2021 Annual Conference

CNS Improving Outcomes
CNS as Researcher
Quality Initiatives

 

Background:  In recent literature, progressive early mobility has been a focus for the Intensive Care Units (ICUs); however minimal literature exists for the medical population.  Decreased mobility and prolonged bedrest have been associated with increased length of stay, increase risk for falls and skin breakdown, as well as increased need for extended-care facility admission.  Mobility status is not commonly measured by nursing, declines in mobility are often not recognized, and Physical Therapists have been the primary drivers for patient mobility.

Aims:  In hospitalized medical patients, does a nurse driven mobility program utilizing the AM-PAC 6 Clicks assessment reduce length of stay and decrease skilled nursing facility admissions?

Method: Using a Quasi-experimental design and convenience sample, a nurse driven Mobility Program was implemented on two medical units within an acute care hospital system.  The target population were patients admitted to the Renal Medical-Surgical unit at Community Hospital East and the Medical unit at Community Hospital South.   All staff (unlicensed and licensed) received education on the mobility program including mobility equipment and the AM-PAC 6 Clicks assessment.  The AM-PAC 6 Clicks assessment was completed upon admission to the unit, daily, and upon discharge.  Based on the 6 Clicks score, the patient’s mobility program was developed within 4 phases (ranging from Range of Motion to ambulation in halls).  Staff then implemented the associated mobility phase.  When a patient met their mobility goal, the next phase of mobility was attempted.

Result: 

There was a statistically significant reduction in length of stay for patients who had increased frequency of mobility (n=200; rho= 0.3, p=0.0005).  Nurses were able to accurately score AM-PAC 6 Clicks when compared to the score conducted by a physical therapist (n=65; Pearson correlation coefficient is 0.85, P-value < 0.05). 

Conclusion: Nurses can accurately utilize the AM-PAC 6 Clicks mobility assessment tool for medical patients within the hospital, as well as effectively implement a mobility program utilizing this score.  Using the 4 phase mobility model, nursing can progress a patient’s mobility across the continuum and allow for more appropriate physical therapy intervention.  Providing an accurate tool to assess a patient’s mobility and model of progression can impact length of stay, quality indicators, and provide a communication tool with Physical Therapy fostering a more multidisciplinary approach to mobility. 

Limitations: We compared the length of stay for the month before the study began, compared with the duration of the intervention.  The intervention occurred during peak flu season, which may be a reason that we did not see the length of stay outcomes we had been anticipating.  We were also limited in the data collection nearing the end of the study, as the COVID-19 pandemic was spreading across the country.  This limited the number of patients data we could collect in our implementation group.