Background: Older adults are at risk for losing their ability to ambulate independently during hospitalization due to multiple barriers that limit walking. “MOVIN” (Mobilizing Older adult patients Via a systems-based INtervention), a mobility intervention, achieved promising pilot results and funded as a clinical trial at the start of the COVID-19 pandemic.

Study Aim: To implement the multicomponent nurse-led MOVIN intervention and monitor for change in nursing unit behavior/culture and outcomes before, during and after a 14-week intervention period.

Methodology: A cluster randomized controlled trial design was used to test the impact of MOVIN by sequentially implementing the intervention on one of four medical units at two facilities over four years. The first unit, a 24-bed adult cardiac unit in a large urban Magnet quaternary medical center, implemented the five MOVIN components (psychomotor training, ambulation pathways, resources, communication mechanisms, and culture support) over 14 weeks with key patient, nurse, and process outcomes metrics to support maintenance. The study team met frequently to maintain study integrity while complying with COVID-19 restrictions.

Results: The intervention was launched on Unit#1 in June 2021. Weekly electronic reports based on care documentation were generated to provide ongoing feedback to celebrate successes and address issues. The pandemic was associated with high patient volumes with room-restricted precautions and staffing shortages due to excessive care requirements, illness, and turnover.

One-year post-implementation, the unit has maintained high a percentage of patients ambulated (average 82 %, 20% above baseline) with ambulation distances averaging 11 miles per week, up 300% from baseline.

Discussion: MOVIN is a promising system-based intervention to promote nurse-led patient ambulation. The clinical team made an impact on the percentage and distance ambulated and sustained the outcomes over time despite the pandemic.

Implications: Real-world research may be challenging and requires vigilant maneuvering around obstacles to ensure the integrity of the study.