Nurse Driven Mobility Protocol Implementation on a Medical Telemetry Unit

Purpose:
The purpose of this project is to decrease the risks associated with immobility in the hospitalized patient. The goals are for patients to remain as active as possible during their stay; maintain functional status; and see decreased fall rates, pressure ulcers, and length of stay.

Significance:
Decreased mobility commonly occurs during hospitalization. After one day in bed, 3% of muscle mass is lost. It takes 3 to 6 days to recover the lost strength. Activity during hospitalization helps maintain strength, improves balance, prevents falls and skin breakdown, and shortens hospital stays.

Strategy and Implementation:
The Mobility Protocol was devised by the unit practice council and the physical therapists. The Mobility Protocol includes an assessment of the patient's mobility each shift using the “Quick 3 Bedside Assessment Tool for Nurses and Therapists.” Based upon the assessment, the RN develops an individualized mobility plan of care that is documented on the Problem List in the electronic medical record. The mobility score is communicated to all caregivers via the white board in each patient room and during handoff between shifts. Ideally the plan of care includes the patient eating all meals in his/her chair and ambulating three times per day in the hall. All Medical Telemetry staff members received education on the new process through staff meetings and handouts in their mailboxes. Audits have been performed to inform staff of their compliance with the protocol. Patients receive education verbally at the time of admission and through the unit newsletter in the admission packet.

Evaluation:
Outcome measurements were initially related to compliance with the process. Peer audits increased compliance. Outcome measures now include fall rates, prevalence of pressure ulcers, and length of stay. Fall rates and pressure ulcers have decreased since implementation. Length of stay has maintained.

Implications for Practice:
Encouragement of patient ambulation and activity are integral nursing practices. The positive outcomes of the Mobility Protocol make it a practical and useful tool to be utilized on any nursing unit. Increasing activity during hospitalization improves nursing patient care and patient outcomes.