Can the Use of an Early Mobility Program Reduce the Incidence of Pressure Ulcers in a Surgical Critical Care Unit?

Dickinson, Sharon; Tschannen, Dana; Shever, Leah L.

doi:10.1097/cnq.0b013e31827538a1

Cited by 20 publications

(26 citation statements)

References 23 publications

(13 reference statements)

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“…41 In one study, 18.7% of the critical care patient sample with impaired mobility developed a sacral pressure ulcer. In the article of Dickinson et al, 43 you will read about one surgical ICUs challenge to decrease the incidence of pressure ulcers while the patient is unable to participate in mobility.…”

Section: Prevent Pressure Ulcersmentioning

confidence: 98%

Building a Protocol to Guide Mobility in the ICU

Dammeyer

Dickinson

Packard

et al. 2013

Critical Care Nursing Quarterly

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Professional experience and wisdom have taught us that immobility is a risk factor for various adverse outcomes, such as deep vein thrombosis, joint contractures, pulmonary dysfunction, and bone demineralization to name a few. Balancing bed rest and mobility may improve both short- and long-term outcomes for our patients. Moreover, early, routine mobilization of critically ill patients is safe and reduces hospital length of stay, shortens the duration of mechanical ventilation, improves muscle strength, and functional independence. At the University of Michigan, we have turned the tides by creating a structured process to get our patients moving through the use of a standardized mobility protocol. Our protocol is simple and can easily be adapted for all patient populations by simply modifying some of the inclusion and exclusion criteria. The activities are grounded in the evidence and well thought out to prevent complications and promote mobilization. The purpose of this article was to present the science behind the development of a multidisciplinary protocol for early mobilization of critically ill patients that can be adapted to any intensive care unit patient with minor modifications.

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Section: Prevent Pressure Ulcersmentioning

confidence: 98%

Building a Protocol to Guide Mobility in the ICU

Dammeyer

Dickinson

Packard

et al. 2013

Critical Care Nursing Quarterly

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“…The mean posttest scores increased by 25 points (95% CI, [20][21][22][23][24][25][26][27][28][29][30], suggesting that 95% of ICU nurses would score 20 to 30 points higher on the posttest after receiving this educational intervention. Although the intervention was effective in increasing the nurses' knowledge, the overall goal of the education was to effectively implement mobility in the ICU.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a Progressive Mobilization Program in a Medical-Surgical Intensive Care Unit

Messer

Comer

Forst

2015

Critical Care Nurse

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BACKGROUND Current literature supports implementation of progressive mobility protocols in intensive care units. Education can help nurses overcome barriers to mobility and increase knowledge about the positive effects of mobility. OBJECTIVE To evaluate the effect of education for a progressive mobilization program for intensive care nurses on knowledge and performance. METHODS A pretest-posttest evaluation was conducted for 41 nurses, and a chart review was performed before and after implementation of the educational intervention to evaluate changes in knowledge and mobilization. RESULTS Scores after the educational intervention were significantly higher than scores before the intervention (t = 2.02; P < .001). Overall mobilization (P = .04) and dangling (P = .01) increased significantly after the education. No significant increases occurred in ambulating or getting patients up to a chair. CONCLUSIONS Mobilization education was effective and increased nurses' knowledge about the benefits of mobility for critically ill patients. The educational program also affected how nurses performed mobility interventions. Although provision of education had positive effects on patients' mobility, leadership and coaching are still important components in implementing change. (Critical Care Nurse. 2015;35[5]:28-42) ©2015 American Association of Critical-Care Nurses doi: http://dx.doi.org/10.4037/ccn2015469 R esearch on early and progressive mobility is currently challenging the traditional standard of care that patients who are critically ill and treated with mechanical ventilation must remain bedfast for days or weeks. 1 Survival of critically ill patients has improved since the mid-1990s, but many of these patients experience long-term disabilities 2 and require rehabilitation after discharge from the intensive care unit (ICU). 1 In the ICU, the focus of care has been the short-term goal of survival, with little attention given to the functional and cognitive impairment of patients.1 One study 3 revealed that the quality of life of ICU patients was largely reduced 6 years after ICU admission; approximately half of the patients still had health problems, including cognitive dysfunction and problems with mobility. The traditional ICU standard of care for patients treated with mechanical ventilation has included deep sedation and prolonged immobility. RN, MSN, CCRN, 10 Firestone Dr, Arden, NC 28704 (e-mail: april.messer@msj .org).To purchase electronic or print reprints, contact the American Association of CriticalCare Nurses, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 899-1712 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, reprints@aacn.org. culture shift in ICU care to include strategies to mobilize ICU patients, 1,2,5,6 many ICUs in the United States have not changed their practice to include mobility of patients. 2,7,8 Nurses are often the key providers of mobility for patients who are critically ill. Barriers to mobility in the ICU include, but are not limited to, clinicians' fear and lack...

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“…The standard of care was that progressive care patients receive 3 episodes of mobility per day no matter which mobility phase was applicable. 4 The goal in phase 0 is for patients to be free of pressure-related skin breakdown and contractures. Exercises focus on passive range of motion (ROM) of the upper extremities (finger, wrist, elbow flexion/extension, shoulder adduction and abduction, internal/external rotation) and lower extremities (toe and ankle flexion/extension, hip flexion, abduction, internal/ external rotation).…”

Section: Practice Changementioning

confidence: 99%

“…4 This protocol was developed with the following principles in mind: (1) link practice with evidence to help dismantle unsupported habits that promote bed rest in the critical care environment; (2) make the protocol uncomplicated by outlining clear and actionable interventions that would allow the clinician to move patients through a continuum of mobility phases; and (3) promote clinical autonomy by empowering frontline staff to drive the protocol with multidisciplinary collaboration.…”

Section: Practice Changementioning

confidence: 99%

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Mobilizing Patients Along the Continuum of Critical Care

Reames

Price

King

et al. 2016

Dimensions of Critical Care Nursing

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The progressive care unit implemented an evidenced-based intensive care unit mobility protocol with their chronically critically ill patient population. The labor/workload necessary to meet mobility standards was an identified barrier to implementation. Workflow redesign of patient care technicians, interdisciplinary teamwork, and creating a culture of meeting mobility standards led to the successful implementation of this protocol. Data revealed that mobility episodes increased from 1.4 at preinitiative to 4.7 at 12 months postinitiative, surpassing the goal of 3 episodes per 24 hours.

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Can the Use of an Early Mobility Program Reduce the Incidence of Pressure Ulcers in a Surgical Critical Care Unit?

Abstract: Despite implementation of the early mobility protocol, we did not see an improvement in the PU rate overall or with time as protocol compliance improved.

Cited by 20 publications

References 23 publications

Building a Protocol to Guide Mobility in the ICU

Building a Protocol to Guide Mobility in the ICU

Implementation of a Progressive Mobilization Program in a Medical-Surgical Intensive Care Unit

Mobilizing Patients Along the Continuum of Critical Care

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