Barriers and Strategies for Early Mobilization of Patients in Intensive Care Units

Improving Health Care for Critically Ill Patients Using an Evidence‐Based Collaborative Approach to ABCDEF Bundle Dissemination and Implementation

“…Despite their benefit, the dissemination and implementation of the SCCM's PAD Guideline recommendations on a large‐scale basis remains very limited (Bakhru, McWilliams, Wiebe, Spuhler, & Schweickert, ; Bakhru, Wiebe, McWilliams, Spuhler, & Schweickert, ; Carrothers et al., ; Miller, Govindan, Watson, Hyzy, & Iwashyna, ; Nydahl et al., ; Pandharipande et al., ). Patients remain on sedation and mechanical ventilation longer than needed and resistance on the part of clinicians to maintain patients at a light level of sedation, use a protocolized mechanical ventilation discontinuation approach, and get patients out of bed during their ICU stay remains high (Baggs et al., ; Bakhru et al., ; Balas et al., ; Carrothers et al., ; Connolly, O'Neill, Salisbury, & Blackwood, ; Dubb et al., ; Laurent et al., ; Miller et al., ; Nydahl et al., ). Knowledge deficits, safety‐related concerns, perceived staffing shortages, and organizational factors such as a lack of institutional commitment to patient safety and quality improvement (QI) efforts further threaten effective PAD guideline adoption (Balas et al., ; Boehm, ; Carrothers et al., ; Costa et al., ).…”

“…Knowledge deficits, safety‐related concerns, perceived staffing shortages, and organizational factors such as a lack of institutional commitment to patient safety and quality improvement (QI) efforts further threaten effective PAD guideline adoption (Balas et al., ; Boehm, ; Carrothers et al., ; Costa et al., ). Moreover, ICU providers often lack effective teamwork and collaboration skills resulting in a fragmented and sub‐par level of care (Baggs et al., ; Dubb et al., ). This is an important challenge when considering that wide‐scale adoption and sustainment of interventions frequently require the collaboration of the entire ICU interprofessional team (Brummel et al., ; Devlin, Fong, et al., ; Devlin, Marquis, et al., ; Orchard, Curran, & Kabene, ; Pun & Devlin, ; Pun, Balas, & Davidson, ).…”

Understanding early goal-directed mobilization in the surgical intensive care unit

“…This facilitator was part of the SICU clinical team and used closed loop communication with the entire patient care team to overcome barriers to achieving the daily SOMS goal. This aspect of the intervention likely helped address a lack of coordination among team members that is a commonly reported barrier to mobilization in the ICU (15). Moreover, the total physical therapy time was only modestly higher in the intervention vs. usual care group, with the SICU nurses actively involved in the mobilization activities (17).…”

“…There are very few studies (11) specifically evaluating early mobilization in surgical intensive care unit (SICU) patients. There are multiple perceived barriers to early mobilization and rehabilitation in the SICU, including concerns related to pain, wound dehiscence, dislodgement of drains and other medical devices, as well as limitations in staffing, time and resources (15). A new, international multi-centered randomized trial (16) evaluating the efficacy and safety of early mobilization and rehabilitation in SICU patients adds to the existing literature supporting this intervention in ICU patients.…”

Adjuvant Therapies for ARDS: Not Ready for Prime Time?

“…Recent investigations related to adoption of early mobility in the intensive care unit characterized four barriers influencing adoption of new therapeutic strategies in critically ill patients (11). Examining those barriers in the context of adjunctive therapies for ARDS can shed light on observations reported by Munshi and colleagues (5).…”