By Tiffany Lai August 12, 2023
As you gain more experience in the hospital, you will find your own style and methods of performing evaluations and treatments. Here is a sample that can be revised and tweaked as you gain experience:
Introduce yourself at the start of the session and give a brief explanation of your role in the hospital. Perform the interview to find out the prior level of function and home environmental setup. Try to talk directly to the patient, not the caregiver.
- Home setup
- Stairs to enter or stairs to bedroom
- Shower stall or bathtub shower
- Caregiver situation
- Is there help at home?
- How often is the caregiver available?
- How can the caregiver assist the patient? Pulling up to stand? ADLs? IADLs?
- Was assistance needed previously and with what tasks?
- Equipment at home
- FWW, cane, wheelchair, commode, shower chair, hospital bed
- Take vitals in supine, sitting and standing
- Draw the curtains or close the door before uncovering the blanket off the patient
- Trace all the lines before mobilizing
- Bring IV poles and medical equipment to the side you’re planning to transfer to
- Remind patient of any precautions before mobilizing
In general, the minimal goal of a therapy session is to transfer to a bedside chair. We are mobility experts that inform nursing how to move patients and it is good for patients to sit up if it is medically safe. However, not every patient will be able to do this.
Here is a general sequence of a session that becomes more challenging as it goes on. Clinical judgment will have to be made to determine how much challenge to pose to a patient.
1.) Assess strength and range of motion while laying in bed. Take a supine BP reading.
2.) Bed mobility - supine to sit at edge of bed.
Assess sitting balance. Take a seated BP reading if you're able.
- Balance difficulty from easiest to hardest:
- Both hands supported on the bed
- One hand on the bed
- Both hands off the bed
- Reaching across midline
- Based on this, assess whether it’s safe for them to sit in a chair unsupervised. Patients with a heavy backwards or side lean are at risk of falling out of the chair. If sitting balance is impaired, standing balance is also likely impaired.
3.) Scooting side to side sitting at the edge of bed.
- Patient is bearing partial body weight on their legs and arms. Standing with a FWW has full body weight supported by their legs and arms.
- Assess for the appropriate transfer technique. Dependent to independent transfer:
- Hoyer lift
- Slideboard
- SaraStedy
- Squat pivot transfer
- Stand pivot transfer
- Stand step transfer with assistive device
- Stand step transfer no assistive device
4.) Stand up with the FWW. Take a standing BP if you're able. If the patient can't stand too long, take it after he/she is seated.
Assess standing balance.
5.) Have the patient weight shift from side to side.
Is the patient able to fully weightshift? Are their knees buckling under their body weight?
6.) Take side steps along the edge of the bed.
- Is the patient able to lift up both legs to step? Knees buckling?
7.) March in place.
8.) Stand step transfser to the chair (2-3 steps)
- Before transferring to the chair, compare the bed height the patient just stood from to the height of the chair. If the chair is lower, place some blankets on top to build up the height or consider not doing the transfer.
- The patient could have difficulty standing back up from a lower height.
9.) Lower body Dressing while sitting down.
10.) Walk to the bathroom
- Tip: if PT has already seen the patient, check how far they walked during their session. Also check the patients AMPAC score.
11.) Toilet transfer.
- Before transferring to a standard toilet, make sure they can stand from that height. Otherwise, transfer to an elevated commode.
12.) Transfer back to the chair.
- After the session, make sure the room is set up so that the patient is in a safe and comfortable position before you leave. This includes:
- Making sure the patient the has their call light.
- Making sure the bedside table is reachable.
- Bedside rails back to how they were if the patient is back in bed.
- Chair alarms and posey on if requested by. nursing or if the patient has cognitive deficits.
- Make sure the IV pole and all lines are plugged in and in a good arrangement.
- Try not to have lines crossing over the patient’s body and especially not under their body.
- What position the patient is in after the session.
- Worrying vitals, skin issues, issues with lines.
- What the patient did.
- Transfer level required and equipment used for the transfer (cane, FWW, SaraStedy etc).
- Patient requests (pain medication, meal etc.)
Document right afterwards or jot down notes on assist levels before going to the next patient.