Chapter 13 Assisting with Mobility 387 Copyright Goodheart-Willcox Co., Inc. Rationale Assisting patients ambulating with crutches re- duces the chance of injury and helps promote safe ambulation. Preparation 1. Make sure you have a written doctor’s order for ambulation with crutches. 2. If the facility has a specifi c policy and procedure for ambulating with crutches, be sure to follow it. 3. Assemble the following equipment: • a robe or well-fi tting clothing • nonslip, properly fi tting, low-heeled footwear • gait belt (check that it is in good condition and is functional) • a pair of crutches that have been properly sized and are in working condition 4. Wash your hands to ensure infection control. 5. Explain in simple terms what you are going to do before assisting the patient to ambulate with crutches. The Procedure 6. Provide privacy. You can draw the bed curtain or put a screen around the bed, if needed. 7. If the patient is in bed, lower the bed to its lowest position and lock the wheels. 8. If the patient is in bed, assist him or her to a dangling (sitting) position on the side of the bed. The patient may be seated in a chair. 9. Help the patient as she puts on the nonslip, properly fi tting shoes and a robe, if needed. 10. Apply the gait belt, if needed. Put the belt around the patient’s waist, over her clothing, with the buckle in the front. Thread the belt through the teeth of the buckle and through the other two loops to lock it. Make it snug, but leave enough room to place your fi ngers under the belt. 11. Ensure the crutches fit properly. Discuss any concerns with the appropriate provider. 12. The crutches should be in the tripod position. Hands should be on the hand grips to absorb the patient’s weight. There should not be any weight placed on the axilla. 13. Determine the gait that has been ordered by the patient’s doctor and have the patient follow the sequence. 14. Remind the patient to maintain an erect posture and keep focused on where she is ambulating to by looking straight ahead and not at her feet. 15. Stay safely to the side of the patient. Watch for signs of a possible patient collapse. Do not attempt to catch a patient who begins to collapse during ambulation. Instead, slowly ease the patient to the fl oor, using your body as an incline. 16. Let the patient set the pace while keeping a fi rm grasp on the gait belt, if used. 17. Encourage the patient to achieve the ordered distance, but be observant. Watch for signs of patient fatigue. If the patient collapses, follow the steps discussed earlier. 18. If permissible, the patient may climb stairs with her crutches. She must have the strength and fl exibility needed. One approach is to hold the handrail with one hand, tucking both crutches under the opposite axilla. When going up stairs, have the patient lead with the strong foot, keeping the weak foot raised behind. When going down stairs, the patient should hold the weak foot up and in front of the body, hopping down each stair on the strong foot, taking it one step at a time (Figure 13.21 on the next page). Place yourself in back of the patient when she is going up the stairs and in front when going down, to assist if needed. Procedure 13.3 Assisting with Ambulation Using Crutches