• Enhanced recovery after surgery clinical pathway implementation effect on postoperative ambulation

      Zeller, Jennifer L.; Gutchell, Veronica (2022-05)
      Problem & Purpose: Enhanced recovery after surgery protocols have been shown to decrease postoperative complications including venous thromboembolism, delayed gastric emptying, and ileus. In a surgical telemetry unit in a suburban community hospital, the average time to first ambulation for patients undergoing pancreatectomy is postoperative day three. Barriers to early ambulation include lack of patient education and lack of standardized goals. Although early postoperative mobility is a vital aspect of postoperative care, enhanced recovery guidelines have limited information about specific protocols or daily goals. The purpose of this project is to implement preoperative patient education and a clinical pathway to encourage early ambulation in patients undergoing pancreatic resection. Methods: Implementation started in September 2021 and continued for 15 weeks. Preoperative education was provided in both verbal and written formats for those patients who met the inclusion criteria. In the surgical unit, the nursing staff received education on the clinical pathway and standardized documentation. The nursing staff then utilized the clinical pathway tool daily to encourage ambulation. Data was collected from the electronic health record on pre-operative education, date of first ambulation, and length of stay. Results: Preimplementation data showed that while the average time to first ambulation was postoperative day three, there was a wide variation from postoperative day one to postoperative day eight. After the implementation phase, seven patients met inclusion criteria. Four patients received verbal and written education. All seven patients ambulated for the first time by post-operative day two, and length of stay for all patients was at or under seven days. Conclusions: Based on the postimplementation data, patients undergoing pancreatic resection ambulated earlier after surgery and had decreased length of stay.
    • Promoting Early Mobility in The Medical Intensive Care Unit

      Lanier, Tatyauna M.; Bundy, Elaine Y. (2022-05)
      Problem: Evidence has shown that early mobilization can improve patient outcomes, expedite recovery time, and shorten the length of stay for hospitalized patients. However, early mobilization of critically ill patients is not routinely practiced in an academic medical center's medical intensive care unit (MICU). The MICU has a higher immobility rate than other units, with only 29% of patients receiving early routine mobilization. Plans to encourage mobility are not routinely discussed during patient care rounds by the multidisciplinary healthcare team in the MICU. Purpose: The purpose of this quality improvement (QI) project was to implement and evaluate the effectiveness of an evidence-based nurse-driven mobility algorithm for adult patients admitted or transferred to the MICU. Methods: The mobility algorithm was implemented in an adult MICU over 15 weeks from August to December 2021. A mobility algorithm was developed based on evidence-based practice recommendations. Following staff education, the mobility algorithm was reviewed with each patient admitted or transferred to the MICU by the oncoming shift during nurse handoff to assess the patient's mobility level and plans to promote mobility. Weekly mobility reports, electronic chart audits, and observation audit tools were utilized to collect staff compliance on utilizing the mobility algorithm. The data was analyzed using run charts to track changes in mobility screens, mobility level door signs, and patient activity. Results: There were positive and negative trends among 520 patients with mobility rates. Results showed that average mobility screen increased (30% to 100%) and mobility level door signs (5% to 100%). There was an increased in patients’ mobility level (29% to 80%) during the fourth week of implementation. Analysis of all run charts showed no shift in trends with rates of early patient mobility utilizing a mobility algorithm. Conclusion: The anticipated outcomes of this QI project were achieved with improvement in inpatient mobility screening, mobility level door signs, and documented patient activity to increase early patient mobility.
    • Reliability and Validity of the UMove Mobility Screen

      Wells, C. L.; Pittas, J.; Roman, C.; Lighty, K.; Resnick, B. (2021)