Background: The benefits of early ambulation for patients admitted to a hospital are well recognized. Our hospital has a “Nurse Driven Progressive Mobility Protocol” which is intended to guide bedside practitioners in implementing individualized progressive mobility for patients and includes several items that nurses are required to document. It categorizes patients into 5 mobility levels; Level 1 being “lying or bedrest” and Level 5 being “Walk Independently”. It then specifies positioning, exercise and recommended activities of daily living (ADL) activity based on mobility level. Our multi-disciplinary team sought to assess compliance with the mobility protocol and identify opportunities for improvement.
Methods: Patients aged 75 years and older admitted to inpatient units under the hospitalist service were included. We collected information on the 3rd day of admission which included: 1) was an admission order for progressive mobility placed, 2) was mobility level documented in nursing notes, 3) was there nursing documentation for ambulation distance recorded, 4) was mobility level documented at 0700 and 1900 hours and 5) were patients with mobility level of 4 or 5 ambulated by hospital day 3. Patients who verbally consented were interviewed on hospital day 3 and asked “Did someone get you up to walk since the time you have been in the hospital?” The study was approved by our institutional review board.
Results: 73 patients were included. 66 (90%) had a progressive mobility ordered placed at admission by the hospitalist or advanced practice provider. Nursing documented mobility level in 56 (77%) of patients and compliance with documentation of mobility level at 0700 and 1900 hours occurred 76% (257 of 336 opportunities) of the time. 32 (44%) of patients had mobility level of 4 or 5 documented at admission. 17/32 (53%) had ambulation distance documented. Of these 32 patients, 30 (94%) indicated they had walked or someone had walked them. Only 6/19 (32%) mentioned walking in the hallways; the remainder mentioned walking only inside the room. Only 10/32 (31%) were documented to have walked more than 20 feet.
Conclusions: Admitting providers are fairly compliant with ordering our nursing progressive mobility protocol. Challenges include improvement in nursing documentation and assisting/encouraging patients that are mobile to walk outside of their rooms. We hope to use baseline data collected during our project as a starting point for future interventions targeting improved mobility.