Kerrie Klepfer, BSN, RN, CNIII, and Jennifer LeBlanc, BSN, RN, CCRN, CNIV, are intensive care unit (ICU) nurses at Duke Raleigh Hospital in Raleigh, N.C. They are two of the four-person nurse team from their ICU that completed the American Association of Critical-Care Nurses Clinical Scene Investigator (CSI) Academy. Their team’s project, “Walk this Way: Early Progressive Mobility in the ICU,” saved Duke Raleigh hospital nearly three million dollars, and their recommendations about increased patient mobility in the ICU have become a standard practice of care in their hospital, as well as hospitals around the world. Read on to learn more about the inspiration for their project and insights about their journey through nursing.
NN: How did you identify the problem of mobility in your patients? What inspired you to develop a solution?
Jennifer: During a roundtable discussion amongst the CSI team of four ICU nurses, we discussed issues in the ICU and decided to choose a project that would impact the entire patient population. We closely looked at our mobility practices and realized that increasing mobility leads to a decrease in ICU length of stay, vent days, and cost to patients and the hospital. In our ICU, we had already implemented other initiatives to support prevention of ventilator-associated pneumonias, but we had not examined the mobility component. The group chose early progressive mobility (EPM), emphasizing “early” as an integral part of our project, which was not always a focus in other mobility initiatives.
NN: Personally, what was the biggest reward of working on “Walk This Way?”
Kerrie: For me, it started with our first test of change toward the beginning of the project. It’s truly amazing to see the progression of emotion displayed by patients who at first are so sick and afraid but then turn that emotion into pride, strength and motivation to surpass their own expectations. Being a part of this positive trend in healthcare has been a sense of pride for me as well. The stories and positive feedback from provider and patient testimonials have been truly incredible.
NN: What challenges did you face in the process and how did you overcome those obstacles?
Jennifer: Throughout the projects we were faced with several challenges, mostly due to inexperience as we had never attempted something like this before. The project demanded a lot of time, always a rare resource for nurses. It was like a small venture business outside of our full-time work schedule. I think the biggest challenges were data collection, audits and data analysis – processes that we as nurses are not typically involved in on a day-to-day basis. But the team was up to the task, and the support from nursing management and coaches helped soften some of the challenges we encountered.
NN: How has “Walk This Way” transformed your approach to patient care?
Kerrie: EPM has become a standard of care at Duke Raleigh and used on a daily basis when appropriate to the patient. We now include EPM in our daily interdisciplinary rounds and work as a team to safely mobilize patients. The relationship with other teams in the hospital seems to have strengthened as well as a result of this shared compassion for improving the strength and mobility of our patients.
Jennifer: For me, the “Walk This Way” project transformed my approach to patient care because I am constantly reminded that I have the power to find solutions that positively impact our patients.
NN: What is the most exciting milestone you’ve witnessed in nursing over the past few years?
Kerrie: Nurses have a voice in healthcare now more than ever. Today, there are more nurse-driven protocols, contributions and responsibilities. Personally, the development and approval of the ICU EPM Protocol was a significant step for our nursing team. At Duke Raleigh, nurses are more motivated and continue to succeed in building new and better ways to improve the care of our patients.
To learn more about the “Walk This Way” project, visit www.aacn.org.