Purpose of the Project: The implementation of early mobility interventions can prevent lasting detrimental physical and psychological effects; however, activity remains limited for many patients admitted to the intensive care unit (ICU). This quality improvement (QI) project aimed to implement an early progressive mobility (EPM) protocol for critically ill patients admitted to the medical ICU of a large academic medical center known for serving complex, high-acuity patients, in order to support nurses in engaging these individuals in mobilization efforts and promoting their activity out-of-bed (OOB). Methods: The Minnesota Health ICU Early Mobility Protocol was implemented by the registered nurses working in this setting for a total of eight weeks. This data, along with eight weeks of pre-implementation activity data, was collected via reports generated by the electronic health record (EHR) and compared using descriptive statistics. Additionally, an anonymous post-implementation assessment was distributed to participants to investigate nurses’ perception of the protocol’s utility in mobilizing critically ill patients. Results: A total of 832 activity items were documented prior to implementation of the EPM protocol, of which 72 (8.7%) were considered OOB activity as defined for this project. Post-implementation, a total of 669 activity items were documented by nurses, with 148 (22.1%) evaluated as OOB activity. Survey results were generally neutral but skewed positively, with the majority of nurses expressing conviction in the protocol’s utility and confidence in their ability to use it to safely and effectively enhance patient mobility OOB. However, over half of the survey respondents stated that they either never or only sometimes integrated the protocol into their clinical practice during the last two weeks of the project’s implementation period. Implications for Practice: Nurse-driven EPM protocols can be an effective tool that encourages OOB mobility in patients admitted to the ICU, resulting in improved outcomes, shortened ICU and hospital length of stay, and total cost savings for the individual and organization. However, they rely on buy-in and active engagement by the bedside nurse.
Stephanie Lo (Thu,) studied this question.