Welcome to This Module
BMAT gives nurses a quick, repeatable way to match mobility decisions to what the patient can safely do right now. The point is not to turn every nurse into a physical therapist. The point is to prevent the two common failures at the bedside: keeping patients in bed when they could safely move, and moving patients with the wrong assist or equipment.
This module is written for Thompson nurses who make or support patient mobility decisions. It is designed to take 20 to 30 minutes, including the final assessment. Complete the five content modules and pass the assessment with a score of 80% or higher to receive credit.
- Explain why nurse-driven mobility assessment matters for patient outcomes and staff safety.
- Perform the BMAT sequence using a safety screen, stop points, and the four core maneuvers.
- Assign a practical mobility level and select an appropriate transfer or mobility plan.
- Apply BMAT reasoning across patient care situations that require judgment.
- Document, hand off, and escalate changes in mobility status using Thompson policy.
Module Map
| Step | Topic | Practice Focus |
|---|---|---|
| 1 | Why mobility matters | Immobility harm, fall risk, staff injury, and mobility as nursing care |
| 2 | The BMAT sequence | Safety screen, sit and shake, stretch and point, stand, step |
| 3 | From level to equipment | Safe patient handling, transfer choices, and what BMAT does not replace |
| 4 | Practice scenarios | Patient care situations that require judgment |
| 5 | Document and escalate | Handoff language, reassessment, PT/OT triggers, and Thompson documentation rules |
| 6 | Assessment | 12-question knowledge check, 80% passing score |
Two narrators walk through this module in a short conversational format. The transcript follows the recording and highlights the matching section of the page.
Transcript lines are timed from the generated recording and can be clicked to jump within the audio.
Module 1: Why Mobility Matters
Mobility Is Nursing Care
Mobility is not an "extra" task that happens only when the shift slows down. For hospitalized adults, time in bed is associated with functional decline, deconditioning, pressure injury risk, delirium risk, discharge delays, and loss of independence. For staff, poorly planned transfers create preventable injury risk.
BMAT helps the nurse answer a bedside question quickly: What can this patient safely do right now, and what support or equipment is needed?
Thompson Policy Snapshot
| Policy Point | What It Means At The Bedside |
|---|---|
| BMAT timing | Administer BMAT at least once per day and as needed when patient status changes. Intensive care unit patients also have physical ability determined with BMAT on admission or transfer to the intensive care unit and at least once per 12-hour shift. |
| Documentation | Document the safe lift/transfer recommendation in the EMR. Thompson's safe handling policy places BMAT documentation in Epic flowsheets, Vital Signs tab, under Mobility. |
| If movement is needed before assessment | Use the highest level of equipment to protect the patient and associates until a validated assessment performed by a licensed nurse is completed and documented. |
| When in doubt | Default to the safest BMAT level and transfer method. The Thompson RN Reference Tool specifically reminds staff to err on the side of caution. |
| Manual lifting limit | No individual should manually lift patients weighing more than 35 pounds without an appropriate assistive device or safe patient handling equipment. |
Why "Right Now" Matters
A patient's baseline matters, but it is not enough. A person who walks independently at home can be unsafe after anesthesia, opioids, sepsis, orthostasis, acute neurologic change, hypoxia, delirium, or a long ED wait. A patient who needed help yesterday may be ready to progress today.
BMAT is useful because it captures the current bedside reality. It gives the nurse a repeatable way to start low, progress only as tolerated, and stop when the next step is unsafe.
A patient was independent before admission but now gets dizzy sitting at the edge of the bed. Should baseline independence override the current finding?
What BMAT Does And Does Not Do
| BMAT Helps With | BMAT Does Not Replace |
|---|---|
| Choosing safe assist level and equipment for routine bedside movement | A full PT/OT evaluation when there is new impairment, discharge planning need, or complex mobility issue |
| Standardizing mobility language across shifts and teams | Clinical judgment when vital signs, lines, sedation, or orders make mobility unsafe |
| Reducing guesswork before getting out of bed, transfers, toileting, and ambulation | Thompson's safe patient handling policy, fall prevention policy, or provider activity orders |
Two narrators walk through this module in a short conversational format. The transcript follows the recording and highlights the matching section of the page.
Transcript lines are timed from the generated recording and can be clicked to jump within the audio.
Module 2: The BMAT Sequence
Start With A Safety Screen
Before any mobility test, ask whether it is safe to proceed. BMAT is not a reason to ignore unstable vital signs, activity restrictions, new neurologic symptoms, severe pain, oversedation, unsafe lines or tubes, or a patient who cannot follow directions.
The Four Maneuvers
BMAT progresses from lower demand to higher demand. The patient should pass the current maneuver before moving to the next. The highest level is based on what the patient can safely complete today.
Interactive: Guided BMAT Practice
Choose the lane that matches your role, then work through one short case at a time. Each case asks you to identify the safety screen, the stopping point, and the practical plan before showing the rationale.
- M - Myocardial stability: no active ischemia or unstable rhythm concern; heart rate and blood pressure are appropriate for activity.
- O - Oxygenation adequate: oxygen and ventilator needs are low enough and stable enough to tolerate activity.
- V - Vasopressors stable: no recent increase in vasoactive support.
- E - Engages: awake enough, cooperative enough, and able to follow cues safely.
- S - Special considerations: lines, drains, labs, bleeding, fractures, procedures, and provider concerns are reviewed before mobility.
Try Your Own Patient
After the guided cases, use this as a quick practice tool. Check any safety issue that applies, then choose the first maneuver the patient cannot safely complete. The recommendation updates immediately.
Select the safety screen and first unsafe maneuver to see a recommendation.
Coaching While You Test
- Explain what you are asking before touching or moving the patient.
- Keep the bed low and locked before standing. Clear lines, drains, oxygen tubing, and the path.
- Guard closely during transitions. Many patients look fine lying down and declare themselves during the first sit or stand.
- Stop for dizziness, buckling, severe pain, dyspnea, chest pain, new confusion, or inability to follow direction.
- Document what the patient actually did, not just what you hoped they could do.
Two narrators walk through this module in a short conversational format. The transcript follows the recording and highlights the matching section of the page.
Transcript lines are timed from the generated recording and can be clicked to jump within the audio.
Module 3: From BMAT Level To Equipment
BMAT Is A Bridge To A Mobility Plan
The level is not the finish line. The level should drive the next safe action: in-bed mobility, chair positioning, dependent transfer equipment, sit-to-stand technology, gait belt or walker use, staff assist, PT/OT referral, or provider clarification.
| Current BMAT Finding | Thompson Equipment / Mobility Plan | Local Teaching Point |
|---|---|---|
| Level 1 - dependent or unable to safely sit/reach | Use ceiling/portable/total mechanical lift for dependent chair transfers. For lateral transfers, boosting, turning, or repositioning, use Comfort Glide or PATRAN with trained staff. | If movement is needed before BMAT is documented, use the highest level of equipment until a licensed nurse completes and documents a validated assessment. |
| Level 2 - sits and participates, but not safe to stand | Do not walk or pivot. Use ceiling/portable lift, Comfort Glide/PATRAN, or a mechanical sit-stand only when criteria are met: seated balance, partial weight-bearing, cognition, and no contraindication. | The Thompson RN Reference Tool notes that standing/transfer with a mechanical sit-stand should be performed with PT first. |
| Level 3 - bears weight or stands, but needs device/assist or cannot walk independently | Use gait belt, manual stand aid, walker/assistive device, or sit-to-stand plan based on training and policy. Stop before ambulation if stepping is unsafe. | If the patient uses an assistive device at baseline, Level 3 is the highest BMAT level in the Thompson reference. |
| Level 4 - modified independence / independent without device | No safe-patient-handling equipment is expected for routine mobility. Encourage mobility three times per day when clinically appropriate and document observed mobility. | Original BMAT wording still leaves room for clinical judgment about supervision. Thompson's local reference keeps assistive-device use at Level 3. |
Safe Patient Handling Setup
Before moving the patient, set up the room and the team. Use a wide stable base, face the direction of movement, avoid twisting, keep the patient close, lock the bed and target surface, lower rails to reduce reach, and set bed height around hip level for moving. Plan the transfer out loud, tell the patient what you are doing, and ask them to help only as much as they safely can.
Thompson Equipment Quick Reference
| Equipment | Use It For | Thompson-Specific Reminders |
|---|---|---|
| PATRAN slide sheet | Lateral transfer, boosting, turning, repositioning | Use the draw sheet/linens as handles; do not pull the PATRAN itself. Remove it after the move. Find through storeroom or patient care supply areas. |
| Comfort Glide | Air-assisted lateral transfer or repositioning | Minimum 2 staff, 3 preferred. Capacity listed in Thompson materials as 1,000 lb; use 2 pumps if patient is over 500 lb. The mat can remain under the patient with hose detached. |
| Total mechanical lift / Hoyer / ceiling lift | Dependent transfer, non-weight-bearing, poor sitting balance, unable to follow commands | Use two or more caregivers. Inspect slings. Ceiling lifts are in intensive care unit; portable/full mechanical lifts and slings are in common patient care supply areas or clean utility rooms. |
| Mechanical sit-stand | Seat-to-seat transfer for partial weight-bearing patient with good cognition and sitting balance | Two or more caregivers. Useful for toileting/pericare. Check contraindications such as certain recent abdominal, cardiac, respiratory, aneurysm, or rib-fracture concerns. |
| Manual stand aid | Patient who can bear weight, has fair upper-extremity strength, good sitting balance, and minimal-assist sit-to-stand ability | Lock wheels during transfer. Patient feet go on platform, knees against shin pads, and patient pulls using their own strength. |
| Gait belt / walker | Assisted rising, transfer, or ambulation when patient can move feet and does not need to be lifted or held up | A gait belt is not a rescue device for collapse risk. If the patient may buckle or fall, use sit-stand or total lift planning instead. |
| HoverJack | Clinically cleared patient after a fall or other vertical lift when weight/girth makes manual lifting unsafe | Capacity listed as 1,200 lb. Use at least 2 caregivers, preferably 3-4. Never leave the patient unattended while inflated. Thompson quick reference lists locations including Nursing Admin, ED, and 3E. |
Interactive: Pick The Safer Plan
When To Bring In PT/OT
BMAT supports nursing decisions, but it does not replace PT/OT. In general, nursing should escalate when the patient has a new mobility decline, new focal weakness, repeated orthostatic symptoms, unsafe gait, complex equipment needs, new discharge concerns, or a mobility plan that is not improving.
For intensive care unit patients, Thompson's A-F Bundle says all patients should have PT/OT consults when medically stable and able to participate with activity. The MOVES note also clarifies that if a patient is presenting at baseline, no PT/OT evaluation is needed; therapy needs a prior level of function to work toward, functional goals, potential to progress, ability to actively participate, and medical criteria for safe mobility. PROM alone is not skilled therapy.
Two narrators walk through this module in a short conversational format. The transcript follows the recording and highlights the matching section of the page.
Transcript lines are timed from the generated recording and can be clicked to jump within the audio.
Module 4: Applying BMAT Across Patient Care
Med/Surg/Observation Care
For Med/Surg and Observation patients, mobility decisions often include oxygen needs, monitoring, orthostasis, exertional symptoms, medications, and line management. BMAT is especially useful before toileting, transfer to chair, first walk after admission, post-op progression, and any time the patient's condition changes.
Choose Your Intensive Care Unit Or MOVES Lane
Everyone needs the same BMAT foundation. The only split here is how much ventilated-patient detail you need. Choose the lane that matches your role today. Both paths are designed to take about the same amount of time.
Non-Intensive Care Unit / Non-Ventilated Patient Path: What To Know
If your usual patient types do not include intensive care unit patients or ventilated-patient care, you do not need to memorize MOVES criteria for this module. You do need to recognize that ventilated-patient mobility is not automatic bedrest and not a casual transfer. It is a coordinated intensive care unit mobility decision.
| What You Need To Recognize | What To Do |
|---|---|
| Ventilated patient, high oxygen needs, vasopressors, multiple invasive lines, or unclear readiness | Do not improvise a transfer. Pause and coordinate with intensive care unit nursing, RT, therapy, and the provider as appropriate. |
| Patient is awake and participating but has intensive care unit-level complexity | BMAT logic still applies, but the readiness screen is broader than floor mobility. The intensive care unit team uses the A-F Bundle and MOVES criteria. |
| Cross-coverage, unfamiliar patient type, or unclear mobility history | Use the same basic BMAT sequence for non-ventilated patients: screen, start low, stop when unsafe, document the plan. |
Intensive Care Unit / Ventilated Patient Path: A-F Bundle And MOVES
Intensive care unit mobility is broader than ventilator mobility. Thompson intensive care unit practice includes patients coming off sedation, patients recently extubated, patients on high-flow oxygen, patients with lines, drains, delirium, vasoactive medication changes, and patients who are ready to progress toward chair or ambulation. The A-F Bundle gives structure for all of that work, with MOVES adding the readiness screen when ventilated-patient complexity is present.
Intensive care unit mobility requires more coordination, but immobility is not benign. Thompson's A-F Bundle states that early mobility is safe and achievable in many critically ill patients, and that initiating therapy as soon as possible in the intensive care unit can reduce delirium days, decrease ventilator time and intensive care unit and hospital length of stay, prevent deconditioning, ventilator-associated pneumonia, and pressure ulcers, and support return toward pre-admission activity.
The A-F Bundle also says all elements should be addressed daily during interdisciplinary rounds, patients should be mobilized to their potential daily, BMAT should be completed on admission or transfer to the intensive care unit and at least once per 12-hour shift, and mobility assessments/interventions by the multidisciplinary team should be documented in the EMR.
| MOVES Screen | Thompson Readiness Cue |
|---|---|
| M - Myocardial stability | No ischemia for 24 hours, no dysrhythmia requiring new IV antiarrhythmic agents for 24 hours, resting HR consistently under 120, and no hypertensive emergency. |
| O - Oxygenation adequate | Examples from policy include FiO2 less than 0.6, PEEP less than 10 cm H2O, RR under 30 at rest, and attention to recent intubation/tracheostomy status. |
| V - Vasopressors | No increase of any vasopressor for 2 hours. |
| E - Engages / able to participate | Able to respond and follow cues safely, maintain alertness, actively cooperate, and SAS 4: calm and cooperative. |
| S - Special considerations | Labs reflect Hgb greater than 7, platelets greater than 20,000, and pH greater than 7.25; discuss mobility with provider for lumbar drain, pulmonary artery catheter, transvenous pacer, or transcutaneous pacer; review open abdominal incision, unstable fracture, active hemorrhage, neuromuscular blockade, and thrombolytic therapy in the previous 24 hours. |
An intensive care unit patient on the ventilator is awake, calm/cooperative with SAS 4, follows cues, FiO2 is 0.45, PEEP is 8, HR is 92, and vasopressors have not increased for 3 hours. What is the best next step?
Urgent Or Unscheduled Mobility
Some mobility decisions happen quickly: bathroom requests, imaging pressure, stretcher-to-chair moves, discharge ambulation, and patients who have been waiting in one position for a long time. BMAT helps slow down the exact moment where a fall often happens: "They look okay, let's just get them up."
Postpartum Recovery
Use the same BMAT logic, but the safety screen must respect postpartum physiology, anesthesia recovery, bleeding risk, magnesium or other medication effects, pain, epidural/spinal recovery, infant-in-room workflow, and privacy. A patient who was independent before delivery may still need a lower mobility plan during first ambulation or toileting.
Post-Procedure Or Anesthesia Recovery
After anesthesia, procedures, or sedation, mobility decisions often happen around stretcher transfers, first movement, toileting, discharge readiness, and procedure-related restrictions. If the patient cannot participate or has not been assessed, Thompson policy supports using the highest level of equipment until a validated assessment is performed by a licensed nurse and the transfer recommendation is documented.
Imaging And Procedure Transfers
Transfer planning should be communicated before the patient arrives when possible. Table transfers, oxygen or monitoring needs, contrast reaction risk, sedation, lines, drains, and procedural positioning can change the safest plan. If the current BMAT or transfer method is unclear, clarify before moving the patient from stretcher, bed, wheelchair, or procedure table.
Scenario Practice
A 64-year-old admitted with pneumonia is now on 4 L oxygen. They pass sit and shake, but become very short of breath during stretch and point. What is the next move?
Two narrators walk through this module in a short conversational format. The transcript follows the recording and highlights the matching section of the page.
Transcript lines are timed from the generated recording and can be clicked to jump within the audio.
Module 5: Document, Hand Off, Escalate
Document What Happened
Good mobility documentation should tell the next nurse what is safe, not just satisfy a field. At minimum, the record should make clear the current BMAT level or mobility status, what the patient actually completed, the assist level, equipment used, tolerance, and any reason the assessment was stopped.
Thompson's safe moving and handling policy says the safe lift/transfer recommendation must be documented in the EMR, and that BMAT documentation is found in Epic flowsheets in the Vital Signs tab under Mobility.
Use Plain Handoff Language
A useful handoff sounds like bedside nursing:
Reassess When The Patient Changes
Mobility is dynamic. Thompson policy requires BMAT at least daily and as needed when patient status changes. Intensive care unit adds a 12-hour-shift cadence through the A-F Bundle. Reassess when there is new sedation, pain medication, worsening oxygen need, new weakness, delirium, fall, post-procedure restriction, orthostasis, prolonged bedrest, or meaningful improvement. The chart should not quietly carry forward an old level when the bedside picture has changed.
Escalate Early
- Escalate to the provider for new neuro change, syncope, chest pain, severe dyspnea, unstable vitals, or unclear activity orders.
- Escalate to PT/OT for new functional decline, unsafe gait, discharge planning needs, or repeated failure to progress.
- Escalate to the SPH unit representative, safe patient handling resources, or a superuser when the equipment plan is unclear or bariatric/complex transfer support is needed.
- Escalate in handoff when transport, imaging, recovery, procedural, or receiving teams need to know the current transfer method.
- Report injuries or near misses related to lifting/transferring through the associate injury reporting process.
Evidence Notes And References
- Boynton T, Kelly L, Perez A, Miller M, An Y, Trudgen C. The Banner Mobility Assessment Tool for Nurses: instrument validation. American Journal of Safe Patient Handling & Mobility. 2014.
- Boynton T, Kelly L, Perez A, Miller M, An Y, Trudgen C. BMAT 2.0 for bedside nurses. American Nurse Journal. 2020.
- Kalisch BJ, Lee S, Dabney BW. Outcomes of inpatient mobilization: a literature review. Journal of Clinical Nursing. 2014.
- Zisberg A, Shadmi E, Sinoff G, Gur-Yaish N, Srulovici E, Admi H. Low mobility during hospitalization and functional decline in older adults. Journal of the American Geriatrics Society. 2011.
- Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomized controlled trial. Lancet. 2009.
- Devlin JW, Skrobik Y, Gelinas C, et al. Clinical practice guidelines for prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult intensive care unit patients. Critical Care Medicine. 2018.
- NIOSH/CDC and OSHA safe patient handling and mobility guidance for reducing caregiver musculoskeletal injury risk.
- Agency for Healthcare Research and Quality. Early mobility programs and tools for hospitalized and critically ill patients.
- UR Medicine Thompson Health. CC.15.004.07 Safe Patient Moving and Handling. Last revised/effective May 5, 2026.
- UR Medicine Thompson Health. CC.13.001.57 Guidelines for Management of Mechanically Ventilated Patients (A-F Bundle). Last revised/effective April 5, 2026.
- UR Medicine Thompson Health. Safe Patient Handling Training. Local training document provided May 2026.
- UR Medicine Thompson Health. BMAT RN Reference Tool - FFTH; BMAT Communication - FFTH; SPH Quick Reference - Thompson. Local reference materials provided May 2026.
Final Assessment
Answer all 12 questions. A score of 10/12 or higher is required for completion.
1. What is the primary purpose of BMAT at the bedside?
2. Which finding should stop BMAT progression before standing?
3. A patient cannot sit upright safely or reach to shake your hand. What is the safest BMAT interpretation?
4. A patient can sit and reach but cannot demonstrate safe leg control during stretch and point. What should you avoid?
5. A patient can stand and walk only with their baseline walker. What is true in the Thompson BMAT reference?
6. Which statement best reflects safe patient handling principles?
7. An awake intensive care unit patient with stable oxygenation wants to sit in a chair. What is the best response?
8. In the ED, a patient with syncope asks to walk to the bathroom before any mobility assessment. What is safest?
9. A patient was walking with a walker this morning but is now newly confused and buckling. What should the nurse do?
10. When should nursing consider PT/OT escalation?
11. A Med/Surg/Observation patient is going for an imaging study. Which mobility handoff is most useful?
12. What is the best final habit for BMAT use?
Thank You
You have completed the BMAT module.