Get EM UP: Early Mobility, Unleashing Potential

Project Topic:

Increasing patient mobility through improving true collaboration

Hospital, City and State:

Cedars Sinai Medical Center, Los Angeles, California

Unit:

Neurological/Neurosurgical Intensive Care Unit (NICU)

CSI Participants:

• Jester Bautista, PhD, RN, CCRN, SCRN
• Katherine Eduarte, MSN, RN, CCRN, PCCN, SCRN, CNRN, ENLS
• Kasey Gillette, BSN, RN, CCRN, SCRN
• Jackie Mann, BSN, RN, CCRN

Project Goals/Objectives:

1. Increase AACN Healthy Work Environment Assessment Tool (HWEAT) True Collaboration score from 4.58 to 4.60
2. Improve nurse perception and confidence in mobilizing their patients
3. Improve communication between disciplines (e.g., physical therapy (PT), respiratory therapy (RT), occupational therapy (OT), safe patient handling physicians (MDs), and nurse practitioners (NPs))
4. Create a workflow to mobilize the neuro-specific patient population

Project Outcomes:

1. HWEAT True Collaboration score increased to 4.77
2. HWEAT aggregate score increased from 4.83 to 4.96
3. All HWEAT standard scores improved
4. Increased nurse participation in mobilizing their patients 93.75%
5. Nursing involved in daily Physical Medicine & Rehab (PM&R) meeting
6. Mobility included in the nursing bundle and daily rounds

Project Overview:

In our unit, patients were not being mobilized due to the lack of a structured workflow for patient mobilization, leading to uncertainty among nurses regarding which patients were suitable for ambulation. There was a lack of confidence among nurses in mobilizing patients, with the prevailing belief that PT involvement was necessary before initiating patient mobilization, despite the presence of activity orders. Additionally, mobility was not routinely addressed during patient rounds or included in nursing handoff procedures. Furthermore, nurses did not possess a comprehensive understanding of the Bedside Mobility Assessment Tool (BMAT).

Based on these findings, the CSI team decided to focus the project on enhancing patient mobility through collaborative efforts with various disciplines, including PT, OT, PM&R, RT, NPs and MDs. Mobility champions worked in conjunction with the leadership team to develop a comprehensive education program encompassing eligibility criteria, BMAT scoring guidelines and suitable activities. BMAT placards were prominently displayed on patients’ doors to serve as visual reminders for the staff. Charge nurses and RT were actively involved in the daily PM&R rounds, resulting in the successful ambulation of three patients who were ventilator-dependent, an unprecedented achievement for our unit.

The integration of mobility discussions during rounds resulted in an increase in the placement of activity orders, subsequently leading to more patients being mobilized. A monthly competition incentivized staff to maximize patient mobilization, resulting in a higher number of patients being mobilized and contributing to reduced rates of perfusion index and hospital-acquired infections. More importantly, nurses felt more empowered to advocate for their patients to receive activity orders and to initiate patient mobilization promptly after orders were issued.

As a result of these initiatives, our True Collaboration score improved from 4.58 to 4.77, and our aggregate HWEAT score increased from 4.83 to 4.96. There is now greater engagement during rounds and improved communication among different disciplines.