Implementation of an Interprofessional Early Mobility Protocol in Multiple ICUs in an Academic Health Sciences Centre.
CCCF ePoster library. Guiyab M. Oct 3, 2017; 198189; 48
Melissa Guiyab
Melissa Guiyab
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Abstract
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Implementation of an Interprofessional Early Mobility Protocol in Multiple ICUs in an Academic Health Sciences Centre.

Guiyab, Melissa1,2 RN, MN; Swift, Shannon1,2 RN, MN; Savedra, Prafulla1 RN; Morrison, Kara1,2  PT, MScPT; Brown, Sarah1,2  PT, MScPT; Smith, Orla1, 2 RN, PhD; Paramalingam, Vasuki1, 2 RN, MSN; Doherty, Kerry1,2  PT, BScPT; Turbak, Jessica1,2  PT, MScPT; Williams, Michelle1, 2 RN, MN; Freethy, Amber1 PT, MScPT; Parkes, Joanna1,2  PT, BScPT; Every, Hilary1, 3 RRT, BA; Greco, Pamela1, 3 RRT, BEd; and Feltracco, Deanna1,2  PT, MScPT.

 

1 Critical Care Department, St. Michael’s Hospital, Toronto, Canada

2 University of Toronto, Toronto, Canada

3 The Michener Institute of Education at UHN, Toronto, Canada

 


Introduction 
Early Mobility (EM) interventions are increasingly recognized as being important in preventing intensive care acquired weakness and deconditioning. Current evidence demonstrates that EM in critically ill patients is safe and feasible1.  An early mobility protocol (EMP) for the intensive care unit that progressively increases activity may benefit patients2.   At St. Michael’s Hospital, clinical practice promoting EM was inconsistent across our four intensive care units (ICUs).  Staff surveys suggested gaps in practice related to lack of knowledge and comfort level with mobilization. 
 
Objectives
Our goal was to implement an interprofessional critical care EMP in the cardiac ICU (CICU), medical-surgical ICU (MSICU), cardiovascular ICU (CVICU) and trauma-neuro ICU (TNICU) through the accomplishment of the following objectives:


  1. Provide a standardized tool to evaluate and communicate patient mobility.

  2. Guide clinical decision making for initiating and progressing EM.      



Methods
A quality improvement approach was taken with Plan-Do-Study-Act (PDSA) cycles.  To understand current state, a literature review, external environmental scan, and staff survey were conducted.  Based on our findings, we defined early mobility as the assessment and initiation of active mobility of a medically stable patient within 48 hours of ICU admission continuing throughout the ICU stay.  An interprofessional EMP outlining criteria for assessing, initiating, and progressing mobility with reference to the ICU Mobility Scale3 to track progress was created.  EMP implementation occurred in Phase 1 in September 2016 via multimodal educational strategies to promote knowledge translation, with additional education in March 2017 in all 4 ICUs.  Biweekly audits and a post-implementation staff survey were conducted to assess implementation success.
 
Results
Education on the EMP was administered to 356 interprofessional staff (n=436) in Phase 1.  Documentation audits to assess use of the mobility scale began in January 2017. Results for May 2017 demonstrate 91% (n=92) of patients in the 4 ICUs used the EMP as evidenced by documentation of a mobility score.  Of those that used the EMP, 77% (n=84) had 2 or more scores documented over a 24 hour period.  The post-implementation survey demonstrated that 89% (n=187) of respondents strongly agree/agree the team is doing a good job with early mobility compared to 81% (n=194 of respondents) surveyed prior to implementation (p=0.03).  70% (n=160) of respondents also strongly agree/agree that the EMP is easy to use. Almost half (42%; n=145) reported that the mobility protocol helped determine the appropriate mobility plan for their patients.
 
Conclusion
Our experience suggests that an EMP can be implemented across multiple ICUs. Our EMP guides clinical decision making for initiating early mobility, provides a standardized tool to measure and evaluate the progression of patient mobility, and creates a safe environment for staff and patients.  Based on survey results, our next steps will focus on measuring the extent to which the protocol is being used to guide clinical decision making and maximize patient mobility, and evaluating the impact of the protocol on weekend mobilization and frequency of mobility. We believe that translation of this quality improvement initiative to in-patient areas of our hospital will promote continued mobility for patients post-ICU.

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