Through employee and patient surveys, it was determined that patients were not being ambulated as frequently as needed or desired. The facility implemented an ambulation team, consisting of physical therapy aides (PTAs) and certified nursing assistants (CNAs). The team was available seven days a week, 0800-1700. This was a nurse driven protocol, all one had to do was reach out and “add the patient name” to the “list”. An excellent idea. But as with so many great ideas, application and follow through failed. Vision and communication failed. 

Discuss how this change in patient care failed. 200 words

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