Each year, as part of Brigham and Women’s Faulkner Hospital’s ongoing commitment to providing the safest, highest quality care to our patients, departments across the hospital are charged with developing and implementing their own Quality Assurance Process Improvement (QAPI) plan. This year, the 7 North team, led by Nurse Directors Juliet Gleason, MBA, MSN, RN, and Brenda Miele, MSN, RN, and Professional Development Manager Susan Belton, MSN, BS, RN, CNL, is focused on expanding their Mobility Rounding efforts to include skin assessments and delirium prevention and treatment.
“During Mobility Rounds, we pull together a team that includes the patient, their provider, their nurse, their PCA and members of the nursing leadership team,” explains Gleason. “We run through a series of questions to assess the individual patient’s needs and help the nursing team determine the best course of action when it comes to caring for their patient. Since we first began, the questions we ask have evolved. We now include more questions related to skin condition and delirium.”
Answers to the questions asked at the bedside are collected via a REDCap survey. “We had help from our Program Manager for Nursing Quality and Magnet Rose LaPlante, MBA, MSN, RN, NEA-BC, who designed the survey and updates the questions as our needs change,” says Miele. “The goal is to ask the nurse about their current practice and offer suggestions to help embed best practices related to mobility, skin assessment and delirium risk in their practice. We take the opportunity right there at the bedside to offer one-on-one, real-time, hands-on education.”
So far, the results are promising. “Already I have seen a change,” says Belton. “We have completed more than 100 Mobility Rounds. In the beginning, some of the team were not prepared, but now, nearly everyone comes to rounds prepared to share and learn. We’ve also seen our clinical leaders and charge nurses step up, not only initiating the rounds, but taking the lead in the conversation.”
Miele agrees. “I see our nurses and PCAs being more proactive and taking more responsibility for their practice. I can tell they are more comfortable with the equipment we use to help patients out of bed, and that they know it only takes a minute to get a patient from the bed to their chair when done properly.”
The staff who participate in Mobility Rounds agree that it has improved their practice. “Mobility Rounds remind everyone—providers and nurses—to double check all orders,” says Jenna Coakley, BSN, RN. “And they encourage the care team to work together to figure out a safe and effective way to keep each of our patients up and moving.”
Ultimately, the goal is change nursing practice on the unit and to embed mobility into that practice. “When a patient spends all day in bed, they are at greater risk for things like skin breakdown, deconditioning and delirium. We aim to get every patient up and out of bed to address these risks,” says Belton. “Mobility Rounds are our way of keeping these concerns at the front of mind and taking action in real time to improve our patient care.”
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