Progressive Mobility Program ®

Initial Patient Level 1: BREATHE Level 2: TILT Level 3: SIT Level 4: STAND Level 5: MOVE
Assessment Patient Assessment: Patient Assessment: Patient Assessment: Patient Assessment: Patient Assessment:
Assess patient’s mobility levels within RASS –5 to –3; SAS 1-2 RASS >–3; SAS >3 RASS >–1; SAS >3 RASS >0; SAS >4 RASS >0; SAS >4
8 hours of admission to the ICU and
(eg, cannot participate) (eg, opens eyes; may have profound weakness) (eg, weak but may move arms/legs independently) (eg, weak but may tolerate increased activity) (eg, weak but may tolerate increased activity)
reassess at least every shift.

Start at level 1 if the patient meets

any of these criteria or skip to level 2.

Pa02/Fi02 <250

Positive End-Expiratory ≥10

Pressure (PEEP) cm H2O

Activities Activities Activities Activities Activities

02 Saturation <90%  Maintain HOB ≥30°  Maintain HOB ≥30°  Maintain HOB ≥30°  Maintain HOB ≥30°  Maintain HOB ≥30°
 q2hr turning  q2hr turning  q2hr turning (assisted)  q2hr turning (self/assisted)  q2hr turning (self/assisted)

Not within 10-30  Consider continuous lateral rotation  Passive/active ROM | 3 times/day  Active ROM | 3 times/day  Active ROM | 3 times/day  Active ROM | 3 times/day
Respiratory Rate (RR) therapy (CLRT)
per minute  Up to 20° Reverse Trendelenburg/  Encourage activities of daily living  Encourage activities of daily living  Encourage activities of daily living
 Passive range of motion (ROM) Tilt Table with lower extremity As tolerated As tolerated As tolerated
2 times/day exercises/retracting footboard
Cardiac Arrhythmias Min 15 mins/Max 60 mins |
 Full chair position (footboard on)  Full chair position (footboard off/feet  Patient stands/bears weight >1 min
New Onset
or Ischemia  Up to 20° Reverse Trendelenburg/Tilt 3 times/day 60 mins | 3 times/day on the floor) | 3 times/day 3 times/day
Table with lower extremity exercises/
retracting footboar  Legs dependent
 Dangling, if patient can move arm  Stand attempts, if patient can move  Patient marches in place | 3 times/day
Min 15 mins/Max 60 mins | 1 time/day 15-20 mins | 3 times/day against gravity | As tolerated leg against gravity (use a sit-to-stand
<60 or >120 lift) 3 times/day
 Ambulate to bedside chair to achieve
Heart Rate (HR)
beats per minute  PT/ Occupational Therapy (OT) “out-of-bed” (use a patient lift)
 Physical therapist (PT) consultation
1 time/day actively involved | 1 time/day  Pivot to chair, if tolerates partial 3 times/day
weight bearing | 2 times/day  PT/OT actively involved | 1 time/day
Mean Arterial Pressure <55 or >140
(MAP) mm Hg
 PT/OT actively involved | 1 time/day

Systolic Blood Pressure <90 or >180

(SBP) mm Hg
Move to Level 2 when Move to Level 3 when Move to Level 4 when Move to Level 5 when Continue to ambulate
the Patient… the Patient… the Patient… the Patient… progressively longer
Vasopressor Infusion New or increasing
 Has acceptable oxygenation/  Tolerates active-assistance exercises  Tolerates increasing active exercise  Can successfully comply with distances as tolerated
2 times/day all activities
hemodynamics in bed
until patient consistently
Richmond Agitation
Sedation Scale (RASS)
<-3
 Tolerates q2hr turning  Tolerates lower extremity exercises
against footboard/Up to 20° Reverse
 Actively assists with q2hr turning
or turns independently
 Tolerates trial periods of full chair
position (footboard off/feet on
participates and moves
 Tolerates HOB >30° or up to 20°
Reverse Trendelenburg
Trendelenburg
 Tolerates full chair position
the floor) 3 times/day independently.
 Tolerates legs dependent / HOB 45° 3 times/day  Tolerates partial weight-bearing
Riker Sedation-Agitation stand and pivots to chair
<3
Scale (SAS)

Assessed to Level 1 or 2 Progress to Level 2 Progress to Level 3 Progress to Level 4 Progress to Level 5 End Protocol

This tool is provided for education and discussion only. Each facility is responsible for the development,
© 2020 Hill-Rom Services, Inc. ALL RIGHTS RESERVED. APR140306-EN-EMEA-R1 22-SEPT-2020 ENG – EMEA adoption and implementation of its own protocols. Follow protocols and rules adopted by your facility.