Date of Graduation
Master of Science in Nursing (MSN)
School of Nursing and Health Professions
Dr Nancy Taquino
Abstract title: Creating A Culture of Patient Mobility in An Acute Care Setting.
Unit: Medical Surgical unit.
Author: Vincent Samuel RN, BSN
Institution: University of San Francisco; Kaiser Permanente Nurse Scholar Academy; Kaiser Permanente Hospital, San Francisco (CNL practicum site).
The medical/surgical unit had the average ambulation score of 54% in the year 2015, much below the benchmark of 65% set for the year. The direct impact of low ambulation score was the increase in patient’s length of stay. The micro-system analysis revealed various factors that contributes to this problem such as, inadequate staffing, unit culture, unavailability of the walking aid, encouraging the patient, lack of skills and knowledge, etc. The review of literature provides convincing evidence that prolonged immobilization of patients results in functional decline, increases the risk of hospital-acquired pneumonia (HAP), and length of stay (LOS). The studies were the guiding principle for the CNL to initially develop a mobility tool to monitor mobility compliance.
The unit has 26 beds and currently has a total of 70 staff members that include 45 full-time and part-time RNs (of which three are MSN, forty are BSN, two are ADN, and four medical-surgical certified), eleven per-diem RNs, eleven patient care technicians, and three unit assistants. The process of patient care starts with admission when admitting nurse and the manager on duty welcome the patient and the family members to the unit.
Global / Specific Aim
The current goal of the unit is to increase the culture of mobility and thereby improve patient length of stay, patient and family satisfaction, reduce cost per admission, mortality rate, and patient and staff satisfaction by December 2017.
The specific aim of this project is to increase patient ambulation score from 65% to the new set target of 70% by the end of December 2017. Improvement efforts began in March 2016 and continue to the present to standardize new mobility process. The preliminary efforts resulted in improvement in ambulation rates of 54% in 2015 to 68% in 2016.
Methods / Programs / Practices
The Clinical Nurse Leader (CNL) used the Model for Improvement (MFI) from Institute of Healthcare Improvement (IHI), Kotter’s eight steps for successful change, and extensive literature review to guide the development of the quality improvement project and worked with the team to discover the gap and to come up with solutions. The project was implemented over 16 months with the completion of three PDSA cycles. The unit is moving forward to the standardizing phase of standardize-do-study-act (SDSA) to make continuous improvement and employee empowerment. The SDSA cycle starts with determining how the current best practice will be standardized in the daily work of the unit.
It is expected that the unit will maintain the patient average ambulation rate of 70% by December 2017. The positive outcomes of target ambulation rate can be measured with the patient data in decrease in average length of stay of fewer than three days, and 0% hospital acquired pneumonia.
In summary, the review of the literature supports the benefits of mobilizing hospitalized patients and the dangers associated with immobilization. It is important that nursing staffs improve knowledge of the dangers of immobility, the importance of mobility, strategies to implement mobility successfully, financial implication of immobility to the organization, and its effect on patient and family members’ satisfaction.
Samuel, Vincent K., "Creating A Culture of Mobility: A Quality Improvement Project" (2017). Master's Projects and Capstones. 588.