Changes in Provider Perceptions Regarding Early Mobility in the PICU*

Abstract

Objectives: Early mobility in the PICU is safe and feasible. However, PICUs continue to meet barriers to implementing early mobility. PICU providers were surveyed before and after initiating an early mobility protocol to determine perceived barriers and continued challenges in performing early mobility. Design: This single-center prospective study surveyed PICU providers regarding 26 potential barriers to early mobility using a five-point Likert scale. A survey was distributed 1 month prior to and 6 months after beginning an early mobility protocol. Setting: Free-standing academic tertiary care children’s hospital. Subjects: PICU providers of various professions. Interventions: Implementation of PICU-wide early mobility protocol. Measurements and Main Results: Paired pre- and post-early mobility protocol implementation surveys from 97 providers were compared. System-based barriers decreased after implementation of the early mobility protocol, such as lack of guidelines (75–20%; p < 0.01), inadequate training (74–33%; p < 0.01), lack of early mobility orders (72–30%; p < 0.01), and delayed recognition of early mobility candidates (68–35%; p < 0.01). Difficulty coordinating early mobility sessions, although significantly decreased, still remained a concern for 66% of providers in the postsurvey. Lack of resources, specifically staff (85–82%; p = 0.68) and equipment (67–60%; p = 0.36), also remained significant barriers. Presence of an endotracheal tube was a barrier for only 29% of providers’ post-early mobility protocol, compared with 69% prior (p < 0.01). Clinical instability remained a top concern (82–79%; p = 0.63) as well as agitation (74–67%; p = 0.23). Day shift providers, with more early mobility exposure, perceived fewer barriers compared with night shift providers. Ninety percentage of post-early mobility survey participants felt that early mobility positively impacted their patients. Conclusions: Implementation of an early mobility protocol significantly changed provider perceptions regarding barriers to early mobility. Certain factors, such as staff availability, coordination difficulty, equipment shortage, and patient clinical factors, continue to be significant challenges to early mobility in the PICU population.

The ICU Liberation Bundle and Strategies for Implementation in Pediatrics

“…Varied developmental stages and a broad spectrum of ages can make EM more challenging in pediatrics [78]. In addition to protocolization and equipment barriers, many studies have found staff perceptions to be a significant barrier [78,79]. However, a systematic review of 11 pediatric EM studies and over 1100 patients found only 1% of patients had any type of adverse event related to EM, suggesting EM is also safe in the PICU population [80].…”

“…However, a systematic review of 11 pediatric EM studies and over 1100 patients found only 1% of patients had any type of adverse event related to EM, suggesting EM is also safe in the PICU population [80]. Staff perceptions may be amenable to change with education and development of a multidisciplinary protocol [79]. EM outcomes data in pediatrics is sparse, but several studies have demonstrated feasibility [78, 81-84, 85•].…”

“…Bedside providers may have concerns about patient safety (especially for early mobility and the use of an analgosedation model) and may think that the risk it poses outweighs potential benefits. With effective education on the safety and feasibility of bundle implementation [79,81] and ongoing feedback to providers with up to date data on how usage of the bundle is helping their patients, providers can feel empowered and motivated to lead bundle reliability performance. Involving multidisciplinary bedside providers and other key stakeholders early on during protocol design is also essential to ensure protocol feasibility and will help buy-in.…”

Lineamientos del Colegio Colombiano de Terapia Ocupacional para la atención hospitalaria aguda y subaguda de pacientes con COVID-19

“…Así pues, al tiempo que disminuye la mortalidad, aumenta la proporción de niñas y niños que son dados de alta con una discapacidad sustancial. La disfunción motora es la principal morbilidad (Hanna et al, 2020), seguida por el delirio infantil hospitalario; respecto a este último, en niñas y niños hospitalizados en UCI pediátrica la prevalencia general es de más del 40% y alcanza hasta el 60% en menores de 5 años, incluidos lactantes (Smith y Williams, 2020), afectando especialmente a quienes ya presentaban retardos en el desarrollo (Kaur et al, 2020).…”

“…El efecto de la enfermedad crítica en la función general del niño o niña, en la calidad de vida y en la reintegración al hogar y a la escuela, así como el potencial de recuperación justifican de manera contundente la rehabilitación temprana (Hopkins et al, 2015). Aunque la literatura relacionada con las prácticas de rehabilitación en UCI pediátrica apenas está emergiendo, la información disponible indica que las actividades de movilización temprana en niños y niñas en estado crítico han demostrado ser seguras y factibles, y que pueden traer beneficios a corto y largo plazo (Wieczorek et al, 2016;Betters et al, 2017;Cuello-García et al, 2018;Fink et al, 2019;Hanna et al, 2020).…”