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Explore Goal

Deciding what you want to change and communicating that intention is the first step of the quality improvement cycle. This page provides a general description of the goal and its benefits to share with your team.

Enhancing and maintaining mobility as a part of daily care helps to maintain a person’s function as well as physical and psychological well-being. Working on this goal will help nursing home staff address mobility and related issues including range of motion, bed mobility, transferring, walking, eliminating physical restraints, wheelchair mobility, and reducing fall risk. Residents’ health and quality of life will improve with added freedom of movement and increased activity.

  • How Does Mobility Benefit Residents?

    Residents’ muscles and bones are strengthened, which makes fractures less likely in the event of a fall.

    Residents’ heart and lung function improve.

    Residents sleep better.

    Residents’ appetites improve, which may help to maintain weight.

    Residents avoid complications associated with immobility, such as muscle wasting.

    Residents are more alert and have better moods.

    Residents move more in bed or when sitting, which reduces the risk of pressure ulcers.

    Residents transfer and walk more safely.

    Residents are steadier when standing or walking.

    Residents are more independent during activities of daily living (e.g., dressing, eating, and using the toilet).

    Residents are less socially isolated.

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  • How Does Mobility Benefit Nursing Home Staff?

    Staff members have meaningful relationships with residents through resident independence and empowerment through self-directed care.

    Staff spend less time providing direct assistance during personal care, bed positioning, and transportation to and from activities.

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  • How Does Mobility Benefit Nursing Homes?

    Nursing homes have enhanced reputation in the community.

    Nursing homes promote a culture of safety.

    Nursing homes demonstrate consistency with culture change and person-centered care.

    Nursing homes can improve in a number of quality measures: falls, physical restraints, pressure ulcers, and weight loss.

    Nursing homes reduce costs associated with treating the consequences of immobility (e.g., pressure ulcers, contractures, constipation, and incontinence).

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Step 2 – Tracking Tool  >

Tracking Tool

The Campaign Tracking Tools allow you to document your work, monitor outcomes and the processes related to your outcomes. To achieve a data-driven quality improvement project, collect data for several months to establish a solid baseline and set a target for your improvement; then continue collecting data -- charts within the workbooks and trend graphs on the website provide you and your team with the feedback you need to determine if the changes you are making are being fully implemented and if they are having the expected impact on your outcomes. Keep your workbook up-to-date on a daily or weekly basis and look at data often to support a rapid cycle quality improvement project. Download the data tracking tool and collect data for a month or so to determine your starting point.

Questions? Contact the NNHQI Campaign Help Desk: Help@nhQualityCampaign.org.

Before you start, read our Tip Sheet on Testing Change & Starting Small (PDF).

Step 3 – Examine Process  >

Examine Process

This set of probing questions will help you evaluate your current processes and provide guidance for ways to make improvements.

  • Why are our mobility rates low?

    • Are our observations borne out by changes to MDS scores on mobility?
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  • Which groups are affected?

    • Are we getting more individuals moving in who weren’t ambulating before? Were they using walkers and wheelchairs already?
    • What kinds of people aren’t going to activities anymore?
    • Have there been changes in the staffing and scheduling of meals or bathing?
    • Are we seeing more residents with diminished capacity?
    • Is this problem occurring throughout the home or is it in just one unit, hallway or floor?
    • Are the declines in mobility seen where we have new staff assigned?
    • Are we seeing patterns related to time of day or shift?
    • Have there been changes in who’s ambulating and how?
    • Has the decline we’ve noticed been in a certain type of residents – for example, residents whose restorative programs were recently stopped?
    • Is what we’re seeing related to family pressure to keep relatives "safe" from falls and hence not up and about?
    • Do we tend to put residents in wheelchairs because it is faster to transport them?
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  • Processes and Resources to Consider

  • What assistive devices are we using?

    • Are residents getting the correct assistance device - for example, canes are adjusted to the correct height?
    • Are assistive devices in good working condition?
    • Are there gait belts routinely available or does each resident have a gait belt?
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  • How do we monitor mobility?

    • Is there a structured way for staff to communicate with each other about a resident’s mobility status?
    • Is there a process in place that alerts staff members to a change in the mobility status of a resident?
    • Do we have any specific tools we’re using to help in our observations about mobility?
    • Has there been some sort of external change that has impacted mobility – for example, it is the middle of winter?
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  • What techniques are we using to support maximum mobility?

    • Are we allowing enough time for personal mobility?
    • Are our ambulation programs sufficient to maintain/promote mobility?
    • Are we encouraging our residents to ambulate?
    • Could lighting be playing a role in our problem?
    • Is there a place outside the nursing home where residents can go and is it easy for them to access it?
    • Are there places along the hallways where residents can sit?
    • How do we know if a person has lost their shoes?
    • Are residents getting proper foot care?
    • Are residents moved to a chair and out of their wheelchair during meals and activities?
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  • Is mobility an organizational priority?

    • Are we making it a priority to help get all residents to activities?
    • Do staff feel a sense of responsibility for maintaining mobility?
    • Are staff held accountable for supporting mobility?
    • Who is responsible for mobility?
    • Is mobility seen as being primarily the responsibility of the therapy department?
    • What is the role and expectation of front-line staff in improving and maintaining mobility?
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  • What type of education are we providing to support staff?

    • Do we emphasize the importance of mobility in our training for caregivers?
    • Are staff educated on how to assist residents?
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Step 4 – Create Improvement  >

Create Improvement

The Science of Change

  • The Circle of Success is a quality improvement framework and a guide to finding the resources you need on the website.
  • Quality Improvement Methods are evidence-based approaches for creating systemic change. This collection includes quick-start instructions, templates, and mini-videos.

Free Online Training

Medline University online courses:
Resident Mobility Assessment Tools
All Resident Levels
Website MDS 3.0 Mobility Assessment
See in particular:
Section G: Functional Status
Section H: Balance During Transitions and Walking
Section J: Falls
For Intervention Ideas See Section I
Adobe PDF Continuing Care Activity Measure (CCAM)
Performance-based measure of gross motor function and mobility developed for long-term care. Higher scores reflect higher level of function. Takes approximately 20 minutes to administer.
Ambulatory Residents
Adobe PDF Timed Get Up and Go Test (TUG)
Widely used performance-based measure of functional mobility in community-dwelling older adults. Quick and easy method to describe and monitor functional mobility. Consists of timing an individual as he or she stands, walks 3 meters, turns 180 degrees, returns to the chair, and sits down. The score on the test is the time it takes (in seconds) to complete the task.
Website The Short Physical Performance Battery (SPPB)
Assessment tool developed by the National Institute of Aging for evaluating lower extremity functioning. Includes gait speed, repeated chair stands, and standing balance.
Video Demonstration of Safe Walker Use: YouTube Video
Introductory video for therapy staff to use in training aides in basic safety issues with walking residents, including demonstrations of adjustment of assistive devices and safe footwear.
Residents in Wheelchairs
Adobe PDF Wheelchair Seating Assessment Form
One page wheelchair seating assessment for therapists to evaluate older adults in wheelchairs that includes recommended interventions.
Website Wheelchair Skills Program (WSP)
Set of assessment and training protocols related to wheelchair skills that includes the Wheelchair Skills Test (WST), the Wheelchair Skills Training Program (WSTP) and related materials.
Mobility Intervention Tools
All Resident Levels
Website Strategies for Improving Resident Mobility
From Illinois Council on Long-Term Care. This website includes information of potential impacts of immobility such as increased stress on heart, loss of bone, muscle atrophy, and others.
Ambulatory Residents
Website Vanderbilt Center for Quality Aging: A Walking Program
Training module that provides instructions for implementing a walking program to help residents maintain function in Activities of Daily Living (ADL). Can be tailored to level of resident; good for those who are minimally mobile if there is supervision and support.
Video Safe Movement: YouTube Video
Includes ideas for therapy staff concerning exercises for strength and balance and fall prevention examples. One on one trained staff supervision is required.
Video Balance Exercises: YouTube Video
Simple exercises, integrated into daily life and care within resident's room for balance training and good movement. One on one supervision needed.
Website Prompt and Praise Procedure for Increasing Walking Distance and Independence
Journal article discussing a program to increase distance and independence of ambulation around meal times.
Video Seniors Exercise Group. The Dance: YouTube Video
Simple music supported standing exercises that include chair exercises for higher functioning residents with one on one staff supervision.
Video Stronger Seniors Chair Exercise - Balance Exercises for Those Able to Stand: YouTube Video
Exercises that demonstrate simple standing exercises and video exercises that allow for work alone or group training. Unusual resource on balance development.
Non-Ambulatory Residents
Adobe PDF Illustrated Chair Exercises for Seniors
Variety of seated exercises divided into four modules. Developed through National Institute on Aging, Tufts University and CDC Growing Stronger: Strength Training for Older Adults and University Of Georgia.
Fall Prevention
Website Blueprint for a Fall Prevention Program
This slide deck walks through a comprehensive example of a falls prevention program, incorporating key quality improvement elements such as a culture of no blame, root cause analysis, and post-fall huddle. Start here and then review the resources below and above to pull in specific interventions, forms and tracking to build your program.

Alarm Reduction: The Blueprint for a Fall Prevention Program includes a subsection with a step-by-step approach to alarm reduction.
Website AHRQ Falls Management Program
Comprehensive, interdisciplinary falls management program for long term care with several toolkits and videos. Useful for setting up a fall prevention program.
Improving Patient Safety in Long-Term Care Facilities Training Modules: Falls Prevention
One of three self directed training modules with an instructor's guide and detailed content for educating staff on reducing falls risk. INSTRUCTOR'S GUIDE.
Improving Patient Safety in Long-Term Care Facilities Training Modules: Falls
Student Workbook of above resource.
Website National Center for Patient Safety 2004 Falls Toolkit
Comprehensive falls management program developed by the VA for both long term and acute care facilities. Includes multiple fall reduction tools addressing clinical interventions, equipment, and environment. Recommendations for hip protector use should be re-evaluated based on latest evidence.
Website American Geriatrics Society Guideline for the Prevention of Falls in Older Adults
Clinical guidelines for the reduction of fall risk in nursing home residents. Useful as background information which summarizes the evidence for and against fall prevention interventions in nursing homes.
Website Centers for Disease Control and Prevention: Falls in Nursing Homes
Website with a variety of background information for nursing home staff, residents, and families.
Website Safety Without Restraints
Minnesota Department of Health website for residents and family givers. Case example of releasing a restraint to enhance continued mobility as well as general education about restraints and safety.
Optimizing Environment and Equipment to Support Mobility
All Resident Levels
Website Dementia Design Info
Website that provides practical design suggestions for supportive environments for people with dementia.
Staff Communication
Website To access the Pioneer Network's free Starter Toolkit for Engaging Staff in Individualizing Care, go to http://www.pioneernetwork.net/Providers/StarterToolkit/.

Step 5 – Engage  >

Engage

Engaging stakeholders creates a robust and successful quality improvement project. Use these fact sheets to start the conversation and encourage everyone to be involved. A story board is a wonderful, visual way to engage your community in the project, keep everyone in the know about new changes that are being tested, and share your challenges and successes along the way.

Story Board Guide
Adobe PDF Storyboard guide from QAPI
Use this guide to create a compelling poster to keep your community engaged in your project, monitor your progress, and celebrate your success. Print outcome trend graphs from your Campaign account to document your change!
Mobility Fact Sheets
Adobe PDF Leadership Fact Sheet
Adobe PDF Staff Fact Sheet
Adobe PDF Consumer Fact Sheet

Step 6 – Monitor & Sustain  >

Monitor & Sustain

Once you make a change or an improvement, it’s important that you continue to collect and submit your data to ensure your improvements are working.

Step 7 – Celebrate Success  >

Celebrate Success

Too often we let accomplishments pass by without notice because we are already moving on to the next step. But, it's important to take a moment to celebrate accomplishments, big and small.

A celebration program can create a spirit of community in your nursing home. Use visible awards such as certificates, plaques and other tangible rewards that can be proudly displayed. Try giving a spontaneous award from time to time to acknowledge people who are going the extra mile.

More resources on their way. Please check back soon.

Back to Goals  >

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