Improving mobility in critically ill adults in a Lower-Middle income country: Opportunities and Challenges
CCCF ePoster library. Tirupakuzhi Vijayaraghavan B. 11/12/19; 285179; EP80 Disclosure(s)(s): None.
Dr. Bharath Kumar Tirupakuzhi Vijayaraghavan
Dr. Bharath Kumar Tirupakuzhi Vijayaraghavan
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Topic: Quality Assurance & Improvement

Tirupakuzhi Vijayaraghavan, Bharath Kumar(1,2), Sneha Mohan(1), Sristi Patodia(1), Sudha Kumarvel(1), Ramesh Venkataraman(1,2)

1: Department of Critical Care, Apollo Hospitals, Greams Road, Chennai, India
2: Chennai Critical Care Consultants, Chennai, India

Critically ill patients in the Intensive Care Unit (ICU) are subjected to prolonged periods of bed rest secondary to critical illness and related therapies. Data suggests that physical impairment can affect nearly half of the patients and 50% of those are unable to return to premorbid levels of functional activity. There is limited data from India on mobilisation practices for critically ill patients and opportunities and barriers remain largely unexplored. We undertook a quality improvement (QI) initiative to understand our mobilisation practices, identify challenges and test interventions to improve mobility.
We carried out a 3 phase QI project comprising an initial audit, an intervention phase and a follow-up phase with post-implementation analysis. The study was conducted in our 24 bedded, multidisciplinary ICU at Chennai. Pre-intervention and post intervention mobility performance and scores were analysed. We also recorded data on adverse events and barriers to mobilisation. Descriptive statistics were used to report all the results.
A total of 140 patients (1033 patient days) and 207 patients (932 patient days) were included in our initial audit and post implementation audit respectively. Pre-implementation, 31.3% of patients were mobilised with an average mobility score of 2. Post implementation, our mobility rates improved to 57.9% and the average mobility score increased to 3.4. We were also able to demonstrate improvements in the mobility scores of our intubated patients (49.8% achieving a mobility score of 3-5 as compared to 16.7% pre-implementation). Barriers to mobility were primary related to non-modifiable disease related factors.

A multi-disciplinary collaborative approach is feasible and resulted in significant improvements in early mobility among critically ill adults in a lower-middle income country.

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