We conducted a quality improvement project aimed at increasing the frequency of mobilisation in our ICU. We designed a four-part quality improvement project comprising: an audit documenting the baseline frequency of mobilisation; a staff survey evaluating perceptions of the barriers to mobilisation; identification of barriers that were amenable to change and implementation of strategies to address these; and a follow-up audit to determine their effectiveness. The setting was a tertiary care, urban, public hospital ICU in South Australia. All patients admitted to the ICU during the two audit periods were included in the audits, while all permanent/semi-permanent ICU staff were eligible for inclusion in the staff survey. We found that patient-and institution-related factors had the greatest impact on the mobilisation of patients in our ICU. Barriers identified as being amenable to change included insufficient staff education about the benefits of mobilisation, poor interdisciplinary communication and lack of leadership regarding mobilisation. Various strategies were implemented to address these barriers over a three-month period. Multivariable analyses showed that three out of four mobility outcomes did not significantly change between the baseline and follow-up audits, with a significant difference in favour of the baseline audit found for the fourth mobility outcome (maximum level of mobility). We concluded that implementing relatively simple measures to improve staff education, interdisciplinary communication and leadership regarding early progressive mobilisation was ineffective at improving mobility outcomes for patients in a large tertiary-level Australian ICU. Other strategies, such as changing sedation practices and/or increasing staffing, may be required to improve mobility outcomes of these patients.

Purpose: Whilst early progressive mobilization is known to be safe and beneficial for patients in an intensive care unit (ICU), barriers still exist to its implementation. As part of a broader quality improvement project that had the overall aim of increasing the frequency of mobilization in our ICU, we conducted a survey of ICU staff to investigate their perceptions of the barriers to the early progressive mobilization of ICU patients. Method: A prospective survey of ICU staff in an Australian, tertiary care, public hospital ICU was undertaken. A total of 93 medical, nursing, and physiotherapy staff participated. A purpose-designed survey that investigated staff perceptions of the barriers to the early progressive mobilization of ICU patients was developed. The survey predominantly comprised closed statements requiring responses using a visual analogue scale. Barriers to early progressive mobilization were separated into three sections: patient-related, institutional-related, and other barriers. Results: Patient-related barriers were generally perceived as having the greatest influence on the mobilization of ICU patients, followed closely by institutional-related barriers. The factors that were perceived as most frequently preventing mobilization were hemodynamic instability, reduced level of consciousness, sedation, agitation, impending medical procedure, staff availability, and time constraints. Conclusions: ICU staff perceived that barriers to the early progressive mobilization of ICU patients were multifactorial and most frequently involved patients’ medical condition and resource limitations.

Purpose: Kinesiotape is an elastic, adhesive tape applied to the skin that has been used extensively to reduce pain associated with various musculoskeletal conditions. Its use in the setting of fractured ribs is less clear. The aim of this preliminary study was to investigate the effect of kinesiotaping for patients with rib fracture(s) on pain levels, pulmonary function, and mobility. Method: We prospectively evaluated five patients admitted with fractured ribs using a single-subject experimental ABAB design. Each phase lasted 24 hours with kinesiotape applied during B phases. All participants received usual medical, nursing, and allied health care. Outcome measures included pain levels (participant-rated), pulmonary function, and maximum mobility. The occurrence of skin irritation was tracked. Results: Considerable variability was seen between- and within-participants for pain levels. There was some evidence, albeit inconsistent, that pain levels were lower when the kinesiotape was in situ compared to when it was not. Pulmonary function and mobility levels showed no consistent pattern between intervention phases. Skin irritation occurred in one participant and another required escalation of medical therapy for pneumonia. Conclusions: Kinesiotaping may reduce pain for patients with fractured ribs but further research, preferably randomized controlled trials with homogenous samples and standardized medication regimens, is required to confirm its effectiveness in the acute care setting.

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