Implementing an Early Mobility Protocol Among Medical/Surgical Geriatric Patients

Abstract

Problem: Hospitalized patients spend most of their stay in bed with little daily mobilization. In geriatrics, this level of immobility is associated with profound loss of muscle mass and strength, increasing the risk of longer hospital stays, falls, hospital-acquired infections, and decreased functionality. A recent audit at a community hospital noted that nearly 90% of admissions required new rehabilitation services at the time of discharge. Additionally, in six months, five cases connected to immobility resulted in almost $230,000 in additional preventable costs. Purpose: This project aimed to improve and increase patient mobility by enhancing nursing knowledge, behaviors, and mobility practices in a medical-surgical unit. Methods: Project interventions included multidisciplinary staff education and collaboration, patient education booklet distribution, and a unit-based mobility metric. The project was implemented in a medical-surgical orthopedic unit at a local community hospital. A one-hour education session was provided emphasizing the importance of geriatric mobilization, negative repercussions of immobility, appropriate mobility assessment and intervention technique, documentation, and facilitators to minimize increased workload. Once educated, staff were challenged to meet mobility metrics based on a patient's capabilities. A mobility packet was also given to patients 65 and older to enhance patient education. Results: Documented mobility assessments and interventions have increased by 10.17% and 65.3%, respectively, from preimplementation. Mobility pamphlets have been successfully distributed to approximately 91% of eligible geriatric patients, and there was a 5% decrease in geriatric patients requiring additional rehabilitation post-discharge. Conclusions: Increased education, collaborative efforts, positive behavior change, and measured metrics are effective methods to increase the frequency and duration of documented mobility assessments and interventions. As mobility improves, it has the potential to impact nursing care culture, patient outcomes, and organizational outcomes.