Early progressive mobilization is a safe strategy in the intensive care unit (ICU), however, it is still considered challenging by the inherent barriers and poor adherence to early mobilization protocol. The aim of this study was to evaluate the effectiveness of a quality improvement (QI) multifaceted strategy with implementation of a specific visual tool, the “mobility clock”, in reducing non-compliance with the institutional early mobilization (EM) protocol in adult ICUs. A single-center QI with a retrospective before-after comparison study was conducted using data from medical records and hospital electronic databases. Patients from different periods presented similar baseline characteristics. After the QI strategy, a decline in “non-compliance” with the protocol was observed compared to the previous period (10.11% vs. 26.97%, p < 0.004). The proportion of patients walking was significantly higher (49.44% vs. 29.21%, p < 0.006) and the ICU readmission rate was lower in the “after” period (2.25% vs. 11.24%; p = 0.017). The multifaceted strategy specifically designed considering institutional barriers was effective to increase out of bed mobilization, to reduce the “non-compliance” rate with the protocol and to achieve a higher level of mobility in adult ICUs of a tertiary hospital.
Background The ABCDE bundle in critical care is recommended to reduce long-term consequences of intensive care unit (ICU) and to promote better outcomes for the patients. Early progressive mobilization, represented as letter “E”, despite of had been proposed as a safe strategy in intensive care unit, it is still considered challenging by the inherent ICU barriers and poor adherence to early mobilization protocol. Recently, the letter “F” was incorporated into the bundle, representing the patient’s family participation, which can optimize care and patient’s recovery. The aim of this study was to evaluate the effectiveness to improve the adherence to the early mobilization protocol after a quality improvement multifaceted strategy which resulted in the development of a specific visual tool, the “mobility clock”, in order to involve in the process beyond the healthcare professionals the patients, and family members. Methods A single-center before-after study was conducted using data from medical records or hospital electronic databases. A sample size of 88 patients per period was calculated to verify a reduction by 10% on the non-compliance rate with the institutional early mobilization protocol. Results Patients from different periods presented similar baseline characteristics. After the intervention, a decline in non-compliance with the protocol was observed compared to the previous period (10.11% vs. 26.97%, p < 0.004). Regarding mobility landmarks, the proportion of patients walking was significantly higher in the “after” period (49.44% vs. 29.21%, p < 0.006). The ICU readmission rate was lower on the “after” period (2.25% vs. 11.24%; p = 0.017). Conclusions The multifaceted strategy specifically designed to the institutional barriers was effective in increasing adherence to early mobilization protocol causing an increasing in the out of bed mobilization rate in the adult ICU of a tertiary hospital.
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