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P10 - Early Ambulation and Documentation for Total Hip and Knee Replacements to Decrease Length of Stay

Purpose: Increase post-operative day-0 ambulation in total hip and knee replacement (THKR) patients to decrease length of stay (LOS).

Description: This quality improvement (QI) project consisted of interventions that support and promote the evidence-based practice of post-operative day-0 ambulation. a) Hallway ambulation markers
b) Documentation that reflects the revised change (documentation tip sheet)

a) Hallway ambulation markers: Markers were added to each of unit’s hallways utilizing Minnesota landmarks to help quantify and motivate patient ambulation. Each landmark marker equaled 25 feet of ambulation.

b) Documentation tip sheet: Displayed a tip sheet to reinforce how to document ambulation in the electronic health record (EHR). It was placed in the middle of the nursing station for easy accessibility.

Evaluation/outcome: It will be evident that this project is successful if the chart reviews show an increase in the percent of patients ambulated on post-operative day 0 by nursing staff, decrease in LOS, and increase in staff documentation of ambulation.

Purpose: Increase post-operative day-0 ambulation of 75 feet of THKR patients in the first 8 hours by nursing staff, increase documentation on ambulation in feet in the EHR, and decrease LOS.

Background: Early ambulation of THKR patients on post-operative day 0 has been found to decrease LOS. Post-operative day-0 ambulation is a core performance measure of the Joint Commission, and 75 feet is the target for THKR patients as a part of the total joint optimal care pathway. Inpatient ambulation of adults has been found to be one of the most frequently missed components of nursing care. Further, immobilization has been directly correlated with increased LOS. Although post-operative day-0 ambulation had been increased by physical therapy staff on this 23-bed orthopedic unit, there was still a gap in mobilization of patients on post-operative day 0 by nursing as well as inadequate documentation.

Method(s): The design was a six-week pre-/post-intervention QI project. 30 chart reviews on THKR patients were completed in the EHR before and after the intervention.

Result(s): A post-intervention chart review showed that the average LOS for 30 THKR patients was an average of 1.5 days, which was an 8% decrease. 90% of patients were ambulated on post-operative day 0 and 80% were by nursing. 40% of patients hit their goal of 75 feet ambulated on post-operative day 0. Documentation of feet ambulated was 77% and was in the correct place 63% of the time.

• Post-operative day-0 ambulation by nursing almost doubled 1-month post-intervention.
•    Documentation improved with a 76% increase overall and a 63% increase in the accuracy of documentation.
•    LOS decreased by 8%.
•    This project showed promising trends with increasing post-operative day-0 ambulation and documentation. Continued ambulation promotion to meet goal of 75 feet in first 8 hours post-surgery is needed.
•    Post-operative day-0 ambulation was added to new hire orientation for sustainment.

References available upon request


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