Early Mobility of Mechanically Ventilated Adult Medical-Surgical Critical Care Patients

Abstract

Title: Early Mobility of Mechanically Ventilated Adult Medical-Surgical Critical Care Patients.

Background: Lack of early mobilization in hospitalized patients requiring mechanical ventilation in the intensive care setting is associated with a decline in physical function, prolonged number of ventilator days, cognitive impairment, and prolonged hospitalization. These associated factors contribute to an increased risk for falls, morbidity, and poor patient outcomes. Despite long-standing evidence that early mobility decreases deconditioning and delirium, bedrest continues to be a standard of practice in most intensive care settings. A multidisciplinary mobility protocol combining an automatic computerized provider order for early mobility accompanied by a validated nurse-driven mobility algorithm to increase mobility may overcome barriers and improve outcomes.

Local Problem: In a Medical-Surgical Intensive Care Unit at a community hospital in Baltimore, Maryland, barriers to implementing early mobility practices and poor patient outcomes associated with prolonged immobility concerns the administration. Administration and staff members are also concerned by the high rates of patients assessed with intensive care unit delirium, increased number of ventilator days and the decreased frequency in which mechanically ventilated patients receive prompt early mobility treatment. There was no formal early mobility protocol in place, and medical providers ordered physical therapy daily on an individualized basis after a physical examination using professional judgment. Intervention: Formal and informal survey of medical providers, nursing, and physical therapy staff provided insight into barriers to early mobilization. An automatic, computerized medical provider early mobility order and a nurse-driven early mobility protocol were developed and implemented over a six-week period to overcome these barriers and improve the timeliness of mobility treatments. Education surrounding the new processes utilized a multidisciplinary approach.

Results: A total of 87 employees within three departments participating in the project were eligible to receive early mobility education. Of all of the eligible employees, 92% (n= 80) received formal education by either the project leader, the unit educator or designated project champions. There were 104 qualifying ventilator days for screening algorithm assessment. Overall, there was a 66.3% (n= 69) compliance rate of screening algorithm utilization by nursing. Of the 104 ventilator days, 21 screening algorithm assessments measured patients as appropriate to receive the early mobility intervention. Of the 21 possible patients eligible to receive treatment, 61.9% (n=13) participated.

Conclusions: A mobility protocol combining a provider order and a nurse-driven mobility algorithm has significantly increased the mobility of hospitalized mechanically ventilated patients and may overcome barriers to improve outcomes. Hospitals and patients may benefit by evaluating their current mobility practices and utilize validated tools to change practices to increase patient mobility and improve outcomes.