Let's Take a Walk! Implementation of an Ambulation Protocol

Purpose:
The unit practice council's goal was to develop a standardized program which would increase the benefits associated with mobilization and ambulation in hospitalized patients. The unit's hospital acquired venous thromboembolism rate was 1.4 clots per month prior to implementation.

Relevance/Significance:
The American College of Chest Physicians guidelines for venous thromboembolism prevention include early mobilization in combination with chemoprophylaxis in many patient populations. Other potential complications of immobility include hospital-acquired pneumonia, pressures ulcers, decreased functional ability, and decreased quality of life post hospitalization. Immobility may also contribute to prolonged hospital length of stay and costs of care.

Strategy and Implementation:
The unit practice council leaders perceived a discomfort among the front line nursing team members related to mobilization of patients without the assistance of physical therapy. A literature review was conducted by the team, and a mobility protocol was selected and modified for use in this patient population. The practice council team partnered with physical therapy to provide an educational in-service on the protocol and other mobility techniques to the nursing team members. Bedside nurses reviewed the electronic health records of every patient on the unit census for documentation of mobilization within 3 days of admission. Three weeks of audit data was collected prior to the in-services. For the first three months following the education, data was collected daily. The audits were then conducted weekly for the remaining three months.

Evaluation:
Prior to implementation, compliance with documentation of ambulation was 60%. Post implementation rates averaged of 77% for the first four months. Compliance throughout the remainder of the year ranged from 72% to 93%. The venous thromboembolism rate remained unchanged, however the team felt that the benefits of ambulating patients may provide other benefits and should be continued.

Implications for Practice:
This project demonstrated that bedside nursing team members can lead an evidence based change to have a positive effect on patient care. The process has allowed the team to experience empowerment, professional development, and the confidence to drive other change initiatives in the future.