Methods: A literature review was completed to evaluate critical care mobility programs that are currently in use at other facilities. Collaboration with Intensivists and nursing staff was done to develop Abbott Northwestern Hospital’s Early Progressive Mobility Nursing Practice Guideline. Based on previous research, our guideline includes three main objectives. The first objective involves screening for physiologic conditions that could jeopardize patient safety with mobilization. Specifically, we identified parameters regarding mechanical ventilation, hemodynamic stability, and other clinical variables that would contraindicate early mobility. Once the first objective is met, the second objective defines a 5-step progressive mobility track in which patients move through at a pace determined by their successful completion of the previous step. This step track also defines the appropriate time for the RN to consult PT, emphasizing a multidisciplinary approach to the guideline. Femoral lines were identified as a barrier to mobilization and further review of literature was indicated to develop criteria for mobilizing patients with venous femoral lines. Research has shown that mobilization in the presence of central lines, including venous femoral access, is feasible without significant complications. This led us to develop our third objective in collaboration with intensivists on our Critical Care Committee. This objective serves to identify concerns, such as coagulopathy or line kinking while patient is resting in bed, that would contraindicate mobilization of a patient with a venous femoral line.
Results: Ultimately, patient mobility is a nurse-driven responsibility. We believe a well-defined protocol to be the best way to inspire our nursing staff to take ownership of such an important step in patient care. The guideline we developed helps nursing staff to gain confidence mobilizing patients in the Intensive Care Unit and helps them decide when mobilization is or is not possible. The enforcement of this protocol is also of value to the PT staff, by encouraging the nursing staff to utilize a multidisciplinary approach to mobilizing their patients. Through this, we anticipate many positive results in patient care. The outcomes described in the literature have shown that early patient mobility in the critical care setting decreases length of hospital stay and days on mechanical ventilation. In addition, early mobility is shown to reduce the incidence and severity of critical illness myopathy, delirium, and Post Intensive Care Syndrome.
Conclusion: Our clinical action team is able to advocate the multidisciplinary approach to combating immobility in the critical care unit setting. Implementation of the Early Progressive Mobility Nursing Practice Guideline includes daily interprofessional rounding on patient units, educating staff members about the protocol, making the protocol accessible in direct patient care areas, and clarifying perceived barriers to early patient mobilization. We plan to conduct a survey of registered nurses and physical therapists in our facility to help identify these barriers, and to determine the effectiveness of our implemented protocol. The feedback from staff will allow us to better develop and expand our current guideline.