Date of Graduation

Summer 8-11-2021

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Cathy Coleman



Problem: The enhanced recovery after surgery (ERAS) Ambulation Project aims to increase early ambulation of cesarean section patients in the maternal child inpatient unit. The current data has shown inconsistency with the application of the ERAS program with the maternal population. Instituting standardization of care and documentation, along with increasing patient centered care, has the potential to decrease the hospital length of stay (LOS).

Context: This quality improvement project standardizes the education provided to staff nurses and patients; allotting more time for staff to create meaningful relationships with their patients. A microsystem culture utilizing patient centered care allows patients to participate in their own care and has potential to decrease the workload on the nurse.

Intervention: This project implements a test of change to standardize care among cesarean patients in the maternal child population. ERAS education is provided to all labor and delivery/mother baby staff nurses addressing key components of the ERAS program. The education is also provided to new employees during orientation. The crossword puzzle education tool serves as a memory trigger for proper documentation. A laminated ERAS timing form is posted in all patient rooms providing patient education on the ERAS program and increasing patient involvement in their own care.

Measures: The measures for the ERAS Ambulation Project are aimed at demonstrating an increase in the maternal population ambulating within the first 12 hours following a cesarean section. The two process measures consist of frontline staff education of proper documentation and the utilization of ERAS signage in patient rooms with patient review during nurse knowledge exchange (NKE) from the post-anesthesia care unit (PACU). The outcome measure will report the percentage of maternal patients who ambulated within the 12 hours following their operating room (OR) departure.

Results: As of July 31, 2021 the ERAS ambulation outcome measure of patients ambulating within 12 hours of delivery in the maternal child population is at 75%. Although this metric was not be met by the original timeline, it is trending upward and when utilizing front line staff to implement, the workflow is showing signs of sustainability. As of July 31, 2021, the process measure of signage in patient rooms being utilized to educate patients on the importance of early mobilization is 75%. Feedback from the frontline staff has included adding ERAS signage in all rooms and bringing in options of different languages. The visual aspect of the ERAS signage is easily understood and can be utilized for vaginal deliveries as well. The maternal patient population is reporting how staff nurses review the workflow signage in the room and personalize to them specifically.

Conclusions: In reviewing the data, the results are failing to meet the anticipated metrics, however, are trending up. The process measures prove to be imperative in creating a sustainable workflow in the maternal child microsystem. Providing 100% frontline staff education on correct documentation and ERAS workflow will provide standardization of quality patient care. With incorporation of staff feedback, accounting for times of high census, low staff availability for education, and staff burn out from working extra hours, covering shifts for staff out during the pandemic; the ERAS ambulation project has continued to gain attention. Developing a workflow which includes new staff education in a microsystem that has high turnover and allocating patient centered care or allowing patients to take part in their own care; the project shows great potential for high sustainability.