Barriers and Challenges to the Successful Implementation of an Intensive Care Unit Mobility Program

Honiden, Shyoko; Connors, Geoffrey R.

doi:10.1016/j.ccm.2015.05.006

Cited by 14 publications

(4 citation statements)

References 21 publications

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“…(21)(22)(23) Studies suggest that ABCDE, and early mobilization in particular, can be challenging to implement in routine practice. (24)(25)(26)42) Over 100 unique barriers have been identified in recent literature reviews. (43) Dubb et al (44) classified these barriers into 4 categories: patient-related (e.g., deep sedation, delirium, new immobility/weakness), structural (e.g., lack of mobility protocol, limited staff and equipment, inadequate training), process related (e.g., lack of coordination), and cultural (e.g., lack of ICU mobility culture, staff buy in, expertise).…”

Section: Discussionmentioning

confidence: 99%

Staged Implementation of Awakening and Breathing, Coordination, Delirium Monitoring and Management, and Early Mobilization Bundle Improves Patient Outcomes and Reduces Hospital Costs*

Hsieh

Otusanya

Gershengorn

et al. 2019

Critical Care Medicine

127

118

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Section: Discussionmentioning

confidence: 99%

Staged Implementation of Awakening and Breathing, Coordination, Delirium Monitoring and Management, and Early Mobilization Bundle Improves Patient Outcomes and Reduces Hospital Costs*

Hsieh

Otusanya

Gershengorn

et al. 2019

Critical Care Medicine

127

118

View full text Add to dashboard Cite

show abstract

“…Among the hypotheses are the organizational aspects of the units and the need for cooperation from the medical team, which are indispensable to the process. It is important to underscore that implementing initiatives to overcome the barriers to mobilization is a factor that still limits adherence by the multiprofessional team, highlighting the difference between evidence-based recommendations and what actually occurs in the ICU in terms of early mobilization [37,38].…”

Section: Discussionmentioning

confidence: 99%

Mobility and clinical outcome of patients admitted to an intensive care unit

et al. 2020

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Introduction: The hospital environment exacerbates the effects of immobility due to several exposure factors, and the functional assessment of individuals using reliable instruments is vital. Objective: To determine the relationship between functional mobility and the clinical outcome of patients admitted to an intensive care unit. Method: This is a prospective quantitative longitudinal study, approved by the institutional research ethics committee, carried out in the intensive care unit of a University Hospital. Clinical data and the Acute Physiology and Chronic Health Evaluation (APACHE II) score were collected 24 hours after admission. The Perne Score was used to analyze patient mobility. Results: 33 patients participated, 63% female. With respect to mobility and transfers, 69.7% required total assistance from the supine to the sitting position and 70% to maintain balance, 9.1% needed minimum assistance from sitting to standing, and 100% total assistance for walking and endurance exercises. The main barriers to mobility were invasive ventilation (60%), assistive devices and intravenous infusion (100%). The following Perne Score domains were significantly associated with the outcome: mental status (p = 0.040), barriers to mobility (p = 0.016), strength (p = 0.010), mobility in bed (p = 0.024) and the total Perme Score ( p = 0.002). There were also significant associations between invasive ventilation and low Perme Scores (p = 0.000), and the Richmond Agitation-Sedation Scale (RASS) (-5 and -4) and death in 66.7% of patients (p = 0.011). The Perme Score and RASS (R = 0.745) were moderately correlated and APACHE II and Perme Score inversely moderately correlated (R = -0.526). Conclusion: Mobility assessed by the Perme Score was related to the clinical outcome and strongly associated with sedation level and patient severity.

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“…RNs and PTs face multiple barriers when trying to implement mobility interventions. The major barriers to ICU-based mobility interventions have been categorized by previous researchers into the following 4 domains: patient (eg, physiologic instability, sedation, patient safety concerns), clinician (eg, inadequate training, workload, safety risk), process (eg, lack of coordination, unclear protocols), and organizational (eg, lack of mobility culture, competing priorities) [11][12][13]. Strategies to address barriers have included use of structured quality improvement models to identify and target local barriers [14], RN-initiated mobility protocols to standardize patient assessment and goal setting [15], and focused interdisciplinary communication and collaboration [16,17].…”

Section: Introductionmentioning

confidence: 99%

Supporting Decision-Making About Patient Mobility in the Intensive Care Unit Nurse Work Environment: Work Domain Analysis

Krupp¹,

Steege²,

Lee³

et al. 2022

JMIR Nursing

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Background Patient mobility is an evidenced-based physical activity intervention initiated during intensive care unit (ICU) admission and continued throughout hospitalization to maintain functional status, yet mobility is a complex intervention and not consistently implemented. Cognitive work analysis (CWA) is a useful human factors framework for understanding complex systems and can inform future technology design to optimize outcomes. Objective The aim of this study is to understand the complexity and constraints of the ICU work environment as it relates to nurses carrying out patient mobility interventions, using CWA. Methods We conducted a work domain analysis and completed an abstraction hierarchy using the CWA framework. Data from documents, observation (32 hours), and interviews with nurses (N=20) from 2 hospitals were used to construct the abstraction hierarchy. Results Nurses seek information from a variety of sources and integrate patient and unit information to inform decision-making. The completed abstraction hierarchy depicts multiple high-level priorities that nurses balance, specifically, providing quality, safe care to patients while helping to manage unit-level throughput needs. Connections between levels on the abstraction hierarchy describe how and why nurses seek patient and hospital unit information to inform mobility decision-making. The analysis identifies several opportunities for technology design to support nurse decision-making about patient mobility. Conclusions Future interventions need to consider the complexity of the ICU environment and types of information nurses need to make decisions about patient mobility. Considerations for future system redesign include developing and testing clinical decision support tools that integrate critical patient and unit-level information to support nurses in making patient mobility decisions.

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Barriers and Challenges to the Successful Implementation of an Intensive Care Unit Mobility Program

Cited by 14 publications

References 21 publications

Staged Implementation of Awakening and Breathing, Coordination, Delirium Monitoring and Management, and Early Mobilization Bundle Improves Patient Outcomes and Reduces Hospital Costs*

Staged Implementation of Awakening and Breathing, Coordination, Delirium Monitoring and Management, and Early Mobilization Bundle Improves Patient Outcomes and Reduces Hospital Costs*

Mobility and clinical outcome of patients admitted to an intensive care unit

Supporting Decision-Making About Patient Mobility in the Intensive Care Unit Nurse Work Environment: Work Domain Analysis

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