Abstract TP334: Implementing an Early Mobility Protocol on a Stroke Unit
Background and Issues: ASA guidelines support early mobilization of less severely affected stroke patients, with bedrest until they are clinically stable. However, there is no standard for assessing clinical stability of patients regardless of severity. Also, therapy resources may be limited, delaying mobility even in appropriate patients.
Purpose: Our goal was to develop, implement, and assess a protocol for nursing staff to assess mobility readiness and advance activity in all stroke patients, within hours of admission.
Methods: Stroke nurses, occupational/physical therapists (OT/PT), and a stroke neurologist, teamed to review mobility literature, then develop an assessment protocol with progressive, monitored levels of activity, usable by nursing and OT/PT. Barriers to implementation were identified and overcome. Adherence to protocol was audited by chart review. Safety was monitored via unusual occurrence reports. Nursing satisfaction was assessed by verbal feedback.
Results: A progressive mobility assessment protocol was developed with staff feedback. Identified obstacles to implementation included: staff protocol awareness, mobility assessment inexperience, work routine alteration, patient safety concern, and lack of a charting system. Educational in-services, posters, emails, and one-on-one training emphasized expected benefits of the program for patients and staff. Meal vouchers were offered as rewards for compliance. Compliance was 18% with a paper charting form, but improved to 85-100% with a revised computer charting system. Patient safety was not compromised, and nursing workflow improved with earlier patient mobilization. Therapists are able to build on previous nursing assessments, enhancing efficiency. Nursing participation in protocol development promoted ownership of the protocol, based on verbal feedback.
Conclusion: Our inter-disciplinary team successfully developed and safely implemented a new mobility practice protocol. This protocol benefits patients, nursing and rehab teams allowing safe and expedited patient activity, and improving efficiency on the stroke unit.
- © 2012 by American Heart Association, Inc.