Bedrest orders or often specified by a physician if a patient is required to stay in bed for a length of time. The physician may indicate a length of time for bedrest and these orders may be removed after the doctor has been consulted.
Sometimes bedrest orders are automated after a procedure and are not removed. When this happens, the physician is usually not immediately consulted and sometimes the length of time for these orders is not clear.
If orders are specific and not automated, the physician should always be consulted before therapy gets a patient out of bed, but what should PT and OT do when a bedrest order is automated.
Physical and occupational therapy should never assume an order for bedrest is automated and should always consult the doctor before removing the order.
Barriers to mobility
We all know how important mobility is for patients who spend most of their day in a hospital bed, so what barriers are preventing these patients from getting out of bed. According to journal of hospital medicine, some of these barriers include
- Weakness
- Pain
- Fatigue
- IV Lines
- Fears of falling (patient or nurse)
- Catheter
- Lack of hospital staff
Some facilities won’t allow nursing or other disciplines get patients out of bed until they’ve been seen by PT or OT.
Why bedrest orders are important
Before a PT or OT sees a patient, they should always look at activity orders. This order set will usually tell a therapist if there are any special weight bearing precautions, bedrest orders, or other recommendations for mobility.
Usually, a physician will prescribe specific instructions, but sometimes the orders don’t provide any special instructions. This is why we should always have clarification from a physician before getting a patient out of bed.
You may contact the nurse, but this may take extra time and the nurse should not lift the bedrest orders unless instructed by the physician. It’s okay to ask a nurse to get clarification from the doctor on bedrest orders, but you should always make sure the order is canceled or removed before proceeding with mobilizing the patient.
Why my facility wants me to see patients with bedrest orders?
You may work for a hospital or other facility that wants you to see patients with bedrest orders. Sometimes it’s inconvenient for the doctor to be contacted to remove these orders and therapy is encouraged to see these patients for ambulation and ADLs.
If possible, contact your director and discuss a plan to implement a policy for activity orders. Discuss why this is an ethical dilemma, and how it could put your job at risk. If you aren’t successful with this approach, bring this up to your hospital board of ethics.
I hope this was helpful. If you have any ideas or policies that have helped your facility, feel free to message me directly on Instagram.
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David is the lead editor of OT Focus. He has been practicing as an Occupational Therapist since 2013. He specializes in acute care, hand therapy, and ergonomics.
