LET’S TAKE A WALK! SSEM PCU AMBULATION PROTOCOL

•  In 2012 and early 2013 the average hospital acquired VTE rate was 1.6 clots/month.

•  The team identified a need to implement a standardized method for mobilizing patients in the PCU.

Approach to the Problem

Stacey Kuhn, RN, PCCN; Jose Soto, RN, BS, PCCN; Paula James, DNP, RN, CCNS; Joan Barrett, MS, BSN, NE-BC; Desiree Lamothe, BSN, RN, PCCN; Justine Hendron, BSN, RN, ONC, PCCN; Vivienne Davis, MSN, RN, PCCN; Vida Olsen, BSN, RN, PCCN; Carol

Winardi, BS, PT, MBA ; Mary Ramos, PT, DPT; Dr. Nathaniel Fleischner, MD; Jennifer Tucker, BSN, RN

•  Metric Definition: Compliance was considered positive for any patient on the PCU census with documented mobilization on the nursing flowsheet at lease once within the first 3 days of hospitalization

•  Exclusion Criteria: Any patients with an order for Bedrest or patients who were discharged in < 3 days.

•  Pre-intervention Data Plan: Three weeks baseline data

•  Intervention: Educational in-service for staff on the protocol

•  Post-Intervention Data Plan: Daily audits for three months. Weekly audits for months 4-6.

Problem

Methods

•  The team identified a need for a mobility protocol and conducted a literature review.

•  A protocol was adapted from Drolet et al. (2013) and selected for daily use in practice.

•  Key stakeholders: nurses, clinical techs, physical therapists, and physicians were involved

57%  

74%   73%  

84%  82%   81%  

71%  74%   74%  

84%  

88%  

97%  

79%  

70%   76%  

100%  

60%  

82%  

76%  

47%  

88%  

60%  

81%  

55%  

82%  

72%  

93%  

0%  

20%  

40%  

60%  

80%  

100%  

Early  Mobility  Initiated    PCU  Inpatients  

Monthly  Pilot  Audit  Rates   On-­‐Going  Weekly  Audit  Rates  

Preintervention  Data  

Educational  Inservices  Provided  

•  Pre-intervention Compliance: 57%. •  February – June 2014 Average Compliance: 77% •  Variability in compliance existed for July and August of

2014 •  End of the year data for 2014 reflected 93% compliance.

•  The ambulation protocol did not have an effect on hospital acquired VTE.

•  The team felt that patient benefits of mobility extended far beyond VTE prevention and that the practice of ambulating patients in a standardized way was beneficial to patient outcomes.

Results

Conclusions & Outcomes

References: Drolet, A., Dejulio, P., Harkless, S., Henricks, S., Kamin, E., Leddy, E. A., et al. (2013). “Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings.” Physical Therapy, 93(2). p. 197-206

Protocol Adapted from Drolet et al. (2013)