Early Mobilization: Changing the mindset Summary: In the surgical ICU, staff has several concern regarding mobilization of intubated patients. In order to assess and improve the staffs mindset on early mobility a Plan-Do-Study-Act model was creating using a multidisciplinary team. Surveys indicate that the after the plan was implemented, the staff changed their mindset regarding early mobility and the perceived barriers. Implementing an interdisciplinary approach with multimodal education and operational support increases the staffs use and mindset of early mobility protocols. Strength: Discusses potential barriers to early mobility and the methods used to decrease them. Weakness: Does not focus on measurable outcomes such as hospital length of stay. Castro, E., Turcinovic, M., Platz, J., & Law, I. (2015, August 1). Early mobilization: Changing the mindset. Critical Care Nurse, 35, 1-6. Retrieved from http://eds.a.ebscohost.com.lopes.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=23&sid=f14b6510-032e-4352-b994-cc415edae47f%40sessionmgr4009&hid=4110 Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: A retrospective cohort study Summary: Bedrest and immobility of patients in ICU can have detrimental effects. Studies have shown that early mobility does not pose a risk for patients or increase costs, and it can decrease the length of stay in the ICU and the hospital. This retrospective cohort study of an interdisciplinary quality improvement study evaluated patients pre and post early mobility program. The study revealed no adverse effects due to early mobility and a decrease in complications associated with immobility. Strength: Discusses measurable outcomes such as a reduction in pneumonia, DVT, and hospital length of stay. Weakness: Focus is specifically on trauma and burn patients. Clark, D. E., Lowman, J. D., Griffin, R. L., Matthews, H. M., & Reiff, D. A. (2013, February, 1). Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: A retrospective cohort study. Physical Therapy, 93, 186-195. Retrieved from http://eds.a.ebscohost.com.lopes.idm.oclc.org/ehost/pdfviewer/pdfviewer?sid=996f332c-cfff-46f3-b20d-bf16a75858b7%40sessionmgr4006&vid=34&hid=411 Move to improve: The feasibility of using an early mobility protocol to increase ambulation in the intensive care unit Summary: Increased bedrest and lack of mobility can lead to deconditioning and longer hospital stays for patients. This study determines the effectiveness of a nurse-driven mobility protocol implemented within the first 72 hours of the patients stay in ICU or MOSU. A multidisciplinary team developed a protocol to guide nursing in mobility assessment. This gave the nurse the ability to order physical or occupational therapy when appropriate. This approach showed an increase in the amount of patients participating in early mobility within the first 72 hours. Strength: Discusses specifics regarding how early mobility protocol was implemented such as how to overcome barriers. Weakness: Focus is on number of patients participating in early mobility, not on other measurable outcomes such as length of stay. Drolet, A., DeJuilio, P., Harkless, S., Henricks, S., Kamin, E., Leddy, E. A., Williams, S. (2013, February 1). Move to improve: The feasibility of using an early mobility protocol to increase ambulation in the intensive care and intermediate care settings. Physical Therapy, 93, 197-207. Retrieved from http://eds.a.ebscohost.com.lopes.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=57&sid=996f332c-cfff-46f3-b20d-bf16a75858b7%40sessionmgr4006&hid=4110 Physical therapy-driven quality improvement to promote early mobility in the intensive care unit. Summary: Evidence shows that early mobility of ICU patients is a safe and cost-effective strategy to improve patient outcomes. For ICUs that have not implemented early mobility, a multidisciplinary approach, including nurses, physical therapists, respiratory therapists, and physicians, is needed. In this study a lead physical therapist was appointed to develop solutions to overcome the barriers of early mobility. Due to the interventions, the number of patients receiving early mobility increased from 364 to 542. 21 patients were interviewed and also describe their experiences and outcomes of earlymobility. Strength: Discusses specific guidelines for patient criteria to be eligible in physical therapy. Weakness: Discussed form a physical therapist point of view regarding interventions. Harris, C. L., & Shahid, S. (2014, July 1). Physical therapy-driven quality improvement to promote early mobility in the intensive care unit. Baylor University Medical Center Proceedings, 203-207. Retrieved from http://eds.a.ebscohost.com.lopes.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=38&sid=996f332c-cfff-46f3-b20d-bf16a75858b7%40sessionmgr4006&hid=4110 Earlier Mobilization decreases the length of stay in the intensive care unit. Summary: Early mobility in the ICU has shown to improve outcomes and decrease length of hospital stay. Many facilities do not implement early mobility due to safety concerns of critically ill patients. This study compared the effectiveness of an early mobility protocol and the standard physical therapy treatment of patients diagnosed with respiratory failure in the ICU. There was a retrospective study of 28 patients with the respiratory distress and qualifying patients that received early mobility protocol were compared to traditional physical therapy in regards to time spent on ventilator and total days spent in ICU. The results indicated that the use of an early mobility protocol decreased length of time spent on a ventilator and in ICU, resulting in a savings of $22,000 per patient. Strength: Discusses specific data such as length of stay in ICU and the cost reduction for patients. Weakness: Study is specific for ventilator dependent patients. Ronnebaum, J. A., Weir, J. P., & lsabeck, T. A. (2012, June 1). Earlier mobilization decreases the length of stay in the intensive care unit. Journal of Acute Care Physical Therapy, 3, 204-210. Retrieved from http://eds.a.ebscohost.com.lopes.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=14&sid=996f332c-cfff-46f3-b20d-bf16a75858b7%40sessionmgr4006&hid=4110 Examining the positive effects of exercise in intubated adults in ICU: A retrospective repeated measures clinical study Summary: This study compared standard care versus early mobility and the effects of inflammatory markers, vital signs, and length of stay of intubated ICU patients. This prospective study included a control period, run-in period, and an intervention period of patients ventilated more than 48 hours. Less than 5% of exercise periods were associated with concerning vitals, reinforcing evidence that mobility of intubated patients is safe. Findings suggest that even a 20 minute intervention two or more days a week can significantly reduce the ICU length of stay. Daily exercise of 20 minutes can decrease inflammation markers suggesting that early mobility can also decrease inflammatory dysregulation of critically ill patients. Strength: Discusses specific measurable data such as inflammatory markers and length of stay in ICU. Weakness: Specific for ventilated patients in ICU. Winkelman, C., Johnson, K. D., Hejal, R., Gordon, N. H., Rowbottom, J., Daly, J., Levine, A. D. (2012). Examining the positive effects of exercise in intubated adults in ICU: A retrospective repeated measures clinical study. Intensive and Critical Care Nursing, 28, 307-320. Retrieved from http://eds.a.ebscohost.com.lopes.idm.oclc.org/ehost/pdfviewer/pdfviewer?sid=49e07136-cece-4872-9f3a-4b6899025d34%40sessionmgr4010&vid=11&hid=4110
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