Early postoperative mobilization in patients undergoing abdominal surgery: a best practice implementation project.

Abstract

OBJECTIVES The aim of this project was to improve early postoperative mobilization in patients undergoing abdominal surgery according to best practice. INTRODUCTION Early mobilization is a crucial element of postoperative care; however, there are challenges implementing early mobilization protocols in daily practice. This project used the evidence to improve awareness and practice of early mobilization in patients undergoing abdominal surgery. METHODS This study utilized clinical audit strategies under the JBI Practical Application of Clinical Evidence System (JBI PACES) module. An audit-feedback cycle was used from April 2018 to August 2018. The baseline audit was conducted using 18 nurses and 30 patients in a general surgery ward. The Getting Research into Practice audit and feedback tool was used to identify barriers, strategies, resources and outcomes. After implementing evidence-based strategies, a re-audit was conducted following the same number of samples and audit criteria. We analyzed the compliance with best practice and its impact on length of hospitalization, postoperative physical activities, gastrointestinal function and complications. RESULTS After implementing best-practice strategies, the compliance rate of the six criteria improved as follows: criterion 1 from 0% to 100% (P = 0.000), criterion 2 from 87% to 100% (χ = 4.29, P = 0.038), criterion 3 from 60% to 70% (χ = 6.67, P = 0.010), criterion 4 from 7% to 79% (χ = 52.55, P = 0.000), criterion 5 from 40% to 70% (χ = 35.00, P = 0.000), and criterion 6 from 0% to 100% (P = 0.000). The differences in the length of hospitalization and physical activities between the pre-implementation and post-implementation were statistically significant (all P < 0.05). The rate of postoperative complications did not show a significant difference because of low occurrence. CONCLUSIONS The results indicate that evidence-based practice is an effective method for enhancing early recovery in patients undergoing abdominal surgery through promoting early mobilization. Sustaining best practice should continue through further follow-up audits.