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Creating a Culture of Mobility

Using Real-Time Assessment to Drive Outcomes

Kappel, Sarah E., BSN, RN-BC, ONC; Larsen-Engelkes, Tamera J., MSN, RN, NE-BC; Barnett, Rachel T., BSN, RN-BC, ONC; Alexander, Jack W., BSN, ONC; Klinkhammer, Nancy L., PT; Jones, Mary J., MBA, PT; Baustian, Theresa L., PT; Ye, Ping, MD, PhD

AJN The American Journal of Nursing: December 2018 - Volume 118 - Issue 12 - p 44–50
doi: 10.1097/01.NAJ.0000549690.33457.bb
Cultivating Quality

Background: Recent studies have demonstrated the safety and feasibility of early mobilization of patients in the hospital setting. Promoting early mobility improves patients' ability to perform daily activities and attend to basic needs. It also preserves patients' dignity and independence. We implemented a culture of mobility program to promote awareness of the importance of early mobility among health care providers, patients, and family caregivers on an inpatient orthopedic unit.

Purpose: The goal of the program was to empower clinical RNs, physical therapists (PTs), and occupational therapists to conduct dynamic, ongoing assessment of a patient's functional status so the plan of care could be modified in real time to promote functional independence and prevent immobility-associated complications.

Methods: Nursing and therapy professionals used three mobility assessments to estimate the degree and type of activities a patient could safely perform during a hospital stay: the Johns Hopkins Highest Level of Mobility (JH-HLM) scale, the Physical Therapy Mobility Assessment (PTMA) scale, and the Occupational Therapy Assistance Assessment (OTAA) scale. The three assessment tools were incorporated into the electronic health record. To evaluate their performance, we retrospectively collected patient data before (baseline) and after (intervention) their implementation. There were 61 patients in the baseline group and 59 in the intervention group.

Results: The clinical characteristics of patients in the two groups were comparable, including demographics, diagnoses, and activity orders. The JH-HLM and PTMA scores correlated significantly with the maximum distance patients ambulated as measured independently by RNs and PTs, suggesting the tools worked as expected to estimate the actual activity patients performed. Importantly, we found that the intervention improved patient mobility, as evidenced by significant increases in the maximum distances and the number of times patients ambulated. Further, the initial scores on the JH-HLM, PTMA, and OTAA scales correlated significantly with the length of stay (LOS), an important outcome variable. This suggests that the mobility assessments can also be used to predict LOS and thus optimize hospital bed management.

Conclusions: Nursing and therapy professionals successfully implemented three new mobility assessment tools on an inpatient orthopedic unit. The tools captured real-time information about patients' functional ability that was used to encourage patients' mobility.

The authors describe how they implemented an intervention based on the use of three new assessment tools to promote awareness of the importance of early mobility among nurses and physical and occupational therapists on an inpatient orthopedic unit.

Sarah E. Kappel is nurse manager, orthopedics, at Avera McKennan Hospital and University Health Center in Sioux Falls, SD, where Tamera J. Larsen-Engelkes is director, orthopedics/brain and spine/rehabilitation/short stay; Rachel T. Barnett is clinical nurse educator, orthopedics; Jack W. Alexander is unit supervisor, orthopedics; Nancy L. Klinkhammer is a joint and spine navigator, physical therapy; Mary J. Jones is director, Brain and Spine Institute; and Theresa L. Baustian is supervisor, physical therapy. Ping Ye is an investigator at Avera Research Institute Center for Pediatric and Community Research at Avera McKennan Hospital and University Health Center. Contact author: Ping Ye, ping.ye@avera.org. The authors have disclosed no potential conflicts of interest, financial or otherwise.

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