An NhamFollow

Date of Graduation

Summer 8-9-2024

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

Kaiser cohort MSN capstone

Abstract

Improving Patient-Specific Mobility in the Telemetry Unit

Abstract

Problem: Prolonged immobilization has been proven to result in numerous adverse outcomes, including reduced ability to perform daily living activities, extended hospital stays, and increased need for rehabilitation discharge (Bergbower et al., 2020). Research reveals that only 5% of patients walk twice daily during hospitalization, and around 73% do not ambulate (Kalisch et al., 2013). In the telemetry unit, the inaccuracy of patients’ function assessment leads to the inability to optimize their mobility to meet daily activity goals.

Context: The patient-specific mobility improvement project addressed the critical quality gap of low mobility performance in the 6th-floor telemetry microsystem. Located in a 242-licensed-bed Northern California hospital, the 42-bed telemetry microsystem primarily cares for patients who require continuous cardiac monitoring due to a prior cardiac history or present diagnoses that may modify their baseline cardiac rhythms. The majority of the patient population is elderly with preexisting chronic conditions such as atrial fibrillation, residual stroke, congestive heart failure, and diabetes. To avoid additional decompensation, preserving functionality for this population should be a top focus. This project’s intervention attempted to educate staff on accurately assessing patients’ functional levels and enhancing mobility in the telemetry unit. The project aimed to improve patient-specific mobility metrics for all patients admitted in the telemetry unit from a baseline of 67.8% in 2023 to a target of above 70% by July 1st, 2024.

Measures: The project’s outcome measure was the percentage of expected bouts of activity that meet or exceed the patient’s CLOF-based mobility goal. This outcome was targeted at 70% or more. To evaluate the intervention, process measures included the percentage of staff who received education, the percentage of patients with CLOF scores correctly documented, and the percentage of expected activity bouts documented. These process measures were extracted from the EHR. The adverse event, such as mobility-related falls, was identified as the balancing measure.

Results: The project, which aimed to elevate the patient-specific mobility metric from a baseline of 67.8% to above 70% by August 1st, 2024, surpassed expectations, achieving an impressive 84.5%.

Conclusion: The patient-specific mobility improvement initiative effectively addressed the patients' functional deterioration caused by prolonged immobilization in the 6th-floor telemetry microsystem using a series of targeted interventions and the dedication of a diverse team. This result demonstrated the effectiveness of a complete approach grounded in evidence-based practices and ongoing staff education. The formation of the Mobility Tiger team, which included a variety of stakeholders, demonstrated that frontline staff can lead and drive change. The telemetry unit's experience is a model for other units pursuing similar initiatives to improve patient care and operational efficiency.

Keywords: patient-specific mobility, Mobility Tiger team, CLOF documentation, CLOF-based mobility goal, improving mobility in the telemetry unit, early mobility, improved care experience.

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