Mobility Risk Assessment Process in Client Care

 
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SASWH acknowledges the Saskatchewan Health Authority-Saskatoon
for the concept to develop this PowerPoint to further
support TLR Client Mobility Risk Assessment
(Oct/20)
 
Material Required
 
Participant
 
Handbook
Mobility Record
Quick Reference Card
Bed or Chair
Transfer Belt
 
 
Learning outcomes:
 
identify risks in the client’s ability to mobilize
Initial
 client mobility risk assessment (provides baseline)
documenting the assessment
eliminate or manage risks
selecting appropriate moving technique
evaluate and communicate
In the Moment
 risk assessment
 
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conducted when the client is assessed for their care
plan to determine their baseline mobility
completed face to face with the client
a focused approach that requires listening, observing
and documenting
conducted 
prior to moving
 the client
documented on a TLR Mobility Record (or an employer’s
comparable form) and becomes part of the client’s
chart
 
 
Conducting the Assessment
 
 
the worker considers their approach and attitude
introduces themselves by providing name and job title
worker explains the assessment process and why it is
necessary
worker considers the potential for assaultive, aggressive or
violent behaviour
considers any existing mobility devices the client may have
 
 
 
Part A
 
Verbal, Written and Observation
 
Areas of risk: Communication Status
 
How do we communicate?
Is language a barrier?
Will vision and hearing impact the move?
 
 
Managing risks of Communication
Status
 
How do we communicate?
Use of sign language, interpreter or devices
For non verbal – may require other methods of
communication e.g. pen and paper, hand gestures, nods
If there is a decreased level of consciousness, move may
need to be delayed.
 
Is language a barrier?
May need interpreter/ family member
Use of cue cards
 
Managing risks of Communication
Status
 
 
Will vision and hearing impact the move?
 
Ensure hearing aides are in the ears and functioning
 
Glasses are on and clean
 
Areas of risk: Cognitive Status
 
Is short-term memory part of the diagnosis?
Does client exhibit appropriate judgement?
Is client’s ability to make decisions compromised?
Alertness?  
(May depend on many factors)
 
Managing Risks of Cognitive Status
 
Is short-term memory part of the diagnosis? Do they exhibit
appropriate judgement? Is their ability to make decisions
compromised?
 
Give short, clear, step by step instructions to decrease
frustration or confusion
Allow client time to process the instructions, before moving
to next task
Gauge clients response to ensure the appropriate decision is
being made
 
Move may need to be delayed if client exhibits poor judgement
 
Managing Risks of Cognitive Status
 
 
Alertness?  
(May depend on many factors)
Diagnosis
Time of day (e.g. sundowning)
Side effects from medications
Move may need to be delayed if there is a decreased level of
consciousness
 
Areas of risk: Emotional &
Behavioural Status
 
 
Will their mood affect a safe move?
Does the client display stable moods?
Does the client display predictable/cooperative behaviours?
Is there history of mood variances, aggressive, or abusive
behaviour?
 
Managing Risks of Emotional &
Behavioural Status
 
 
Will their mood affect a safe move?
 
Check for any client history of mood variances as certain
diagnosis can alter a clients mood
Mood can vary throughout the day (e.g. sundowning)
Delay move if client is uncooperative
 
Managing Risks of Emotional &
Behavioural Status
 
 
Does the client display stable moods?
 Does the client display
predictable/cooperative behaviours? Is there history of mood
variances, aggressive, or abusive behaviour?
 
Delay move in order to allow a cooling down period
Involve a worker or family member who has an approach that
the client may respond favorably to
Assess the reason for the behavior e.g. pain, fatigue,
depression
 
Areas of risk: Medical Status
 
Are there medical conditions, diagnosis or skin integrity
concerns?
Is body awareness/weight distribution an area of concern?
Will an attachment/appliance affect a safe move?
Will pain/fatigue affect a safe move?
What medications are being taken that may interfere with a
safe move?
Are any mobility assistive devices used by the client?
 
Managing Risks of Medical Status
 
 
Are there medical conditions, diagnosis or skin
integrity issues? Are there body awareness or weight
distribution issues?
 
The level of assistance may need to be increased
Consider a specialized client mobility risk assessment
 
Managing Risks of Medical Status
 
Will an attachment/appliance affect a safe move?
Ensure training needed for proper application of devices is
provided
Consider a specialized client mobility risk assessment
 
Will pain/fatigue affect a safe move?
Clients with stiffness from arthritis may need a slower pace
Daily activities that tire clients may require additional
workers to assist with the moving task after activities
Timing of specific medications may need to be considered
 
Managing Risks of Medical Status
 
 
What medications are being taken?
Understanding potential side affects
Additional workers may be required for assistance
 
Move may need to be delayed
 
Are mobility assistive devices used by client?
Ensure device is used during Part B testing
 
P
a
r
t
 
B
 
Testing and Observation
 
Physical and Functional Status
 
 
Pre-mobilization testing
Upper limb tests
Lower limb tests
Core tests
 
Mobilization testing
Sitting tests
Standing tests (transfer belt required)
Walking tests (transfer belt required)
 
Physical and functional status:
 
 
Pre-mobilization testing
Requires
 hands on approach by the worker completing the
risk assessment
The client can be assessed either in a seated or supine
position
 
Mobilization testing
Requires
 hands on approach by the worker completing the
risk assessment and use of a transfer belt
The client requires a degree of mobility
A second worker 
must
 be immediately available
 
Pre-mobilization testing
 
Upper limb tests:
 
Does the client have the ability to grip, push and pull your hand
in a handshake approach?
On their right?
On their left?
 
 
What information will you gather from this test?
 
 
 
Lower limb tests:
 
Does the client have the ability to lift one leg at a time off the
bed or seated surface, and bend and straighten the knee?
Does the client have the ability to move their foot up and down
at the ankle?
Tests needs to be conducted on both legs
 
 
 
What information will you gather from this test?
 
Core testing:
 
In supine:
Can the client bridge?
Can the client roll from side to side?
OR
In sitting:
Raise their buttocks off a seated surface?
Can they hip walk forward?
 
 
What information will you gather from this test?
 
Mobilization testing
 
Sitting Tests:
 
Does the client have the ability to get themselves into a seated
position?
Does the client have the ability to remain seated, with feet on
floor, for 20 seconds?
Can the client right themselves if gently “tipped” in all four
directions?
If client has a weaker side do not tip in that direction!
 
What information will you gather from this test?
 
Standing Tests with Transfer Belt:
 
Does the client have the ability to:
- position themselves in preparation for standing ?
- remain standing for 20 seconds?
- raise one arm at a time to front and side and remain steady?
 
 
What information will you gather from this test?
 
Walking tests:
 
Does the client have the ability to:
- shift weight from one foot to the other?
- walk (or shuffle) on the spot?
- take 3 steps forward and 3 steps back?
 
What information will you gather from this test?
 
 
 
In the Moment 
Risk Assessment
 
This is a mental checklist to aide in identifying risks on a regular
basis
 
Changes that alert the worker could include:
facial asymmetry
paleness and cyanosis
shortness of breath
slurring or incoherent speech
not sitting well in a chair (slumping or sliding out)
 
Remember to incorporate self, environment and equipment
assessments at the time of the move
 
Workers may need to increase the level of assistance at the
time of the move
Workers 
CAN NOT 
decrease the level of assistance without a
documented re-assessment completed
Any changes to the level of assistance must be communicated
and documented
After two separate documented changes, a re-assessment is
completed
 
 
In the Moment 
Risk Assessment
 
Problem-Solving Risk Factors:
 
Select another safe approach at the time
Seek assistance to problem solve
Identify and schedule tasks for when working alone and team
approach is safest.
Document and forward concerns to supervisor
Forward concerns to OH&S if not resolved at supervisor level
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The Mobility Risk Assessment Process in Client Care involves conducting initial assessments to determine baseline mobility, identifying risks, selecting appropriate moving techniques, and effectively communicating and evaluating risks throughout care. The assessment considers communication status, potential aggression, and existing mobility devices. Strategies for managing communication barriers and decreasing consciousness levels are integral parts of the process.


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  1. Client Mobility Risk Assessment SASWH acknowledges the Saskatchewan Health Authority-Saskatoon for the concept to develop this PowerPoint to further support TLR Client Mobility Risk Assessment (Oct/20)

  2. Material Required Participant Handbook Mobility Record Quick Reference Card Bed or Chair Transfer Belt

  3. Learning outcomes: identify risks in the client s ability to mobilize Initial client mobility risk assessment (provides baseline) documenting the assessment eliminate or manage risks selecting appropriate moving technique evaluate and communicate In the Moment risk assessment

  4. Initial Client Mobility Risk Assessment conducted when the client is assessed for their care plan to determine their baseline mobility completed face to face with the client a focused approach that requires listening, observing and documenting conducted prior to moving the client documented on a TLR Mobility Record (or an employer s comparable form) and becomes part of the client s chart

  5. Conducting the Assessment the worker considers their approach and attitude introduces themselves by providing name and job title worker explains the assessment process and why it is necessary worker considers the potential for assaultive, aggressive or violent behaviour considers any existing mobility devices the client may have

  6. Part A Verbal, Written and Observation

  7. Areas of risk: Communication Status How do we communicate? Is language a barrier? Will vision and hearing impact the move?

  8. Managing risks of Communication Status How do we communicate? Use of sign language, interpreter or devices For non verbal may require other methods of communication e.g. pen and paper, hand gestures, nods If there is a decreased level of consciousness, move may need to be delayed. Is language a barrier? May need interpreter/ family member Use of cue cards

  9. Managing risks of Communication Status Will vision and hearing impact the move? Ensure hearing aides are in the ears and functioning Glasses are on and clean

  10. Areas of risk: Cognitive Status Is short-term memory part of the diagnosis? Does client exhibit appropriate judgement? Is client s ability to make decisions compromised? Alertness? (May depend on many factors)

  11. Managing Risks of Cognitive Status Is short-term memory part of the diagnosis? Do they exhibit appropriate judgement? Is their ability to make decisions compromised? Give short, clear, step by step instructions to decrease frustration or confusion Allow client time to process the instructions, before moving to next task Gauge clients response to ensure the appropriate decision is being made Move may need to be delayed if client exhibits poor judgement

  12. Managing Risks of Cognitive Status Alertness? (May depend on many factors) Diagnosis Time of day (e.g. sundowning) Side effects from medications Move may need to be delayed if there is a decreased level of consciousness

  13. Areas of risk: Emotional & Behavioural Status Will their mood affect a safe move? Does the client display stable moods? Does the client display predictable/cooperative behaviours? Is there history of mood variances, aggressive, or abusive behaviour?

  14. Managing Risks of Emotional & Behavioural Status Will their mood affect a safe move? Check for any client history of mood variances as certain diagnosis can alter a clients mood Mood can vary throughout the day (e.g. sundowning) Delay move if client is uncooperative

  15. Managing Risks of Emotional & Behavioural Status Does the client display stable moods? Does the client display predictable/cooperative behaviours? Is there history of mood variances, aggressive, or abusive behaviour? Delay move in order to allow a cooling down period Involve a worker or family member who has an approach that the client may respond favorably to Assess the reason for the behavior e.g. pain, fatigue, depression

  16. Areas of risk: Medical Status Are there medical conditions, diagnosis or skin integrity concerns? Is body awareness/weight distribution an area of concern? Will an attachment/appliance affect a safe move? Will pain/fatigue affect a safe move? What medications are being taken that may interfere with a safe move? Are any mobility assistive devices used by the client?

  17. Managing Risks of Medical Status Are there medical conditions, diagnosis or skin integrity issues? Are there body awareness or weight distribution issues? The level of assistance may need to be increased Consider a specialized client mobility risk assessment

  18. Managing Risks of Medical Status Will an attachment/appliance affect a safe move? Ensure training needed for proper application of devices is provided Consider a specialized client mobility risk assessment Will pain/fatigue affect a safe move? Clients with stiffness from arthritis may need a slower pace Daily activities that tire clients may require additional workers to assist with the moving task after activities Timing of specific medications may need to be considered

  19. Managing Risks of Medical Status What medications are being taken? Understanding potential side affects Additional workers may be required for assistance Move may need to be delayed Are mobility assistive devices used by client? Ensure device is used during Part B testing

  20. Part B Testing and Observation

  21. Physical and Functional Status Pre-mobilization testing Upper limb tests Lower limb tests Core tests Mobilization testing Sitting tests Standing tests (transfer belt required) Walking tests (transfer belt required)

  22. Physical and functional status: Pre-mobilization testing Requires hands on approach by the worker completing the risk assessment The client can be assessed either in a seated or supine position Mobilization testing Requires hands on approach by the worker completing the risk assessment and use of a transfer belt The client requires a degree of mobility A second worker must be immediately available

  23. Pre-mobilization testing Upper limb tests: Does the client have the ability to grip, push and pull your hand in a handshake approach? On their right? On their left? What information will you gather from this test? Ability to comprehend and cooperate Pain Range of motion in each shoulder Ability to grip with each hand Weight bearing ability through each shoulder Strength and control of each upper limb

  24. Lower limb tests: Does the client have the ability to lift one leg at a time off the bed or seated surface, and bend and straighten the knee? Does the client have the ability to move their foot up and down at the ankle? Tests needs to be conducted on both legs What information will you gather from this test? Ability to comprehend and cooperate Pain Range of motion for each hip, knee and ankle Lower limb strength and control for each hip, knee and ankle Core strength for stabilization Weight bearing ability through each lower limb

  25. Core testing: In supine: Can the client bridge? Can the client roll from side to side? OR In sitting: Raise their buttocks off a seated surface? Can they hip walk forward? What information will you gather from this test? Ability to comprehend and cooperate Pain Balance Strength Possible hypotension (dizziness) Endurance Trunk control and strength

  26. Mobilization testing Sitting Tests: Does the client have the ability to get themselves into a seated position? Does the client have the ability to remain seated, with feet on floor, for 20 seconds? Can the client right themselves if gently tipped in all four directions? If client has a weaker side do not tip in that direction! What information will you gather from this test? Ability to comprehend and cooperate Pain Balance Strength Possible hypotension (dizziness) Endurance Trunk control and strength

  27. Standing Tests with Transfer Belt: Does the client have the ability to: - position themselves in preparation for standing ? - remain standing for 20 seconds? - raise one arm at a time to front and side and remain steady? What information will you gather from this test? Ability to comprehend and cooperate Pain Balance Strength Possible hypotension (dizziness) Endurance Use their arms functionally Leg strength and control Trunk and pelvic strength and control Capacity to bear weight

  28. Walking tests: Does the client have the ability to: - shift weight from one foot to the other? - walk (or shuffle) on the spot? - take 3 steps forward and 3 steps back? What information will you gather from this test? Ability to comprehend and cooperate Pain Trunk control Strength Possible hypotension (dizziness) Endurance Dynamic balance Ability to weight transfer Strength Safely walk on the spot Weight bear while walking (or shuffling) Coordinate functional movement

  29. In the Moment Risk Assessment This is a mental checklist to aide in identifying risks on a regular basis Changes that alert the worker could include: facial asymmetry paleness and cyanosis shortness of breath slurring or incoherent speech not sitting well in a chair (slumping or sliding out) Remember to incorporate self, environment and equipment assessments at the time of the move

  30. In the Moment Risk Assessment Workers may need to increase the level of assistance at the time of the move Workers CAN NOT decrease the level of assistance without a documented re-assessment completed Any changes to the level of assistance must be communicated and documented After two separate documented changes, a re-assessment is completed

  31. Problem-Solving Risk Factors: Select another safe approach at the time Seek assistance to problem solve Identify and schedule tasks for when working alone and team approach is safest. Document and forward concerns to supervisor Forward concerns to OH&S if not resolved at supervisor level

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