• Evaluating the Effectiveness of a Multicomponent Care Bundle Among Intubated Patients

      Givens, Sarma Klimanis; Gourley, Bridgitte (2022-05)
      Problem: At a community hospital, the current intensive care unit (ICU) length of stay (LoS) is increasing. In January 2021, the LoS was 3.84 days, and in December 2020, it was 3.0. Also, it is above the average ICU LoS in the United States, which according to the Society of Critical Care medicine, is 3.8 days. Prolonged LoS can lead to ICU delirium, higher hospital bill costs, decreased quality of life, long-term physical impairments, and is associated with increased risk of long-term mortality after hospital discharge. Purpose: The purpose of this quality improvement project is to implement and evaluate the effectiveness of the ABCDEF bundle in an adult medical/surgical ICU. ABCDEF stands for: assess, prevent, and manage pain; both spontaneous awakening and breathing trials; choice of analgesic/sedation; delirium: assess, prevent, and manage; early mobility and exercise; and family engagement. It is anticipated that the implementation of this bundle could result in a shortened LoS among intubated patients. Methods: Data was collected using an observational checklist adopted from the Society of Critical Care Medicine’s website. All nurses were educated on how to use this tool. The tool was completed once a day, around the time of rounds, by charge nurses to assess which of the ABCDEF bundle elements were applied to intubated patients. The observational checklists were collected and analyzed weekly. Results: By the end of the implementation phase, 100% of staff nurses have received education on patient eligibility for the bundle, 22.9% of intubated patients (who met criteria) received all components of the ABCDEF bundle, and 67.4% of intubated patients were assessed via Observational Checklist, and the average LoS during the 15 weeks was 7.53 days. Conclusions: Though LoS was not decreased, progress was achieved. Nurses demonstrated proficient skills when applying the bundle to patients and nurses gained confidence in initiating SAT/SBTs and early-mobility practices. Post-implementation the SAT/SBT provider order became available for use in EPIC and the SAT/SBT policy has been updated and published on the institution’s intranet. Limitations such as high staff turnover may have negatively impacted this project.
    • Promoting Early Mobility in The Medical Intensive Care Unit

      Lanier, Tatyauna M.; Bundy, Elaine Y. (2022-05)
      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.