Implementation of Nurse-Driven Early Mobility Protocol in an Inpatient Medical-Surgical Unit

Abstract

Problem: In a 30-bed Medical-Surgical Unit at a community hospital, a lack of early mobility practices led to prolonged immobility and poor patient outcomes. The unit struggled to reach the hospital's benchmark goal of 80% for early mobilization. There was no formal early mobility protocol in place to guide the nursing staff in assessing and managing patients' mobility. Purpose: This quality improvement project implemented and evaluated the effectiveness of a nurse-driven early mobility protocol using the Johns Hopkins Highest Level of Mobility (JH-HLM) scale with defined goals to increase mobility documentation and decrease the length of hospital stay. Methods: Mobility documentation and length of hospital stay data were collected through chart audits for three weeks before project implementation to establish a benchmark. The nursing staff was educated on admission screening and how to document in the electronic health record (EHR). An early mobility provider order and a nurse-driven early mobility protocol using JH-HLM were developed and implemented over 12 weeks. Weekly audits were done by the project lead and champions. Results: After 12 weeks of implementation, mobility documentation increased from 60% to 93%, with a mean of 89. Length of hospital stay baseline data showed an average of five out of 30 patients stayed in the unit for one to five days. During the initial phase of the implementation period, an average of 21 (70%) out of 30 patients met the benchmark, staying for one to five days. Only nine (30 %) patients stayed beyond five days. This showed significant improvement in the length of hospital stay. Conclusions: The results indicate that the nurse-driven early mobility protocol using JH-HLM increased mobility documentation. The length of hospital stay showed significant improvement until the unit was converted into a COVID-19 unit, demonstrating the effectiveness of this tool with the usual population served in this unit.