Implementation of Early Mobility Screening in the Surgical Intensive Care Unit

Abstract

Problem: A lack of early mobility screening in the adult critical care population may lead to adverse healthcare outcomes. In the past months preceding the practice change, a Surgical Intensive Care Unit (SICU) experienced seven hospital-acquired pressure injuries (HAPIs) and three inpatient falls. Purpose: The purpose of this quality improvement (QI) project was to implement and evaluate the effectiveness of early mobility screening via the Johns Hopkins Highest Level of Mobility (JH-HLM scale) in a 12-bed adult SICU in a community hospital setting. Methods: The JH-HLM scale was implemented over a 13-week period and was used to assess patient’s daily mobility level. Data on nursing compliance of use of mobility scale and improvement in mobility scores were collected via manual chart audits, and run charts were used to track and analyze results. Falls and HAPIs were also tracked. Results: Analysis of run charts for nursing compliance in use of the scale and improvement in mobility scores showed no shifts, trends, or non-random variation of runs, suggesting no effect due to the practice change. However, nursing compliance with use of the scale was consistently 85% to 100% and improvements in patient mobility occurred in 41 (35%) out of 116 patients screened. Although there was no decrease in patient falls, HAPIs decreased when compared to the previous eight months. Conclusion: The JH-HLM scale was found to be a safe and feasible screening tool useful by nurses in promoting early mobility in an acutely ill population. Additional QI projects are needed to determine if improved patient outcomes are associated with early mobility screening within 72 hours of ICU admission through discharge.