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Although hospitalization is necessary for persons needing medical management for various acute and chronic disease processes, being in the hospital is accompanied by increased risk for the development of complications (Mattison, 2018). In particular, immobility or decreased mobility often is associated with hospitalization and puts patients at risk for development of hospital-acquired conditions (HACs). HACs are described as "reasonably preventable conditions that are not present when patients are admitted to a hospital, but that develop during the hospital stay" (Shoemaker, 2016, p. 80). HACs, such as pressure ulcers, pneumonia, blood clots, and physical deconditioning, can be caused by immobility of hospitalized patients (Teodoro, 2016). As Shoemaker (2016) noted, HACs also can increase the length of hospitalization. To decrease adverse effects, improve patient outcomes, and decrease overall length of stay (LOS), nurses must emphasize the importance of early assessment of patient ambulation ability and initiation of ambulation routines into patient care.
Project Site and Reason for Change
The project team included the Director of Nursing, Magnet Program Manager, clinical nurse specialist, nurse educator, clinical nurse, certified nurse assistants, and the manager of Inpatient Rehabilitation Services. Team members wanted to develop a mobility program that could be hardwired on the medical-surgical unit to improve patient quality of care and shorten hospital LOS. They believed increased adherence to ambulation routines should become part of interprofessional care in the inpatient setting. Complications occurring during hospitalizations at the project site due to immobility and subsequent deconditioning included longer LOS, increased costs related to discharge to higher levels of care versus discharge to home, and poorer patient satisfaction survey results. Through observation, medical record reviews, and staff interviews, the project team identified the barriers to ambulation included orders for bed rest, nurse concern about fall risk, and competing priorities to patient ambulation by staff. Interprofessional collaboration by physical therapists, hospital leaders, and nursing staff in creating a mobility plan tailored to a patient's abilities also could increase staff morale through use of a successful ambulation protocol. In particular, team members believed nursing staff should acknowledge the importance of routine patient ambulation and identify potential barriers to performing ambulation.
Program
The project was reviewed by the Institutional Review Board and registered as an evidence-based practice project. The project unit was chosen to...