Promoting Early Mobility in The Medical Intensive Care Unit

Abstract

Problem: Evidence has shown that early mobilization can improve patient outcomes, expedite recovery time, and shorten the length of stay for hospitalized patients. However, early mobilization of critically ill patients is not routinely practiced in an academic medical center's medical intensive care unit (MICU). The MICU has a higher immobility rate than other units, with only 29% of patients receiving early routine mobilization. Plans to encourage mobility are not routinely discussed during patient care rounds by the multidisciplinary healthcare team in the MICU. Purpose: The purpose of this quality improvement (QI) project was to implement and evaluate the effectiveness of an evidence-based nurse-driven mobility algorithm for adult patients admitted or transferred to the MICU. Methods: The mobility algorithm was implemented in an adult MICU over 15 weeks from August to December 2021. A mobility algorithm was developed based on evidence-based practice recommendations. Following staff education, the mobility algorithm was reviewed with each patient admitted or transferred to the MICU by the oncoming shift during nurse handoff to assess the patient's mobility level and plans to promote mobility. Weekly mobility reports, electronic chart audits, and observation audit tools were utilized to collect staff compliance on utilizing the mobility algorithm. The data was analyzed using run charts to track changes in mobility screens, mobility level door signs, and patient activity. Results: There were positive and negative trends among 520 patients with mobility rates. Results showed that average mobility screen increased (30% to 100%) and mobility level door signs (5% to 100%). There was an increased in patients’ mobility level (29% to 80%) during the fourth week of implementation. Analysis of all run charts showed no shift in trends with rates of early patient mobility utilizing a mobility algorithm. Conclusion: The anticipated outcomes of this QI project were achieved with improvement in inpatient mobility screening, mobility level door signs, and documented patient activity to increase early patient mobility.