistribution mattress that  accommodates patients up to 500 pounds to aid in the prevention and treatment of pressure ulcers through Stage IV. It utilizes  Advanced Microclimate^TM Technology for the management of the patient's  moisture and skin temperature,  and is designed to minimize shear and friction. If needed, this surface can deliver Percussion and Vibration therapy in addition to CLRT. The TotalCare ® bed is a "smart" bed;  it can help automate documentation to the Electronic Medical Record (EMR), and may reduce the potential for charting errors.  Patient weight, head of bed angle, integrated air surface data, and bed exit status are examples of  data that can be documented to the EMR.  As a smart bed, it provides actionable bed data that can help reduce the most common adverse events in hospitals, including  pulmonary complications such as  VAP.

Keys to Success

Using appropriate protocol is key for safe and effective Progressive Mobility, including   CLRT. An example of a CLRT protocol that may be in place when using the TotalCare  SpO2RT® bed  would include the following: 

• Rotate minimum 18 out of 24 hours/day
• Customize "%" rotation to maximum amount tolerated
• Ideal goal: 100% rotation, minimum 70%

• Use 'Rotation Training' to begin therapy
• Frequency of turn: Pause times 0.5 mins
• Assess need for percussion and vibration

• Turn patient and conduct skin assessment every 2 hours

Another key to a successful CLRT program includes development of a standard of care,  clinical practice guideline, or care bundle to guide  consistent implementation and provide the best opportunity for improved outcomes(7). For example, use of an approved practice guideline allows early identification of patients who  would benefit from CLRT,  and ensures documented  staff   training on the  protocol, and on the TotalCare SpO²RT® bed to maximize its effective use.  The practice guideline also establishes the criteria for  discontinuance of CLRT.

This short article provides a high level overview of  Progressive Mobility and CLRT. For easy access to more information, visit Hill-Rom's Clear Lungs website or contact your local Hill-Rom representative.

Hill-Rom today

Hill-Rom draws on a heritage of more than 80 years of innovation and excellence to provide solutions that enhance the lives of our customers and their patients.  Today, Hill-Rom's mission is to enhance outcomes for patients and their caregivers and that mission guides our work in helping find solutions that enable health care professionals in delivering safe,  effective and efficient care  in acute care, long-term care and home care environments. The company's extensive product and service offering includes: patient care beds, stretchers, therapeutic surfaces and devices, patient flow systems, nurse communication systems, headwalls and facility assessments.

In addition, Hill-Rom provides comprehensive asset management programs and on-demand medical equipment rental, utilizing nearly 200 service centers located strategically throughout the United States. The company also offers expert clinical and equipment services and programs that can help improve asset productivity, operational efficiency and patient outcomes.

Hill-Rom's vision is for a real-time, connected care environment that delivers actionable information to the right people at the right time. Hill-Rom  is now focused on creating interconnectivity with its portfolio of communication and patient flow solutions, and  its intelligent bed and therapy surface products. Delivering the right information to the right people at the right time helps the hospital staff care for patients more safely, efficiently and effectively.

Hill-Rom's global headquarters is in Batesville, Ind. Hill-Rom has major manufacturing or office facilities in Batesville, Ind.; Cary, N.C.; Charleston, S.C.; St. Paul, Minn.; Acton, Mass.and worldwide in  Paris, Pluvigner and Montpellier, France; Sydney, Australia,; Monterray, Mexico; Singapore, and Lulea, Sweden The company, employs approximately 6,200 employees worldwide and  has service centers, subsidiaries and representatives throughout the world.

(1)   Introduction to Progressive Mobility, Kathleen Vollman, Progressive Mobility in the Critically Ill, Critical Care Nurse, April, 2010

(2)The occurrence of VAP in a community hospital: risk factors and clinical outcomes.  Ibrahim, EH, Tracy, L, Hill, C, et al, Chest, 2001

(3)Continuous lateral rotation therapy for acute hypoxemic respiratory failure:  timing matters. Fleegler B, Grimes C, Anderson R. Dimensions in Critical Care Nursing 2009;28(6):283-287.

(4)As the bed turns: Clinical and cost management of lateral rotation. Riggs L. AACN/NTI presentation 2005.

(5)The impact of continuous lateral rotation in overall clinical and financial outcomes of critically ill patients. Swadener-Culpeper L, Skaggs,  Critical Care Nursing Quarterly. 2008; 31: 270-279

(6)Continuous Lateral Rotation Therapy to Prevent Ventilator Associated Pneumonia, Staudinger et al, Critical Care Medicine, Vol 38 Number 2, 2010

(7)Continuous Lateral Rotation,  Leslie Swadener-Culpepper , Progressive Mobility in the Critically Ill, Critical Care Nurse, April, 2010