Poster Presentation for APTA National Conference Thrive in 2011, National Harbor, MD

1. Outcomes of an Acute Care Patient Ambulation Program
for Postoperative Thoracic Patients
Nawawi A., Fagan L., Oeffner J., Dekerlegand J.L.
Good Shepherd Penn Partners, Division of Therapy Services, Philadelphia, Pennsylvania
Background: Patient Ambulation Protocol: Results:
 After three months of implementation:
 Acute care physical therapy quality improvement (QI) projects often focus  Due to patient complexity, an education module was developed by the  Physical therapy efficiency improved from 82.1% to 100%
on improving efficiency of care. therapy department and unit-based clinical nurse educator for the certified  Monthly falls did not increase with this program; in fact a
 Inpatient therapists are frequently faced with the challenge of prioritizing nursing assistants (CNAs). decrease was noted from a monthly average of four to one.
extensive patient caseloads.  Press Ganey Scores in patient satisfaction improved from 72.9-
 This physical therapy QI project collaborated with other disciplines to  This module included education on: 85.4 to 100 for all four questions.
implement an ambulation program on a post surgical floor.  Safe patient handling and body mechanics
 The goals of this program included:  Line management
 Creating a cohesive interdisciplinary team focused on  Signs of patient distress
providing the appropriate level of care  Pain assessment and management
 Increasing patient, surgeon and physical therapist satisfaction  Proper use of assistive devices and safe mobilization
 Improving communication between all caregivers using a
simple visual tool  Physical therapists performed an initial assessment and completed a pre-
 Continuity of care seven days per week ambulation checklist to provide the CNA’s with information for safe
 Optimal utilization of skilled physical therapy services mobilization.
 This checklist was updated as the patient progressed with skilled physical
therapy interventions.
Purpose:
 The purpose of this project is to describe the implementation of a
patient ambulation program (PAP) by the Physical Therapy department
utilizing the certified nursing assistants on a thoracic surgical floor.
Discussion:
 This program successfully increased the frequency of daily patient
mobilization on a postsurgical nursing unit.
Methods:  Therapists continued to maintain a role in returning patients to their prior
functional status, while delegating non-skilled care to more appropriate
 An ambulation tool, which was updated daily, was posted on the patient’s personnel.
 This project was implemented on a fourteen bed thoracic surgical unit at
door to guide the CNA on the patient’s plan. The tool contained the  This program encouraged greater collaboration between the nursing and
a 300 bed urban academic medical center.
following: therapy staff, while promoting patient and family participation in care and
 All patients with diagnoses including lobectomy, pneumonectomy,
 “Safe to Walk by CNA”, designation by green or red colored circle recovery.
esophagectomy, wedge and sleeve resections, admitted to the unit over a
 “Walking Icon” used to document the number of walks  The visual tool improved communication with the patients and their
three month period, were included in the PAP.
completed caregivers by overcoming visual, cognitive, language, literacy and memory
 Outcome measures were collected on a monthly basis and included:
 Other icons used included the “W”, indicating the need for daily barriers.
 Number of patient falls
weights and the “B”, indicating a bath was completed
 Therapist efficiency, defined by the number of completed
patient interactions divided by the number of expected
interactions converted into a percentage
 Patient satisfaction per Press Ganey Scores, with a focus on Conclusion:
overall care, staff attention to personal and emotional needs,
patient participation in decision making, and staff  This simple program fostered collaboration with nursing, engaged the
collaboration patient/caregivers in the plan of care, and improved therapist efficiency in
 Patients and their caregivers were educated on the PAP project and the postoperative thoracic population.
encouraged to participate.  Team members gained an increased understanding of the role of physical
therapy and delineated skilled care to the most appropriate staff.