This member-only article appears in the October issue of Patient Safety Monitor Journal.
The benefits of mobility among hospitalized patients are well-known: decreased pressure ulcers, deep vein thrombosis (DVT), and functional decline, to name a few.
“Hospital-acquired pressure ulcers, falls in the hospital, falls that cause injury, DVTs, and pulmonary emboli are also caused by immobility,” says Maggie Hansen, RN, BSN, MHSc, senior vice president and chief nurse executive at Memorial Healthcare System in Hollywood, Florida. “They have other factors that contribute to them, but [nursing] is taking ownership for preventing some of those things that should never happen to patients.”
Still, finding the time to ambulate patients during a busy shift is something nurses often struggle to do.
“We heard feedback [from nurses] like, ‘I really wish I had more time to ambulate my patients,’ ” says Leslie Pollart, RN, MSN, MBA, director of nursing at Memorial Regional Hospital in Hollywood, Florida. “While they knew it was important, competing priorities often impeded their ability to ensure timely patient mobility, and sometimes patients need more than one person to assist them in getting out of bed.”
To address this issue and ensure patients were getting the ambulation they needed to achieve optimal outcomes, the hospital revamped its mobility program, including creation of a designated mobility team.
According to Hansen and Pollart, the program has had numerous results. Pollart says lower-extremity DVTs in patients have decreased by more than 30% since implementation of the program. They have also seen improved disposition to the right level of care.
“What we have found by having the more aggressive mobility program is we’re not having physical therapists bogged down with doing consults that aren’t medically necessary,” Pollart says. “Now they can focus their time on the cases they really need to see. What we’re seeing is a better disposition for the patients when they leave.”
Families are also more confident taking patients home from the hospital, and conflict at discharge has decreased, she says.
“When you talk about discharge planning with a family member and the only paradigm they see is [a] loved one is always in bed, they start to get anxious because they think, ‘How am I going to be able to care for him or her at home?’ ” So we wanted to make sure that we changed that perspective so that when that family came in, they saw patients who were out of bed for meals [or walking],” says Pollart.
Hospital employee injuries have also decreased.
“At the start of the program, our employee-related patient handling injuries were quite high,” Pollart says. “They averaged anywhere from on the low end to maybe nine or 10 a month, and on the high end to maybe 25 to 30 a month.” After going live with a mobility team and investing in patient handling equipment, the hospital reduced employee injuries by more than 60%.
“When you look at that just from an employee standpoint, one employee injury is too much,” Hansen says, “but when you look at [the] financial standpoint—if you were only looking at the dollars—every workers’ compensation claim … averages $20,000. The investment in that equipment is easily justified by the fewer number of injuries.”
Finally, staff engagement and satisfaction has also increased. Some nonclinician mobility team members who help with the program have been inspired to follow a career path in healthcare, Pollart says.
“I have a couple that are going to continue to go to school to be therapists. Another one really likes exercise physiology,” she says. “So, it’s really helped them shape their future career path.”
And hospital staff understands that the organization is committed to creating a safe work environment.
“The fact is that our hospital did recognize [the staff’s] priorities and gave them a team and invested in the equipment,” Pollart says. “Their perspective about senior leadership understanding the complexities of the work they do has significantly increased because of it. They feel like the organization is committed to their safety.”