1. Walk 4 Your Heart CABG Ambulation Project Project Team: 3NEWS 3NE/SW Nursing Staff Cardiac Rehabilitation

2. Opportunity Statement There was an opportunity to increase ambulation to four times per day for patients recovering from coronary artery bypass graft surgery (CABG). Addressing ambulation required improving patient involvement, staff education and data collection

3. Most Likely Causes: Why Patients Do Not Ambulate Physiologic Reasons –Patients are unstable –New onset of atrial fibrillation/tachycardia –Patients refuse due to pain or fatigue –Patients have chest tubes –Patients are off the floor for testing/dialysis –PT/OT is following patient

4. Patient Related Solutions Implemented Cardiac Rehab implemented an Ambulation Care Map and instructed patients on it’s use Every time patients ambulate they are given a sticker that says “Walk 4 Your Heart” that they place on their Care Map (it is a visual cue for the patients, physicians, Nurse Practitioners and staff to remind the patient to ambulate and for anyone caring for the patient to quickly see how well the patient is doing) Nursing staff was educated about Care Map and Walk 4 Your Heart Stickers Nurse Practitioners became involved in pre-op teaching regarding importance of post operative ambulation

5. Data Collection Solutions Implemented Simplified the Data Collection form Involved Charge Nurses in data collection: to query the RN every time they received report on patients concerning number of times pt ambulated and document on data collection form Educated Nursing Staff regarding data collection process

6. Results Increased awareness by the patient, patient’s families and staff about importance of ambulation Increased motivation of patient participation in post operative ambulation Increased department customer satisfaction including patients, physicians, nurse practitioners. Increased accuracy of monitoring data Increased the number of walks after Care Map was introduced. Sustained performance continues to be a challenge.

7. Definition: Total number of walks for coronary artery bypass graft (CABG) patients / 4 walks per CABG patient per day Data Source: NE/SW daily nursing reports Analysis: The number of patients walking has consistently remained above pre-project performance

8. Next Steps Continue to educate and encourage staff on use of the Ambulation Care Map and ambulation of CABG patients. Extend program to all CV and Cardiac patients Involve Physical Therapy patients as appropriate