Integrating a multidisciplinary mobility programme into intensive care practice (IMMPTP): A multicentre collaborative

Bassett, Rick; Vollman, Kathleen M.; Brandwene, Leona; Murray, Theresa

doi:10.1016/j.iccn.2011.12.001

Cited by 72 publications

(74 citation statements)

References 37 publications

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“…We did not define early. We defined mobility as "a planned series of exercise of a patient in a sequence that begins at a patient's current mobility status and returns the patient to their baseline mobility status" (25).…”

Section: Survey Developmentmentioning

confidence: 99%

Intensive Care Unit Structure Variation and Implications for Early Mobilization Practices. An International Survey

Bakhru¹,

et al. 2016

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Rationale: Early mobilization (EM) improves outcomes for mechanically ventilated patients. Variation in structure and organizational characteristics may affect implementation of EM practices.Objectives: We queried intensive care unit (ICU) environment and standardized ICU practices to evaluate organizational characteristics that enable EM practice. Methods:We recruited 151 ICUs in France, 150 in Germany, 150 in the United Kingdom, and 500 in the United States by telephone. Survey domains included respondent characteristics, hospital and ICU characteristics, and ICU practices and protocols. Measurements and Main Results:We surveyed 1,484 ICU leaders and received a 64% response rate (951 ICUs). Eighty-eight percent of respondents were in nursing leadership roles; the remainder were physiotherapists. Surveyed ICUs were predominantly mixed medicalsurgical units (67%), and 27% were medical ICUs. ICU staffing models differed significantly (P , 0.001 each) by country for high-intensity staffing, nurse/patient ratios, and dedicated physiotherapists. ICU practices differed by country, with EM practices present in 40% of French ICUs, 59% of German ICUs, 52% of U.K. ICUs, and 45% of U.S. ICUs. Formal written EM protocols were present in 24%, 30%, 20%, and 30%, respectively, of those countries' ICUs. In multivariate analysis, EM practice was associated with multidisciplinary rounds (odds ratio [OR], 1.77; P = 0.001), setting daily goals for patients (OR, 1.62; P = 0.02), presence of a dedicated physiotherapist (OR, 2.48; P , 0.001), and the ICU's being located in Germany (reference, United States; OR, 2.84; P , 0.001). EM practice was also associated with higher nurse staffing levels (1:1 nurse/patient ratio as a reference; 1:2 nurse/patient ratio OR, 0.59; P = 0.05; 1:3 nurse/patient ratio OR, 0.33; P = 0.005; 1:4 or less nurse/patient ratio OR, 0.37; P = 0.005). Those responding rarely cited ambulation of mechanically ventilated patients, use of a bedside cycle, or neuromuscular electrical stimulation as part of their EM practice. Physical therapy initiation, barriers to EM practice, and EM equipment were highly variable among respondents. Conclusions:International ICU structure and practice is quite heterogeneous, and several factors (multidisciplinary rounds, setting daily goals for patients, presence of a dedicated physiotherapist, country, and nurse/patient staffing ratio) are significantly associated with the practice of EM. Practice and barriers may be far different based upon staffing structure. To achieve successful implementation, whether through trials or quality improvement, ICU staffing and practice patterns must be taken into account.

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Section: Survey Developmentmentioning

confidence: 99%

Intensive Care Unit Structure Variation and Implications for Early Mobilization Practices. An International Survey

Bakhru¹,

et al. 2016

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“…Coaching teams to this culture is a process. 18 Our team retooled processes of a long-term residential unit to processes for a shorter-stay transitional unit (Table 3). Admissions were no longer for "residence" but for "rehabilitation.…”

Section: The Culture Of Mobilitymentioning

confidence: 99%

“…During handoffs, teams identify mobility that gets woven into the fabric of daily activity, rounds, and plans of care. 18 To cite examples: "Ms T will go to the recreation therapy activity of computer-simulated bowling today and work on Early mobility in the intensive care unit accelerates the return to premorbid functional status and reduces the duration of mechanical ventilation, the physical weakness associated with bed rest, and the neuromuscular effects of critical illness.…”

Section: The Culture Of Mobilitymentioning

confidence: 99%

“…Coordinating the delivery of oxygen for trips off the unit for therapy is vital to safe mobility. 18 Hemodynamic stability goals are clearly defined and communicated among all team members to ensure safety and maximal benefit from interventions. 20 Acceptable ranges of exercise parameters are established by the nurse practitioner and followed by the rehabilitation therapist and nurse.…”

Section: Functional Mobility In Transitional Carementioning

confidence: 99%

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Progressive Mobility As a Team Effort in Transitional Care

Ecklund¹,

Bloss

2015

Critical Care Nurse

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With changing health care, progressive care nurses are working in diverse practice settings to meet patient care needs. Progressive care is practiced along the continuum from the intensive care unit to home. The benefits of early progressive mobility are examined with a focus on the interdisciplinary collaboration for care in a transitional care program of a skilled nursing facility. The program's goals are improved functional status, self-care management, and home discharge with reduced risk for hospital readmission. The core culture of the program is interdisciplinary collaboration and team partnership for care of patients and their families. (Critical Care Nurse. 2015;35[3]:62-68)

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“…Fitzgibbon 42 found that before an educational intervention, 40% of nurses understood the concepts of early mobility, and 30% of nurses performed passive range-of-motion exercises on patients. After the educational intervention, 98% of nurses understood concepts of early mobility, and 100% performed passive range-of-motion exercises on their patients.Recent research 15,17,23,[26][27][28][29][30]32,[35][36][37][39][40][41] on ICU mobility suggests that patients who are critically ill should engage in daily, early exercise to achieve better outcomes. Although implementing mobility in ICU patients should be done cautiously, mobility is safe and feasible.…”

mentioning

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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Integrating a multidisciplinary mobility programme into intensive care practice (IMMPTP): A multicentre collaborative

Cited by 72 publications

References 37 publications

Intensive Care Unit Structure Variation and Implications for Early Mobilization Practices. An International Survey

Intensive Care Unit Structure Variation and Implications for Early Mobilization Practices. An International Survey

Progressive Mobility As a Team Effort in Transitional Care

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

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