The use of a progressive mobility protocol to enhance patient outcomes
Date
2019
Authors
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Journal ISSN
Volume Title
Publisher
University of Delaware
Abstract
Background: Physical inactivity is associated with a wide range of medical disorders that leads to unfavorable outcomes for critically ill patients. Consequences from prolonged immobilization or constrained activity include functional deterioration, increased risk for falls, hospital acquired pressure ulcers (HAPU), ventilator duration, and length of stay (LOS). Local Problem: Despite the supporting evidence of early mobility, many nursing units are unsuccessful in integrating early mobility practices into patients’ daily schedules. Intervention: The purpose of the performance improvement project was to increase mobilization and prevent functional decline and hospital-associated complications. A standardized early mobility protocol was developed and implemented with an organized evaluation of an individual’s mobility status. The protocol encompasses progressive mobilization and ambulation with the progression based on a patient’s functional capability and ability to tolerate the prescribed activity. The protocol was divided into 4 levels. Each level includes guidelines on positioning, therapeutic exercises, transfers, walking reeducation, and duration and frequency of mobility sessions. Additionally, the criteria for progressing to the next phase was provided. Results: Results demonstrated a reduction in ICU LOS (-0.17 days), overall LOS (-0.49 days), ventilator duration (-0.13 days). The prevalence of HAPU(s) reduced by two cases and VTEs reduced by one case. All results were not statistically significant, but had significant, positive clinical and financial implications for the organization. Conclusion: Implementing evidence-based early mobilization strategies as a routine part of care provides innumerable opportunities to improve health and outcomes in the surgical critical care and transitional surgical care patient population. ☐ Keywords: early mobilization, mobilization protocol, early mobility protocol, early ambulation, early activity.