A team approach to the introduction of safe early mobilisation in an adult critical care unit

Abstract

Delirium and intensive care unit acquired weakness are common in patients requiring critical care and associated with higher mortality and poor long-term outcomes. Early mobilisation has been shown to reduce the duration of both conditions and is recommended as part of a strategy of rehabilitation of critically ill patients starting during their stay in intensive care. Our aim was to achieve 95% reliability with a standardised mobilisation process. Multidisciplinary involvement through the use of regular focus groups lead to the development of a standardised process of sitting a ventilated or non-ventilated patient at the side of the bed for a set period of time, which was called the daily dangle. Team learning from Plan, Do, Study, Act (PDSA)cycles, as well as feedback from both staff and patients, allowed us to develop the process and achieve a median 87% reliability. Delirium rates fell from 54.1% to 28.8%. There was no change in average length of stay, and no adverse events. Ownership by the staff, development of the process by staff, iterative testing and learning, and designs for reliability were the factors behind the successful adoption of a new and challenging process. Particular changes which drove reliability were standardisation of the criteria for a dangle, standardisation of the dangle itself and a reminder included on the daily goals checklist.

Mobilization practices in critically ill children: a European point prevalence study (EU PARK-PICU)

“…Daily review of the potential for devices to be removed can both reduce the risk of hospital-related infections and avoid confining patients to bed. Out-of-bed mobility can be safe, when a device is secured during the pre-mobility planning [36], especially if a dedicated multi-professional mobilization protocol and trained team are available. Other perceived barriers to out-of-bed mobility included medical status, lack of physician order, isolation precautions, and oversedation.…”

Muscle wasting in the critically ill patient: how to minimise subsequent disability

“…Mobilisation is extremely difficult to deliver outside a holistic bundle. As a component of the ABCDEF bundle (Ely 2017), the effects on mortality and length of stay have been demonstrated in service improvement settings (Marra et al 2017;Chohan et al 2018).…”