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Background
Patient safety aims to continually improve the care provided to patients to reduce harm. Falls are the
most commonly reported adverse event in hospitals and while the majority of inpatient falls are
associated with minor injury, more serious events such as fractures, intracranial injury and death also
occur.
Balance and mobility problems are a risk factor for falls in hospital
1
. Balance and mobility are often
poorer when a person is in hospital, compared with their usual level of function. This may be due to the
effects of medications (including anaesthetics), acute events and illnesses (e.g. stroke, hip fracture,
infection), cognitive impairment and/or delirium. Balance and mobility may further deteriorate during a
hospital stay if a person is less active than usual due to their medical condition, or due to the hospital
environment, which can discourage mobility
2
.
The terminology used by clinicians, such as physiotherapists, occupational therapists and nurses, to
describe patient mobility and the required level of assistance is therefore a key aspect of promoting safe
mobilisation and participation in daily tasks such as toileting, showering and dressing.
It has been identified that there is inconsistency in the terminology used both inter- and intra-
professionally to describe the level of assistance a patient requires with mobility and functional tasks.
This issue emerged as a theme through review of South Eastern Sydney Local Health District (SES LHD)
fall incidents with serious harm as an outcome. For example, terms such as supervision and standby
assistance and the level of assistance that a patient consequently requires have different meanings to
people within and across professions.
A multidisciplinary SESLHD-wide survey confirmed a lack of clarity amongst clinical staff in relation to the
meaning of commonly used mobility terms, potentially compromising patient safety.
The literature addressing this topic is limited and no international, national or state-wide guidelines
have been found. The Functional Independence Measure (FIM™) * is used to track the changes in the
functional ability of a patient during an episode of hospital rehabilitation care and includes a 7-point
rating scale related to independence
3
. However, there has been some confusion with a few terms that
have been identified such as standby assistance and supervision which are not defined within the FIM™.
The terms defined in this guide are consistent with, but more detailed than described in the FIM™,
ensuring they are relevant to staff in both an acute and rehabilitation setting.
* Please note that the Functional Independence Measure (FIM™) is used in rehabilitation settings and is not routinely
completed by clinical staff within the acute hospital setting. However, when patients are type care changed to rehab in acute
settings, they often stay within the acute hospital as a rehab patient and a FIM is attended as part of the reclassification
assessment and is undertaken by designated accredited staff.