Optimising Functional Independence in Skilled Nursing Facilities: An Interdisciplinary Mobility Quality Improvement Program Development and Implementation Protocol

Background: Functional mobility decline and falls affect approximately 50% - 75% of skilled nursing facility residents annually, with 10% - 20% resulting in serious injury. These events are associated with increased morbidity, prolonged length of stay, rehospitalization, and rising healthcare costs. Objective: This manuscript describes the development and implementation protocol for an interdisciplinary mobility quality improvement (QI) program designed to integrate structured mobility practices into routine skilled nursing facility care. Methods: Using Plan-Do-Study-Act quality improvement methodology guided by the Model for Improvement, this protocol was developed for skilled nursing facilities serving approximately 80 - 150 residents. The program integrates physical therapy, occupational therapy, nursing, restorative care, and medical oversight through structured needs assessment and stakeholder engagement. Implementation Framework: The protocol specifies phased implementation, accountability structures, fidelity monitoring, and sustainability strategies. Conclusion: This protocol provides a scalable, systems-level framework for addressing mobility decline in skilled nursing facilities.