NR 631- Nurse Executive Concluding Graduate Experience

At my organization, the average percent for compliance of mobility documentation is 69%. The goal of the practicum project is to increase mobility and mobility documentation compliance to 82% organization wide. The barriers that have prevented nursing staff from documenting mobility includes staffing shortage issues, lack of ability to document in real time, and lack of education regarding the importance of mobility and the documentation requirements. Mobility can decrease the number of falls in a hospital setting because it decreases the patient’s risk of becoming deconditioned and weak. Patient’s who are admitted to the hospital are less likely to ambulate and become more deconditioned which can lead to a longer length of stay and an increased chance of having to go to a skilled nursing facility for continued rehab, which can delay discharge and further patient deconditioning. Evidenced- based practice has suggested that when patients are offered mobility during purposefully rounding, they are less likely to attempt to get out of bed without assistance and therefor decreases the chance of the falls. My practicum project will be implementing a work flowsheet on our mobile EMR system called the ROVER and will allow nursing staff the opportunity to document mobility when mobilization occurs. By implementing a way to document in real time will assist with increasing compliance with mobility documentation. For the CGE project, I have worked with my organizations Fall’s Prevention Committee, my mentor, nursing informatics, education department, and a nurse analyst to create an education piece that will be shared to all nursing staff to educate staff regarding the new workflow sheet that allows staff to document mobility on the Rover device. After the education is approved by the education committee, it will be assigned to all nursing staff to complete the online education. This project will run until November 2022. The education piece is currently in the process of 4 being approved by the education committee at the June monthly meeting. After the education is officially approved, the education department will assign each nursing staff the education module. As the project manager, I will look at the monthly unit report cards for each unit to see if the metrics have had an increase in mobility compliance. Currently, my unit is at 42% for mobility compliance and the organizations’ goal is 83%. For the month of May, my unit had a total of five falls and two of those falls were with injury. When looking at monthly metrics, I will look at the number of falls per month and the percentage of mobility compliance to see if there is an increase in mobility documentation compliance and a decrease in falls. By looking at these metrics monthly, it will allow me to discuss with staff any barriers they see are preventing them from utilizing the new intervention from the project. 5 Literature Review: Mobile EMR to Increase Compliance for Mobility Documentation According to the Agency for Healthcare Research and Quality, between 700,000 and 1,000,000 people in the United States fall in the hospital resulting in fractures, lacerations, or internal bleeding, leading to increased health care utilization (Agency for Healthcare Research and Quality, 2021). Falls are an issue healthcare organization all over have been working to prevent and a review of evidence-based literature has suggested that there are current interventions in practice to assist with preventing falls. Healthcare organizations look at quality metrics regarding mobilization and currently documentation compliance for mobility at my organization is 69%. In this paper I will discuss the current evidence- based literature regarding falls, mobility, mobility documentation, and the current interventions for all, how the current evidence- based literature relates to my practicum project, and an analysis of the literature. Review of Evidence Based Literature Mobility is an important aspect of nursing that can contribute to patient healing and decrease the length of stay for patients. Immobility in the hospital can lead to the development of hospital acquired conditions including pressure ulcers, pneumonia, blood clots, and physical deconditioning. According to Dewitt et al., ambulation of patients remains one of the most ignored patient care activities (Dewitt et al., 2019). There could be many different things attributing to mobility being one of the most ignored patient care activities including lack of time, fear of patient falling, and lack of knowledge of proper mobility techniques. Many nurses look to the physical therapist for their input and rely on the physical therapist to mobilize their patients. Although it is good to have input from the physical therapist regarding the patient’s assistance level, the physical therapist is not used to solely mobilize the patient but instead are there to evaluate the patients in an acute care setting to make recommendations for further 6 treatment plans. Patients should be mobilizing at least three times a day to prevent any hospital acquired conditions which cannot be completed by physical therapist staff alone without the help from nursing (Lim et al., 2020). One issue found was that nursing staff feel uncomfortable assessing patient’s mobility before physical therapy’s assessment. The Bedside Mobility Assessment Tool (BMAT) is a validated mobility assessment tool that nurses can use at admission and every shift to score the patient’s mobility needs. The assessment tool uses numbers 1-4 (1= patients with total care needs and 4= independent patients) to help nurses identify mobility equipment that may be needed to assist with transfers. After determining the patient’s mobility needs, a study suggested that creating color coordinated magnets to place on the patient’s care boards to notify other staff of what level of mobility assistance is needed to help the patient will improve nurses’ willingness to ambulate the patient and feel more comfortable with knowing their assistance level (Rose et al., 2022). In the current times of nurses being short staffed, there have been issues related to nursing staff not having the time to document mobility when it occurs in real time. Mobility may be occurring but just not being documented due to current inability to document in real time. In a study completed by Asmirajanti et al., the researchers looked at the different nursing interventions and whether or not the intervention was documented; only 37.5% of the mobility that occurred was actually documented (Asmirajanti et al., 2019). Regarding documentation in general terms, documentation is critical in nursing because it allows for interdisciplinary teams to be aware of any changes in the patient and to document the patients’ current status. Current interventions to increase nursing compliance with documentation is education, education may include online training modules, simulations, lectures, etc. In a study completed by Bunting and 7 De Klerk, documentation compliance increased to 70% after initiating online education modules because nurses felt they were more educated on what they were documenting (Bunting & De Klerk, 2022). Others way to assist with increasing compliance with documentation is to implement a reminder system to remind staff to document important things throughout their shift. A study was completed that looked to improve physicians charting found that reminders, in the form of physician question lists or chart stamps, significantly improved the quality documentation when compared with unformatted paper charts (Lorenzetti et al., 2018). A study completed by Popoola et al., looked at the different barrier levels of why mobility is not being completed at an organizational, individual, and patient level. The barriers included staffing levels, time and workload, resources, knowledge and training, stress, patient safety, and noncompliance of patients (Popoola et al., 2021). Evidence suggests that a huge barrier was time and staffing limitations (Montgomery et al., 2021). Although evidence has suggested that increasing mobility decreases falls in hospitalized patients, the implementation of electronic medical records has led to increased clinical documentation needed during each shift by 30% (Anderson et al., 2018). In a study by Ehrler et al., the aim of the study was to implement a Bedside Mobility app to support nurses in their daily workflow and to facilitate documentation at the bedside and the study showed that the mobile app was rated a mean average score of 76.3 by a nursing survey of the nurse participants (Ehrler et al., 2018). Implementing a mobile app that allows nursing staff to document in real time will also increase the amount of time they can spend with the patient which will increase the patient’s satisfaction scoring. In a later study completed by Ehrler et al., it was found that prior to initiating a mobile application for documentation, documentation in the electronic health record accounted for 12.35 minutes per hour in the baseline periods and went 8 down to 8.25 minutes per hour during the intervention period. It overall increased nurse’s patient interaction time from 7.84 to 9.30 minutes per hour (Ehrler et al., 2021). Another study agreed with the above study and suggested that completing documentation at the bedside with tablets reduces nurses’ time spent recording compared with the current system in which nurses use a computer on wheels. This difference is due to improved workflows, as bedside documentation completion with a tablet avoids unnecessary travel and facilitates access to patient information at the tips of the nurses’ fingers (Perez-Marti et al., 2022). When planning to implement a flowsheet for nurses to document mobility on a mobile electronic health record, evidence has shown that this method has been widely used among physicians to place orders at the touch of their fingers when not able to enter them into a desktop computer. In a study completed by Kim et al., the researchers looked at the time it took to enter orders in for patients on a desktop computer versus a mobile electronic health record, at the end of the study it suggested that it reduced the task completion time by approximately 16 seconds (Kim et al., 2020). Based on the information provided in the study above, it suggests that documenting via a mobile electronic health record can decrease the time documenting and placing orders and increase the amount of time face to face with patients. When implementing a new way of documenting to the nursing staff, there may be some hesitation due to the way of documenting changing from what it has always been. A study completed by Vossebeld et al., experimented with how nurses would adjust to the change of implementing a mobile electronic medical record (EMR). The study suggested that nurses were more likely to be compliant with the change if they were involved in the change process and their input being utilized (Vossebeld et al., 2019). 9