Raising Early Mobility to New Heights
CCCF ePoster library. Palleschi M. Nov 1, 2016; 150912; 45 Disclosure(s): Pilot study with Kreg and Vitalgo bed. No financial compensation. Free trial of products
Maria Teresa Palleschi
Maria Teresa Palleschi
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Abstract
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#45

Topic: Quality Assurance & Improvement

Raising Early Mobility to New Heights


Sirianni, S.; Sinai Grace Hospital, Detroit Medical Center, Detroit, MI, USA
Palleschi, Maria Teresa, Harper University Hosptial, Detroit Medical Center, Detroit, MI, USA



Abstract:

          1.State the epidemiology and impact of immobility on critically ill patients.

  • 2.Discuss screening and implementation strategies to improve mobility by providing an interprofessional approach to mobility practices
  • 3. Review of integrating the protocol into the system culture post implementation.
     
    Mobility is not a new concept and has been cited in the literature since the 1960’s (Olsen, 1967). The results of immobility and deconditioning affect multiple organs and systems. Yet despite the knowledge that prevention is the best medicine, one of the barriers to dissemination and adoption of early mobility for critical care patients is nurse adoption (Herridge, 2009). Herridge (2009) and Morris (2007) speak to the constraints that may well influence attitudes and beliefs toward mobilization of critical care patients. Specific fears related to adverse events influence the beliefs and include such occurrences as an increase in cardiac arrhythmias, a decrease in oxygenation, and other patient safety concerns (e.g. loss of vascular access lines, dislodgement of endotracheal tubes).  In addition, the lack of mobility equipment (cardiac chairs, lifts and portable vents), safety, and lack of nursing time, adds to the nurses’ concerns about mobilizing their critically ill patients (Herridge 2009, Morris 2007). 
     
    Immobility and deconditioning poses a huge threat for both patients and staff. In an effort to decrease the deleterious effects of immobility, an interprofessional group collaborated to develop and implement an early mobility protocol
    The interprofessional group led by a group of Advanced Practice Nurses consisted of the:  Registered Nurse (RN), Physician (MD), Respiratory Therapist (RT), Physical therapist (PT), Occupational Therapist (OT) and Patient Care Associate or Tech (PCA). As part of the ABCDE bundle implementation, the hospital instituted a 5 phased early mobility protocol which was embedded in the electronic medical record as part of the ICU admission orders. The improvements asserted by the new practice extended far beyond the patients physical recovery to include a sense of progress.
    Most recently the 2 hospitals  participated in an interprofessional collaborative effort to improve the  ICU mobility. Recongnizing that deconditioned and bariatric patients presented the greatest  challenge for the staff, the APNs piloted verticalization/tilting of patients with the Kreg Catalyst Bed.
     
    In collaboration with PT / OT, RN staff were able to stand deconditioned and bariatric patients. By progressively increasing the degrees of height and time in the vertical position, staff could evaluate patient tolerance and strength in a controlled and safe environment.  Eleven patients were verticalized for on average of 14 sessions per patient @ 49 degrees. The mean time of verticalization was 29 minutes. This intervention; allowed the staff to evaluate the patient strength; increased frequency of discharge to rehabilitation facilities; and increased progression through the established mobility protocol. Furthermore, this test of strength and stamina has the potential to decrease falls and employee injuries which will be evaluated in future studies. 
     
     
     

References:

Herridge, M. S. (2009). Legacy of intensive care unit-acquired weakness
                [Supplemental material]. Critical Care Medicine, 37,10, S457-S461.
                doi:10.1097/CCM.0b013e3181b6f35c
Morris, P. E., & Herridge, M. S. (2007). Early intensive care unit mobility: Future
                directions. Critical Care Clinics, 23, 1, 97-110. doi:10.1016/j.ccc.2006.11.010
 
Olson, E.V., Johnson, B.J., Thompson, L.F., McCarthy, J.A., Edmonds, R.E.,
                Schroeder, L.M., & Wade, M. (1967). The hazards of immobility. American
                Journal of Nursing, 67,
4, 780-797.
 
 



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