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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)