The Bedside Mobility Assessment Tool (BMAT)
Can one simple tool help prevent falls and injuries in nursing homes? The Bedside Mobility Assessment Tool (BMAT) is designed to quickly evaluate a resident’s mobility and guide safe care decisions. When used correctly, it can reduce risks and improve outcomes for vulnerable patients. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guest Teresa Boynton to talk about how the BMAT works, why it matters, and how it can be used to protect nursing home residents.
Boynton:
So the four components are, can you first sit unassisted, so unsupported and cross midline and shake hands. So if they can’t do that, I would be leery to have them stand. I would be cautious about having them stand, sit and shake, stretch, and point, stand and step with two components. March in place, step forward, step back, step forward, step back.
Schenk:
Hey, out there. Welcome back to the Nursing Home Abuse podcast. My name is Rob. I’ll be your host for this episode. This is a, an excellent episode because we have on we have a guest this week that’s been on the show at least a couple times, Theresa Boynton, and we’re gonna be talking about. An assessment tool for mobility for long-term care residents and actually acute care residents as well called the Bmat or the Bedside Mobility Assessment Tool.
And we’ll get into that with her and she’s very passionate about it and we are gonna have a great conversation. This week, as I mentioned, I’m happy to have this conversation with Theresa Boynton. She actually this will be, I think the fourth time.
This is the fourth. The time that she has guested on the show, the last time was in April of 2020, so it’s been a minute, but we’re happy to have her back. Theresa is an occupational therapist and an independent consultant specializing in safe patient handling and mobility with over 26 years at Banner Health and experience at Hill with over 26 years at Banner Health.
And experience at Hillrom. She has helped healthcare organizations improve injury prevention programs. She frequently consults and presents on the bedside mobility assessment tool or bmat, and has shared her expertise on multiple podcasts. Theresa is currently working on a project focused on safer toileting for older residents, and we are so happy to have her on the show.
What is the Bedside Mobility Assessment Tool (BMAT)?
Schenk:
Theresa, welcome to the show. Thank you. Alright, so I’m gonna give you the most softball question. In the history of softball questions, and that is what in the world is the bedside mobility assessment tool.
Boynton:
It’s a quick tool initially developed to help nurses in acute care settings to be able to identify their patient’s real time, current time, mobility status, and needs.
Especially around using safe patient handling and mobility equipment such as mechanical lifts, non-powered stand aids. So to give them some better guidance on what are the patient’s needs right now. It was validated and then it’s really spread to other settings. Including, long-term care assisted living as a potential tool, again, to help determine real time mobility needs and then use the right equipment based on what the resident needs.
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Schenk:
Okay. So many questions. The first one, and this is again, this is another softball question. What constitutes mobility?
What, when we say mobility, what is that?
Boynton:
Good question. So it really does depend on the setting and who you’re talking to. Historically it’s been typically how do you get around in your community? Are you able to walk a certain distance? Are you able to drive? So that was always considered mobility in the hospital setting in long-term care.
Setting, we’re looking at it more broadly. Looking at in bed, are you able to turn yourself, are you able to scooch up? Are you able to get yourself to the edge or side of the bed in order to get outta the bed with or without assistance? So much broader. And then again, within hospital setting, long-term care settings, are you able to get yourself to the toilet?
Are you able to get yourself on and off of the toilet? Are you able to sit. Eat. So all of that constitutes different aspects of mobility, how you move around in your environment, how you’re expected to move around in your environment in order to complete all the tasks that people need to do throughout the day in a long-term care setting.
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How does BMAT help nursing home residents in Georgia?
Schenk:
In at least my understanding is. That what you’ve described, whether it’s how the individual is gonna ambulate, how they can move around in bed the cognitive capacity to do those things, the physical capacity to do those things, those are accomplished through different assessments. So tell me then why the bmat, why the Bedside Mobility Assessment Tool to replace those other assessments that already existed?
Boynton:
And not that they necessarily need to replace, but I think they can be a good adjunct. And again, the real focus of the BM A, the Bedside Mobility assessment tool is to link to safe resident handling and mobility equipment, such as non-powered stand aids. Powered sit to stand lifts or total lifts that use a seated sling to help move someone.
So that was the focus of the BM A. Now, it’s also used, for example, it could be used in conjunction with a simple test that at least some long-term care facilities of implemented the chair or the sit stand. Test. So going in the morning and making sure, is the resident able to stand up, sit down, stand up, sit down the way they did the day before, if you implemented the bmat, I take it, the Bmat has basically four steps. And before I’d ask someone to stand, I’d wanna make sure that they’re ready to stand. So can they sit unassisted? Can they maintain their posture and do a little stretch reaching across midline with their hands? Can they get their legs moving, straighten out their knees, pump their ankles a few times?
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That’s one of the things that we can do, the skeletal muscle pump to help. Fluid shift and again, to make sure are the ankles moving? If your ankles aren’t moving, you can’t straighten out your leg, you’re gonna have a tough time standing and a real tough time walking. So I’d have ’em do those two things before I’d have them then stand.
Can they stand for at least a brief amount of time? And then sit back down and do it again. So I would incorporate the BM a t into the chair stand, just being a little bit more cautious, again, depending on the level of of dependence, independence for the resident.
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Schenk:
Is this something in your mind?
And you said real time, so I’m assuming that this might be something that’s done every shift, maybe multiple times a shift, or is this more something like, it’s a comprehensive assessment that’s done, unless there’s a change in condition or there’s a new admin or something like that.
Boynton:
And again, different in acute care versus long-term care.
Sure. In acute care recommend it be done on admission. At least minimum once per ship and with any significant change in the patient status in long-term care. Again, depending on the type of residents that are in the facility or in the unit, I’d look at does it need to be done on a daily basis? Maybe not.
If their condition is really plateaued, they’re maintaining. Then you might not need to or want to do it quite as often. Again, I think it’s a good idea to ask people to get up and move a little bit to maintain their mobility status. I know at some long-term care facilities, they’re having the aids go in and I would have them do the first steps of the bmat.
Can you sit unsupported? Are you waking up? Get, make sure the brain and the feet are connected and can you pump your ankles? Now let’s have you stand. How does that feel? Now? Let’s have you sit down and do it again. Again, that would be a nice little exercise to do. I think with pretty much every resident, whether assisted living if you’re doing their med pass, it’s okay, just take ’em through this and then frankly note, do you see any change or they reporting any change?
Who’s going to come in and maybe say, you know what? We think we’re seeing a change in this resident. It’s time to maybe do a more thorough assessment.
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What are common inaccuracies in mobility screenings?
Schenk:
You described, four components. Walk me through those components and you also hit on something interesting that you, it seems to me from my understanding of what you just said, that an aid can do at least the first couple steps.
So walk me through the four steps and who you envision is accomplishing these steps.
Boynton:
And again, just to be real clear, the BM A was validated as a nursing assessment as part of the comprehensive assessment, but then based on regulations state nursing laws, a number of things if a nurse can delegate that as a recheck.
To an aide. So that’s how it’s being used is a quick exercises or a recheck, but that has to be very clearly defined. Who’s responsible for what and who’s liable, or where, what, where are the liability issues? Yeah, so a lot of aides are doing it because they’ve been trained on it. It’s very simple.
It’s very simple to train patients, residents, family members on how to do it. So the four components are, can you first sit unassisted? So unsupported and cross midline and shake hands. So we’re just challenging your sitting balance slightly by having you do an activity, reach across your body, shake a hand.
And then that’s the first step, sit and shake. The next one is called stretch, or Stretch. And point, again, wanting to connect the brain and the feet basically get fluid, shifting more. So straighten out one leg, straighten out the knee and pump the ankle, move the ankle back and forth through dorsiflexion plan or flexion, and then do it with the other leg.
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If they can’t do that, I would be leery to have them stand. I would be cautious about having them stand, because again, you need to have that kind of control in order typically to have good standing balance. The next step is stand and in a hospital setting, if there’s any concern about orthostatic hypertension, which can also be an issue in long-term care we have ’em stand for up.
To a minute. Research shows that usually within the first minute is when those symptoms of orthostatic hypertension you’re going to experience. So what’s their standing tolerance? Their standing balance. And then if they pass that, yep, they’re looking good, then you have the march in place again, shift their weight from one leg to the other.
Really need to be able to do that. If I’m gonna now ask you to walk to the bathroom or walk over and sit down in your chair or walk to the dining room. So the next step or the last one is, can you march in place? I. Not a high march, just shift weight from one foot to the other. And then the last component is step is step forward with one foot, bring the foot back, step forward with the other foot, bring the other foot back.
So if you start to egress or leave the bedside or the chair side and you’re going, woke getting a little lightheaded, I want you to be able to take a step back and sit back down or help guide you to sit back down. So I don’t want you getting too far, but it’s just a more cautious approach. So those are the four.
Components. Sit and shake, stretch and point, stand and step with two components. March in place, step forward, step back, step forward, step back.
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How does the new Mobility Screening and Solutions Tool (MSST) address these errors?
Schenk:
Let me ask this so does the BA, is the bmat envisioned to be modified? Particularly in the long-term care setting, for example, where somebody is in a wheelchair, so they can probably do the first step, which is the bed mobility part. But nothing else is it designed for that person as well?
Boynton:
It’s designed for if you fail a component, let’s say sit and shake, you come in and it’s whoa, this person obviously cannot get to the side of the bed, or they can’t have the bed and chair position and sit unsupported.
That’s apparent. They’re automatically a mobility level one patient or a mobility level one resident, meaning they are going to need a lot. Of assistance and typically would be using a total lift with a seated sling, for example, to move that patient from their wheelchair to a recliner to their bed the next, if they pass that.
They pass, sit and shake. So now I’m gonna go ahead and test stretch and point. Okay, so now we have them. Can you straighten out your leg and pump your ankle? No, they cannot do it. They’re a mobility level two patient or resident, if they have no weight bearing. Issues. And depending on what their upper extremity strength is, I may be able to use a non-powered stand aid with them.
So there’s no reason they can’t weight bear, it’s just I know that they can’t walk safely because they can’t, they don’t have enough lower extremity strength or control. So they would be a mobility level two patient or resident. And again, I’m going to look at what’s gonna be the most appropriate piece of equipment.
Typically for those types of folks, we’re looking at non-powered stand aid or potentially a powered sit to stand lift to mobilize them, to move them.
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Schenk:
Okay. So at the end of the day, it’s the bmat is going to spit out a number, for lack of a better term. Yeah. And one through four. If I understand correctly.
Okay. And then one through four it’s gonna be the degrees of support device for that particular resident. Can you just in general explain the different, I know you hit on it a little bit, but what we’re looking at, like level four is what, versus level one?
Boynton:
So a level four, and now I’m talking about Bmat 2.0.
So just to be clear on that, level four means they passed sit and shake. Stretch and point stand, but they did not pass step. So I’m going to be looking at something that can help them walk in a hospital setting. I haven’t seen it used much in long-term care, although I think it could be used effectively.
I’d be looking at a lift where I can attach a walking harness or vest and I’m going to allow. The patient to do some strengthening or the resident to do some strengthening that way, or again, if they’re a level four and it’s like their stepping isn’t great, that may, they may be a great patient where I’m going to use a non-powered stand aid.
Get them upright, have them some of the stand aids, you really can step in place do some marching in place and that would be an effective tool to help them progress. In long-term care, I’m typically looking at, okay, how can I get them safely from their wheelchair, from their bed over to a recliner over to the dining area.
So if they can pass all four of them, then they’re actually, they’ve passed all four, and depending on the setting, they’re called an all a four. AP All Pass, or some folks are calling mobility level fives that, they really don’t need equipment. They’re looking good. They’re real stable.
So they would be the folks that again, typically they’re not going to be in a wheelchair. I, I may allow them to do a short distance, but it, again, they’re going to be somebody that really is very independent.
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Can inaccurate mobility assessments lead to falls or injuries?
Schenk:
Would this, would the bmat be something, and forgive me if I’ve already asked this in a different way, but would the bmat be something that could be incorporated like into the MDS assessment?
Is this something that’s goes hand in hand or is this sub separate and apart? I.
Boynton:
I think it absolutely could be. Again, I think you need to look at, we don’t wanna be overly redundant. I don’t wanna have staff to do more than what they need, but to me it’s that cautious and we’re, I’ve really seen it be impactful is AIDS have told me, I go in and the nurse says they’re this, or the PT says they’re this, and I’m looking at him going, oh.
They just don’t, they’re not expressing that they’re doing all that well, or I am thinking, I have reason to question what they’ve said, so I’m gonna take ’em through this quick recheck and then I’m gonna go ahead. Even though PT said they were independent, nurse said they were independent, they wanna get onto the toilet.
I’m going to use my non-powered stand aid based on just a quick recheck and say, let’s get you on the toilet and get you back to bed. Then I’m going to let the PT or the nurse know, I think you need to redo this. I think there’s been a change or a decline with this particular resident or patient.
Now, again, how frequently you do that and how you empower aids to do that I think really depends on the specific setting and the type of residents you have in that setting.
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What should families ask nursing homes about mobility testing?
Schenk:
So what is Theresa Boyton’s Association with the Bmat? What? What brings you to the bmat?
Boynton:
I worked for Banner Health.
I started off working in outpatient industrial rehab. So with injured workers way back when was seeing way too many of the hospital. We were associated with nurses, especially CNAs, the certified nursing assistants or aides. And other folks from the hospital. I was very much focused on rehabbing people and then preventing injuries.
It’s okay, let’s go into the hospital. I was invited to by the risk manager who was a friend to take over, become a work for the hospital as the ergonomics and injury prevention specialist. It became real apparent to me early on that we were seeing injuries especially from controlled dissents or assisted falls to staff people, and that if we had a better mobility assessment where they were really looking at the realtime status of the patient, not what they looked like in the morning, not what they looked like the day before, but right now I have reason to doubt that you’re able to get yourself safely out of bed to the toilet.
So started looking at tools that were around, really couldn’t find anything. This was back in 2003. It, and I tried a variety of things. I looked at a variety of things and was always working with nursing staff. I was sitting in on all the falls team meetings. This originally was for four hospitals in Colorado and then it became 11 hospitals in the Western region and then started leading the safe patient handling and mobility practices system-wide.
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That also included some of our small rural facilities, had long-term care associated with those rural hospitals. So became very much aware of what was going on in that setting and nursing home settings. Anyway, and looked at what was out there in 2007, found a tool at a conference the quick three, and thought this had promise.
Eventually talked a nursing leader into piloting it. They, the nurses on that unit had a lot of good feedback and because they recognized, the nurses recognized that they were getting their patients up more consistently, often, and early, using equipment consistently. The SPHM lifts and. Nurses, aides were getting injured less frequently, a whole lot less frequently, and patient falls were going down.
So it really was a, okay, this is doing what we were hoping it would do. Built from that initial pilot study, ended up validating the tool at one of the banner hospitals in Arizona. Baywood had a great team down there that helped to validate the tool and started seeing the same things. Consistent use of safe patient handling and mobility equipment.
A decrease in falls because we’re getting our patients up earlier and often getting ’em moving, much more aware of their real-time status and staff were not getting injured because they were using the equipment. So that was and then it really did spread. It’s what are their areas?
Can it be used in either as is. Or sometimes as a pre-questionnaire type of thing sometimes used as a tool to teach family members in the nursing homes. Really looking at how they were using their SPHM equipment. Did they have enough equipment, the right kind of equipment for.
Their residents and did they have enough staff? Were they able to follow the regulations that, to use a lift? A lot of states say you have to have two people. And the reality is a lot of times that was very difficult to accomplish or sometimes I. Just absolutely not able to accomplish that.
So that’s where that kind of led me. And then it’s been used nationally and internationally and I’ve gotten a lot of feedback. I’ve had a number quite a few nurses that use it as their capstone projects for their doctoral projects. And yeah, so it’s really taken off. It’s a very simple tool, really pretty straightforward, and the focus is, please be more cautious.
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Schenk:
The congratulations. That’s amazing. What’s the stats like? Like how many how many long-term care facilities are you aware of that, that this is their assessment tool?
Boynton:
I don’t have any numbers. And again, typically for me, when I talk to them, talk to folks, it’s what other tools are you using and how can you incorporate this in? So I really don’t know. I do know that, facilities, long-term care that really have adequate amounts and type of safe resident handling and mobility equipment.
It’s a good tool. It, it’s working well for them along with some of their other tools. What other tools are you using to assess mobility? Are you looking at. Foot. What’s your, how do you assess for foot issues, shoe issues? Incorporating it all in.
It really does need to be a more comprehensive program, but I’m afraid. I, I don’t have any straightforward numbers. I just know over the years I’ve talked to a number of nursing home organizations. I’ve talked to individual nursing homes. I’ve gone into nursing homes, typically after an incident where it’s oh gosh.
You don’t have the right training you don’t have the right equipment, or you don’t have enough slings. So need to fill that gap. Now let’s talk about the assessment because if you’re assessing or screening even for something. It should lead you to take a certain action, but if you cannot take the action because you don’t have the right equipment you don’t have the staffing issue air, you don’t have enough staffing you don’t have the right slings, it’s like all of that needs to be filled before is this tool or any mobility assessment tool going to work for you?
You gotta fill those gaps first.
Schenk:
Makes absolute sense. And Theresa really very much appreciate you coming on the show, sharing your knowledge. We, I can see you’re very passionate about this and as you should be. It’s an amazing, it’s an amazing tool and I hope that it spreads everywhere. Thank you.
All right folks. I hope that you found this episode educational. If you have any ideas for topics that you would like for me to talk about, please let me know. If you have any ideas for any guests that you would like for me to talk to, please let me know that as well. New episodes, the Nursing Home Abuse podcast come out every single Monday.
For all those who are entering to win the Nursing Home obese podcast mug. I wish you the absolute best of luck. And with that folks, we’ll see you next time.
Teresa Boynton’s’ Contact Information: