ADDITIONAL TLB CLINICAL BENEFITS
Non-pharmacologic Primary prevention is preferred; however, some degree of delirium is inevitable in the ICU. Although there are no data on primary prevention (non-pharmacologic) trials in the ICU, the data in non-ICU settings focuses on minimizing risk factors.The strategies include the following interventions:
- repeated reorientation of patients
- provisions of cognitively stimulating activities for the patients multiple times a day
- a non-pharmacological sleep protocol
- early mobilization activities
- range of motion exercises
- timely removal of catheters and physical restraints
- use of eye glasses and magnifying lenses
- hearing aids and earwax disimpaction
- early correction of dehydration
- use of a scheduled pain management protocol
- minimization of unnecessary noise/stimuli
Strategies for the prevention and management of delirium in the ICU are important areas for future investigation.
Tilting the patient improves lung function and the ability to clear the lungs of mucus. This should prevent vent related pneumonias, which is a "never event". Patients on vents need to get out of bed but it is often difficult because they are heavy, have lines and tubes, and the unit doesn't have enough help. It can literally take 5-6 people to accomplish this.
Tilting then walking off the footboard is easier, both for the patient as well as the staff. You should see increased compliance with out of bed orders. Early mobility therapy which is described as getting the ICU patient out of bed within 24 hours of being admitted to the ICU is one of the up and coming trends in ICU.
Dr. Needham from Johns Hopkins is one of the gurus. He has an early mobility program in his ICU and has shown:
- decreased mortality (18% down to 12%)
- decreased length of stay in ICU (5.5 days vs. 6.9 days)
- decreased length of stay in the hospital (11.2 days vs. 14.5 days)
- decreased time on the ventilator (8.8 days vs. 10.2 days)
- By using the straps the patient can be tilted safely and reduces the chance of falling.
- ICU's are often the blockages of patient transfer through the system. The Emergency Dept. gets backed up because all the iCU beds are full. This is one tool that should help decrease the length of stay in the ICU. Ask the staff, "how much an average day in the ICU costs?" - it can be $10,000 to $20,000 a day. Getting the patient out quicker saves the hospital money.
- Post OP:
Anyone who had an operation knows it is extremely painful to step out of bed. Being so, we don't always do that. As a result the healing process is less good. By just being tilted, it is like we step out of bed and even better as we are avoiding all risks involved.
- Spinal Cord Injury:
Bone mineral loss and osteoporosis are common consequences after spinal cord injury. Therapeutic standing; a weight-bearing intervention that can be applied using the TLB.
- Renal Urinary Tract Problems:
Hypercalciuria resulting from bone changes due to immobilization predisposes the patient to tract calculi and infection. Also standing frequently in the TLB can prevent urine form becoming stagnant in the Kidneys because gravity will assist in drainage
- Skin Integrity (Wound Care):
The prevention and treatment of ulcers can be accomplished by postural changes. The TLB allows for a change in a whole new direction other than just side to side. Also the TLB allows for the transfer of weight from the Ischial Tuberosities, Trochanters, and Sacrum to the long bones of the legs.
After a period of Immobilization if an individual attempts to sit or stand there is a marked pooling of blood in the lower extremities causing a decrease in circulating blood volume. Blood pressure drops and the brain is depleted of blood and oxygen, which leads to fainting.
The TLB allows for a caregiver to gradually increase the patients standing angle with full control while being able to monitor blood pressure. It's not an all or nothing approach that often results in fainting thus leading to falls and injuries. The problem of Orthostatic Hypotension can be improved by repeated standing.
- Digestive System:
Immobilization leads to a general decrease in gastrointestinal activity. This often leads to constipation. Prolonged constipation may lead to fecal impaction and serious intestinal dysfunction.
- Muscular System:
Studies have shown that Immobilized individuals with complete bed rest have reversed increased calcium excretion by quiet standing 3 hours per day. Also Muscle stretch by weight load in standing was able to reduce spasticity by 26%-32% depending on the flex of the feet. Muscles at rest lose strength at a rate of 10%-15% a week therefore a patient will lose 50%-60% of their strength in a 4 week stay.
- Skeletal Mass:
Bones need the stress of Gravity and Tendons to maintain their mass. Patients who have been immobilized for several weeks will not regain their pre-morbid bone density for several Months so have a increased risk of fracture should they fall during that time.
It's no secret that a patient who can stand and face his caregivers and peers face to face is is going to be better off. It will increase awareness, alertness, socialization and decrease depression. Also the ability to see the world from a standing view again can give a patient hope that that it may be possible again through aggressive therapy.
- Skin tears, Bruising, Shearing:
They are all common problems associated with moving and handling patients. With the use of TLB you don't have to move patients and manually handle them as much because you can do a lot more routine task right in the bed. Also you have easier access to the patient and the bed for routine care like changing the bed sheets, applying lift slings, and turning the patient.
Just getting patients up and out of bed is not a simple task, we risk injuring a caregiver and a patient fall, which can have traumatic effects. The VitalGo bed offers the patient a natural progression through the phases of mobility.Amber Perez - LPN, CSPHA, Safe Patient Handling Specialist