• Implementation of Early Mobility Screening in the Surgical Intensive Care Unit

      Jones, Lindsay K.; Bundy, Elaine Y. (2021-05)
      Problem: A lack of early mobility screening in the adult critical care population may lead to adverse healthcare outcomes. In the past months preceding the practice change, a Surgical Intensive Care Unit (SICU) experienced seven hospital-acquired pressure injuries (HAPIs) and three inpatient falls. Purpose: The purpose of this quality improvement (QI) project was to implement and evaluate the effectiveness of early mobility screening via the Johns Hopkins Highest Level of Mobility (JH-HLM scale) in a 12-bed adult SICU in a community hospital setting. Methods: The JH-HLM scale was implemented over a 13-week period and was used to assess patient’s daily mobility level. Data on nursing compliance of use of mobility scale and improvement in mobility scores were collected via manual chart audits, and run charts were used to track and analyze results. Falls and HAPIs were also tracked. Results: Analysis of run charts for nursing compliance in use of the scale and improvement in mobility scores showed no shifts, trends, or non-random variation of runs, suggesting no effect due to the practice change. However, nursing compliance with use of the scale was consistently 85% to 100% and improvements in patient mobility occurred in 41 (35%) out of 116 patients screened. Although there was no decrease in patient falls, HAPIs decreased when compared to the previous eight months. Conclusion: The JH-HLM scale was found to be a safe and feasible screening tool useful by nurses in promoting early mobility in an acutely ill population. Additional QI projects are needed to determine if improved patient outcomes are associated with early mobility screening within 72 hours of ICU admission through discharge.
    • Implementing a Mobility Scale to Increase Postoperative Mobility Levels

      Marasa, Mary C.; Bundy, Elaine Y. (2021-05)
      Problem: Gynecologic oncology treatment plans often involve invasive surgeries that put patients at risk for complications and long hospital admissions. Enhanced Recovery After Surgery protocols improves outcomes for gynecologic oncology patients, especially when patients are compliant with getting out of bed on postoperative day zero. At an urban Mid-Atlantic hospital, 3% of gynecologic oncology patients got out of bed on postoperative day zero and the average length of stay was 2 days between February 2018 and January 2020. Delaying postoperative mobility increases the risk for longer hospital stays. Purpose: The purpose of this quality improvement project is to implement the Johns Hopkins Highest Level of Mobility (JH-HLM) scale with defined goals to increase postoperative mobility levels and decrease the length of hospital stay for postoperative gynecologic oncology patients. Methods: Quantifiable mobility goals were defined for postoperative patients based on the JH-HLM scale. The nursing staff was educated about the mobility goals and JH-HLM scale through unit presentations, email communication, and annual competencies. Mobility documentation was standardized in the electronic health record. Education materials were disseminated to the inpatient oncology unit, post-anesthesia care unit, rehabilitation department, and patients. Patient age, diagnosis, type of surgery, mobility levels, and length of stay were collected through chart reviews for 3 weeks before implementation and during the 12-week implementation period. Run charts were used to analyze the data. Results: Results showed that average mobility documentation increased (10% to 46%). There was an increase in mobility levels on postoperative day zero (6% to 33%) and by discharge (13% to 45%). The average length of stay during the 3-week pre-implementation period was 1.6 days and after implementation it was 1.8 days. These results were not statistically significant. Conclusion: Findings suggest that quantifying and standardizing mobility goals may increase postoperative mobility levels. However, more investigation is needed to demonstrate statistical significance. Length of stay was not decreased and was likely impacted by a variety of factors. Further investigation of improving mobility documentation, decreasing data variability, and increasing compliance is warranted.