Background: Hospitalized patients have been shown to spend 87-100% of the day sitting or lying in bed, leading to many complications including venous thromboembolism and hospital acquired pneumonia. An important step to improve mobility amongst a diverse patient population is to establish an individualized mobility goal, which can be accomplished via a simple, validated mobility capacity assessment, such as the Activity Measure for Post Acute Care (AM-PAC). AM-PAC results can then be translated into the Johns Hopkins Highest Level of Mobility (JH-HLM) goal. At our large, tertiary care academic medical center, we have already incorporated assessment of the Activity Measure for Post Acute Care (AM-PAC) into daily documentation for nurses. However, we conducted a retrospective analysis and noted ambulation was documented for inpatients only 3.8% of inpatient days. We describe our multilateral hospital-wide mobility initiative with focus on the electronic health record (EHR) based dashboard to monitor documentation of mobility in real time.
Purpose: To initiate and evaluate an inpatient mobility program through education, goal alignment, nursing documentation of Johns Hopkins Highest Level of Mobility (JH-HLM) and a dashboard to monitor Key Performance Indicators.
Description: Our program to create a culture of mobility involved a multifaceted approach. We created a system-wide mobility “pillar” goal that helps incentivize care team members to mobilize patients, as these goals are used in team member pay for performance. We also built system-wide education regarding reasons to mobilize patients and development of mobilization skills. Then, we constructed a significant change in EHR documentation for nurses. Prior state included multiple options for mobility documentation, many of which were nonspecific, e.g. “up ad lib.” In our initiative, we transitioned to a single question, asking whether the patient met their Johns Hopkins Highest Level of Mobility (JH-HLM) goal for that shift. Additionally, we created a mobility dashboard to track 3 key performance indicators in real time: AM-PAC accuracy, AM-PAC timeliness on admission, and mobility goal achieved. AM-PAC accuracy is defined as nursing assessment of AM-PAC compared to same-day physical therapy assessment. AM-PAC timeliness is defined as an assessment of AM-PAC documented within 8 hours of admission. Our focus key performance indicator is mobility goal met – defined as the percent of total AM-PAC assessments where the mobility achieved is greater than or equal to the JH-HLM calculated mobility goal. Missing mobility achieved documentation during a nursing shift counts as not meeting the goal for that assessment. Though AM-PAC scores are assessed every shift, we are only monitoring mobility goal met for day shift in this initial phase. These metrics are shared with nursing leadership in real time to provide feedback to bedside nurses. Through our interventions, we have seen improvement in mobility goal met from 17% in month 1 to 39% in month 6. See Table 1 for achievement of the Key Performance Indicators over time since go-live.
Conclusions: Our mobility initiative showed consistent nursing accuracy of AM-PAC and improvement in timeliness of first AM-PAC assessment. Most importantly, we have noted a significant increase patients achieving their mobility goal since go-live. As we gather more data, we look forward to analyzing the effect of this increased mobility on patient outcomes. Our multi-prong approach can be replicated at other centers.
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