"Better Ambulation Helped Our Patients Recover Faster"
Young Patient Walks His Way to Recovery
After nearly five days in the ICU, an 8-year-old boy arrived in the surgical unit at Nicklaus Children’s Hospital in Miami, recovering from a gun-shot wound to the abdomen. He had a wound vac, IV, PCA, Foley catheter, two chest tubes and oxygen. He was in pain and fearful of ambulating, but staff knew that it was important to get him up and moving as often as possible.
Given that the patient had so much equipment, it would have been impossible for him to ambulate with the help of a single caregiver using traditional ambulation equipment. It also would have been difficult for staff to put together a team to ambulate the patient with the optimal frequency of three times a day.
Staff brought in the IVEA. Once the IVEA was loaded with the patient’s equipment, not only was the patient able to ambulate with the help of just one nurse, the patient’s mother was also able to assist with her child’s care by helping him walk without clinician assistance.
During the patient’s stay clinicians were concerned that he had developed deep vein thrombosis, and he was placed on bed rest for two days. The patient was a naturally athletic child and as soon as he was released from bedrest, he was eager to move again using the IVEA. He used it for a few more days, completing a two to three-week stay, and was discharged without further complication.
“This case was really a driver of our nurses’ enthusiasm for the IVEA,” says Clinical Nursing Director Deborah Hill-Rodriguez. “When they saw how easy it was for a patient with so much equipment to ambulate with just one caregiver, and saw him actually ask to use it, that really showed them how effective it was.”
Nurses Benefit from Equipment They Helped Design
Nurses on the fourth floor Surgical Unit at UCHealth Poudre Valley Hospital have a particular fondness for the IVEA. They were first introduced to the product when it was still in development, and their feedback during the evaluation period helped shape the equipment now used by hospitals everywhere.
Heather Roth, who was a staff nurse when the IVEA was first brought in and is now a nurse manager on the unit, says the IVEA was a winner because it provides ease of use and movement while holding all necessary equipment.
“The fact that it holds multiple pieces of equipment like IVs, oxygen and portable suction, and still moves easily makes it really useful,” says Roth.
With the IVEA now established as the unit’s ambulation go-to, Roth says the nurses have seen marked improvement in efficiency. “It definitely cuts down on the time it takes to get a patient ready to ambulate,” she says. “Many of our patients have had bowel surgery, so it’s very important that they walk three or four times a day. With the IVEA we can load the equipment and the patient can walk with just one nurse and, if they have less equipment, even get up on their own.”
This is particularly liberating for patients who’ve been transferred from the ICU and haven’t been able to move much. Roth says it’s amazing when they actually feel like they can be mobile and have some independence. Most, she says, are willing if not eager to walk, and the IVEA helps make that possible.
“Whether they have a lot of equipment or just need something stable to hold onto, the IVEA makes it easier for them to move and for staff to have the time to help,” she says.
Added safety is also a consideration. “If staff have to carry equipment while ambulating a patient, obviously that’s going to be less safe than being able to load all the equipment on the IVEA,” says Roth.
On a unit where nurses prioritize ambulation as an essential element of recovery, Roth and her staff have found the IVEA to be an easy-to-use patient ambulation solution. The fact that they had something to do with its effectiveness is simply icing on the cake.
One SICU Manager’s Rude Awakening Leads to Big Changes in Ambulation
When a surgeon at his Texas-based hospital told this SICU Manager that he was concerned his patients weren’t ambulating often enough, the manager was taken aback. After all, he was confident that every clinician in his 16-bed unit understood the importance of early and frequent mobility and knew that ambulation in particular was key to avoiding hospital-acquired conditions and functional decline in patients.
Unwilling to let the comment go unchallenged, he set out to prove his critic wrong by conducting his own ambulation audit. He was convinced that a bit of research would show that ambulation orders were being met and patients were walking the halls on a regular basis.
He began with a review of EMR data, looking at the number of ambulation events documented for a representative sample of about 100 CV patients over a period of 60 days. The results were alarming. According to the data, only 18 percent of these patients ambulated.
The manager wondered if perhaps nurses had simply neglected to chart ambulation events, so he added a second phase to his impromptu study: an observational audit. For several hours he sat at the nurses’ station and made note of all the ambulation events he saw. It wasn’t many. In fact, it was far more common to see a nurse spend 10 or 15 minutes searching for a walker, wheelchair or other ambulation equipment and, in some cases, simply give up.
Chagrined, the manager was forced to acknowledge that his staff simply wasn’t getting patients up as often as they should. PT could only do so much, and while the nurses knew that ambulation was important, the actual logistics of getting equipment set up to ambulate and finding one or two coworkers to help manage the patient and the equipment was so time consuming, they simply weren’t able to get it done.
Once he understood the problem, this diligent leader immediately sought the solution. He launched an awareness campaign to draw attention to the issue and brought multiple IVEAs into the unit. A new tool required some education, so he made sure his staff understood that the IVEA stayed with the patient bedside as well as during ambulation. With IVs, oxygen, drainage devices and other equipment already loaded and organized on the IVEA, it became almost effortless for one caregiver to ambulate a patient.
He didn’t have to wait long to see results. Within weeks, ambulation rates went from a dismal 18 percent to 63 percent, and average length of stay decreased from 7.4 to 7.3 days – a small increment but significant when applied across a broad patient population.
Since introducing the IVEA, this manager has also noticed that while previously PTs had driven ambulation, now nurses are playing a more active role in walking patients. Improvements have been so dramatic, he’s noticed that some patients who leave his unit to complete their recovery in med-surg, actually return to the SICU with new conditions because ambulation has fallen off. With plans to add more IVEAs, this SICU manager expects patient ambulation to only continue to improve and with it, both clinician and patient satisfaction.
Versatile Peds Department Finds Multiple Uses for the IVEA
The 17-bed Peds Plus unit at UCHealth Poudre Valley Hospital in Northern Colorado sees a wide variety of patients, including pediatric patients of all ages, mothers and babies, and women recovering from gynecologic surgery.
Department nurses have found the IVEA particularly useful for pediatric surgical patients who are at least eight years old and tall enough to use it and for women recovering from surgery.
“The IVEA has been great for our surgical patients who are a bit older and have had complications or had a longer recovery,” says Nurse Manager Cynde Donley. “They often have IVs, pumps, oxygen and a catheter, and the IVEA’s design is perfect for them.”
Donley says the same is true for hysterectomy patients who require a longer stay than the typical one night in the hospital. These patients often have more equipment, and it’s important to ambulate them, but it may take an extra person to roll the oxygen tank to manage equipment in order to get them walking.
As more nurses become familiar with the IVEA, they’re finding more opportunities to use it, notes Donley. “It’s like anything,” she says. “Once they try it and see for themselves how useful it is, they’re more comfortable using it with other patients.”
WATCH FOR MORE CASE STUDIES AS MORE CLINICIANS SHARE STORIES OF THEIR EXPERIENCES WITH THE IVEA.
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