Implementation of an Interdisciplinary AACN Early Mobility Protocol

Abstract

Background Increasing mobility in the intensive care unit is an important part of the ABCDEF bundle. Objective To examine the impact of an interdisciplinary mobility protocol in 7 specialty intensive care units that previously implemented other bundle components. Methods A staggered quality improvement project using the American Association of Critical-Care Nurses mobility protocol was conducted. In phase 1, data were collected on patients with intensive care unit stays of 24 hours or more for 2 months before and 2 months after protocol implementation. In phase 2, data were collected on a random sample of 20% of patients with an intensive care unit stay of 3 days or more for 2 months before and 12 months after protocol implementation. Results The study population consisted of 1266 patients before and 1420 patients after implementation in phase 1 and 258 patients before and 1681 patients after implementation in phase 2. In phase 1, the mean (SD) mobility level increased in all intensive care units, from 1.45 (1.03) before to 1.64 (1.03) after implementation (P < .001). Mean (SD) ICU Mobility Scale scores increased on initial evaluation from 4.4 (2.8) to 5.0 (2.8) (P = .01) and at intensive care unit discharge from 6.4 (2.5) to 6.8 (2.3) (P = .04). Complications occurred in 0.2% of patients mobilized. In phase 2, 84% of patients had out-of-bed activity after implementation. The time to achieve mobility levels 2 to 4 decreased (P = .05). Intensive care unit length of stay decreased significantly in both phases. Conclusions Implementing the American Association of Critical-Care early mobility protocol in intensive care units with ABCDEF components in place can increase mobility levels, decrease length of stay, and decrease delirium with minimal complications.

Physical Therapy Practice for Critically Ill Patients With COVID-19 in the Intensive Care Unit

“…14 Chung and Mueller 13 presented a summary of factors that might limit safe mobilization of patients with ARDS and MV. There is evidence to support mobility for patients with a higher FiO 2 and PEEP, 17,22 although this differs from articles by Hodgson and Adler recommending for the FiO 2 to be #60% and PEEP #10. 14,49 During this pandemic, the clinical decision-making algorithm evolved from current practice using the literature referenced in this manuscript and clinical experiences to identify patients ready to participate in PT intervention.…”

“…There are multiple published guidelines related to mobilizing patients in the ICU and patients on mechanical ventilation (MV). [13][14][15][16][17][18][19][20][21][22] Physical therapist intervention and early mobilization in the ICU are proven to be safe and feasible 23 to diminish the consequences of PICS and ICUAW, [24][25][26] and to decrease ICU and hospital length of stay. 27 Patients who participate with physical therapy demonstrate better functional outcomes, are more likely to discharge home, and are more likely to return to an independent functional status.…”

Perioperative care in open aortic vascular surgery: A consensus statement by the Enhanced Recovery After Surgery (ERAS) Society and Society for Vascular Surgery

“…246,247 Successful mobilization strategies require a multidisciplinary approach, objective evaluation of patient safety and ability for early ambulation, and tracking progress with a formal mobility scale. 248 An early mobility protocol with at least twice daily assessments increases mobility and decreases delirium and length of stay. 248 Those who are more physically fit preoperatively will be able to achieve postoperative mobility goals more quickly, 96 but all patients should have a tailored, safe plan for ambulation.…”

“…248 An early mobility protocol with at least twice daily assessments increases mobility and decreases delirium and length of stay. 248 Those who are more physically fit preoperatively will be able to achieve postoperative mobility goals more quickly, 96 but all patients should have a tailored, safe plan for ambulation. 248 If patients are not progressing, then causes of failure need to be analyzed by the multidisciplinary team, including physical therapists, and corrective measures should be instituted quickly.…”

One Year Post-Discharge Outcomes After Implementation of an ICU Early Mobility Protocol

“…In an attempt to improve the outcomes of critically ill patients, we implemented an early mobility protocol in 7 specialty ICUs in an academic medical center 12 . The American Association of Critical Care Nurses (AACN) mobility protocol was used to increase mobility 13 .…”