By Dr.

Faizan ur Rehman Barki

Mobilization protocols ( as
being performed in hospitals)
PROTOCOL FOR BED TO CHAIR AMBULATION

 Long term bedridden patients, sickest patients or

patients have surgery should be mobilized as early as
possible because early mobility is associated with
greater independence, enhances quality of life, better
outcomes and an improved likelihood of early
discharges.
 During assessment phase, Rehabilitation staff assess
the level of assistance required for or during the
transfer to prevent fall / other injuries.
 If an order is given for “bed to chair’ from physician, it
should be done as follows:
 Session Duration: 30 minutes minimum.
 Components:
 
 Step 1:
 Confirm the patient's identity
 Review the MR and confirm the order; reviewing the MR will also help you determine whether the
patient requires other services such as OT and ST or whether patient should be sent to the OPD gym
for additional exercises
 Ensure appropriate PPE use and perform hand hygiene before entering bedside
 Introduce yourself and indicate that you are a Physiotherapist; be sure to greet the patient with a
smile; be polite and friendly
 Advise the patient that his/her doctor has ordered physiotherapy and you are there to fulfil the order
 Advise the patient what you are going to do (see steps below); you may have to encourage and
reassure the patient
 Obtain the patient’s verbal consent to proceed with the session
 Ensure the bed wheels are locked
 Throughout the session, involve the patient’s attendant so that he/she feels a part of the team; this
will improve the patient’s compliance
 Provide privacy and do not leave patient unattended during the session
 Step 1: Assess patient
 Check the patient’s level of consciousness and his/her ability
to follow instructions
 Check active and passive ROM of neck, upper and lower
extremity joints
 Check strength of U/E and L/E and neck
 Auscultate if indicated
 Step 1 will help you determine the level of assistance
required for the treatment session and whether the patient
requires other services such as OT and ST or whether patient
should be sent to the OPD gym for additional exercises.
 Step 2:
 Safe guard the patient's lines, catheters, tubes
then sit patient up in bed and encourage patient to
take active involvement during position change
 Check if O2 saturation drops or remains stable
 Check if patient is dizzy; provide encouragement
and remain with patient
 Do a few deep breathing exercises; do chest physio
if indicated (percussion in sitting, coughing,
breathing techniques, etc.
 Step 3:
 Safe guard patient's lines, catheters, tubes then sit patient up in over the side of
the bed and encourage patient to take active involvement during position change
 Check if O2 saturation drops or remains stable
 Check if patient is dizzy; provide encouragement and remain with patient
 Apply safety belt/neuro belt
 Ensure feet are flat on the floor and that patient is wearing shoes
 Do a few deep breathing exercises in this position
 To prepare patient for standing, advise patient how to stand and encourage
patient to push up from bed with hands, keeping eyes open and using legs to
stand; encourage patient to lean forward and to participate in the position
change; assist patient as needed
 Remain standing for 1 to 2 minutes
 Do few exercises in standing to ventilate the lungs: arm raises, marching, toes
raises, etc
Step 4:
Safe guard patient's lines, catheters, tubes then sit patient up in over the side of the bed and
encourage patient to take active involvement during walking
Walk with patient to the chair; advise on proper walking technique and encourage patient to
take active involvement with walking; aim for at least 5 to 7 steps
Advise the patient on how to sit in the chair with proper technique; patient should turn and
take a few steps backwards until he/she feels the chair against the back of their legs; patient
should bend their knees and lower their body, and should reach back for the forearms of the
chair; guide patient into the chair and ensure this is done slowly and in a controlled manner
Keep patient in chair for 30 to 60 minutes
Remove safety belt/neuro belt
If patient demonstrates stability and physical tolerance while sitting on a chair for 30 to 60
minutes, have the patient progress for ambulation at the next session and advise head nurse
and/or doctor or your coordinator to get new order from physician
Depending on the level of weakness and deconditioning, patient may need BID; advise head
nurse and/or doctor or your coordinator to get new order from physician
 
 Step 5:
 Engage patient with exercises while patient is
seated in chair; below are a few examples
 Alternate knee extensions
 Ankle dorsiflexion and plantarflexion
 Alternate hip flexion
 Bilateral shoulder flexion; coordinate with deep breathing
 Bilateral shoulder abduction; coordinate with deep
breathing
 Neck stretching: side flexion, etc
 Step 6:
 Return patient to bed using proper techniques as per the steps below
 Apply safety belt/neuro belt
 Safe guard patient's lines, catheters, tubes encourage patient to take
active involvement during the position change
 Ensure feet are flat on the floor and that patient is wearing shoes
 To prepare patient for standing, advise patient how to stand and
encourage patient to push up from bed with hands, keeping eyes
open and using legs to stand; encourage patient to lean forward and
to participate in the position change; assist patient as needed
 Remain standing for 1 to 2 minutes
 Do few exercises in standing to ventilate the lungs again: arm raises,
marching, toes raises, etc
 Check if O2 saturation drops or remains stable
 Check if patient is dizzy; provide encouragement and remain with patient
 Safe guard patient's lines, catheters, tubes and encourage patient to take
active involvement during walking
 Walk with patient to the bed; advise on proper walking technique and
encourage patient to take active involvement with walking; aim for at
least 5 to 7 steps
 Advise the patient on how to sit on the bed with proper technique; patient
should turn and take a few steps backwards until he/she feels the bed
against the back of their legs; patient should bend their knees and lower
their body, and should reach back for the bed; guide patient onto the bed
and ensure this is done slowly and in a controlled manner
 Give the patient a break for 1 to 2 minutes the return the patient to supine
or side lying in bed
 Step 7:
 Provide patient with a few exercises to do while in bed;
this can include deep breathing, ROM and strengthening
exercises (bridging, leg raises, etc), and stretching
exercises (what you prescribed depends on what is
needed by the patient)
 Inform the patient that you will return for second session
or that you will return the next day to see them again
 Reassure the patient that he/she can contact you in case
they have questions and provide the department’s
number or your number.
 Step 8:
 Ensure proper disposal of PPE and perform
hand hygiene after leaving the bedside
 Document your session in the MR
 Use SOAP format
 Include the start and end time of the session
 These are the protocols that are being
followed in AKUH.
THANK YOU