Mobilising intensive care patients early

Abstract

Background: Early mobilisation in the intensive care unit has been suggested to improve outcomes. However, safety and practical concerns have led to the slow uptake of early mobilisation. Objectives: We designed a study to evaluate the practicability and efficacy of an early mobilisation protocol in intensive care unit patients. Methods: We performed a prospective non-blinded observational cohort study based on a quality improvement project. We implemented a protocol for early mobilisation of suitable patients admitted to medical and surgical intensive care units of a tertiary care hospital. All other aspects of patient care were managed as usual. Patients were followed up to discharge. Data were collected from July to August 2016 pre-implementation and from November 2016 to February 2017 following protocol implementation. The primary outcome measure was the mobilisation rate, defined as the number of days mobilised divided by the number of days each patient met mobilisation criteria. Secondary outcome measures included adverse event rate, length of mechanical ventilation, intensive care unit and hospital stay, intensive care unit and inhospital mortality and discharge destination. Results: A total of 312 patients were analysed, of which 60% were men with a mean age of 63.4 years. Following early mobilisation implementation, the mobilisation rate increased from 39% to 65% ( P=0.006). The percentage of patients discharged home increased from 49.0% to 75.9% ( P<0.001). Mortality, length of mechanical ventilation, length of stay and adverse event rate did not differ significantly. Conclusion: The implementation of an early mobilisation protocol in our intensive care unit was both safe and effective without requiring additional staffing. Efforts are ongoing to increase compliance with the protocol.

Perceived barriers to mobility in the intensive care units of Singapore: The Patient Mobilisation Attitudes and Beliefs Survey for the intensive care units

“…24 This issue is expected due to the competing priorities, 21 or the lack of assistive mobility devices and inadequate staffing. 13 Future studies can explore the underlying reasons hindering nurses from engaging in more early mobilisation.…”

“…This study reported a negligible correlation between years of experience and barriers to mobilisation, contrary to a similar survey conducted in the USA. 18 One study demonstrated the effectiveness of a mobilisation protocol on increasing mobilisation in Singapore's ICU, 13 which suggests a preeminence of protocol over years of experience within local ICU. Another reason may be the culture of continuing education, which involves regular interdisciplinary ward rounds and case discussions among ICU professionals, a recommended strategy to overcome barriers to inadequate experience in mobilising patients.…”

“…A 5-point Likert scale (1 = strongly disagree; 2 = disagree; 3 = neutral; 4 = agree; 5 = strongly agree) was used to obtain responses. With Items 1,3,4,7,10,12,13,15,17,19,21 and 23, the reversed 5-point Likert scale (5 = strongly disagree; 4 = disagree; 3 = neutral; 2 = agree; 1 = strongly agree) was used instead. 18,21 The PMABS-ICU-SG scoring system is consistent with the PMABS-ICU.…”

“…Nurses and doctors who perceive the patients are unstable may choose to enforce bed rest. 13,24 Education on the low adverse event rate associated with mobilisation 25 and modification strategies to achieve increased mobilisation may be employed to overcome this barrier.…”

“…7,8 Early mobilisation, defined as the application of physical activity as early as the second to the fifth day after the onset of critical illness or injury, has been shown to reduce the incidence of ICUAW at the point of ICU or hospital discharge, improve patients' unassisted walking distance, and to decrease the overall length of stay at ICU, hospital and rehabilitation facilities. [9][10][11][12][13] Despite the convincing evidence, the practice of early mobilisation among ICU healthcare workers appears to be low. 11,[13][14][15] Haemodynamic instabilities with medical contraindications, delirium and deep sedation, pain and fatigue are the most commonlycited patient-related barriers to mobilisation.…”