Background

Early mobilization of the post-operative bariatric surgery patient has been demonstrated to improve patient outcomes. People with severe obesity are at increased risk for post-operative complications including pain, constipation, nausea, skin breakdown, venous thromboembolism, and pulmonary complications. Therefore, a quality improvement project was initiated to identify methods to enhance early mobilization among post-operative bariatric patients. The quality improvement team determined a goal of ambulating patients within 2 hours of discharge from anesthesia. An early mobilization plan was initiated beginning with pre-operative patient education highlighting the importance of early mobilization. To gain additional stakeholder support, education was provided to nurses, clinical care technicians, anesthesiologists and surgeons regarding current best practices. The multi-disciplinary and quality improvement teams collaborated to create a nurse driven electronic documentation section within the surgical information system. Audits were performed to evaluate for compliance with established goal. Multidisciplinary support for the project included the utilization of abdominal nerve blocks to reduce the need for opioids, thereby improving safety while maintaining adequate pain control. These interventions resulted in a 20% increase of post-operative patients mobilized within 2- hours of discharge from anesthesia. These results have been sustained over two years with approximately 90% compliance. Based on the success and improvement in patient outcomes, our continued mobility initiatives are to improve the frequency and distance patients are walking throughout their hospitalization course.