Date of Graduation

Summer 8-5-2020

Document Type

Project/Capstone

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

First Advisor

Liesel Buchner

Abstract

Problem: The critical care patients in a large medical center in Northern California are not consistently optimized medically for mobility and are not mobilized to their maximum capacity. The contributing factors to these problems include poor adherence to standard workflows, insufficient staff knowledge on use of mobility equipment and documentation of activities performed, inadequate provision and utilization of mobility equipment, reduced interdisciplinary staff motivation and skill, and inconsistencies in staffing levels/availability to meet the personnel needs to mobilize patients.

Context: Microsystem and culture assessments with gap analysis were performed to assess the need for quality care improvement. The microsystem’s current practice on mobility is focused on ambulation for the most “able” patients; the more critical and unstable patients are not supported to avoid prolonged immobilization. The current performance data was reviewed and compared to the desired performance outcomes. The review revealed a performance gap in patient mobility and that key improvement efforts are needed to achieve the desired outcomes.

Interventions: The mobility project “Keeping Patients Vertical in the Intensive Care Unit (ICU)” was initiated to mitigate the microsystem’s identified problem. Multiple interventions implemented include the following: mobility champions were established, education on equipment use and mobility documentation were completed, patient’s mobility information has been incorporated in the Nurse Knowledge Exchange (NKE) and daily multidisciplinary rounds (MDR). A process board was created to include mobility scores in huddles. The mobility equipment has been made available and more accessible for staff to use. Mobility exclusion criteria was established and the goal was set to include mobilizing two intubated patients daily that meet the established criteria. The Sara Combilizer (SC) was trialed for 90 days and was adopted for use to help maximize patient mobility.

Measures: The performance outcome measures were identified as follows: the outcome measures are the Average Maximum Mobility (AMM) scores and the Percent Mobilized (PM). The AMM is the highest achieved scores the day prior, up to two highest mobility bouts. The PM is the percentage of patients with documented active mobility performed adhering to the existing time on the unit rules. The process measures are the percent lift utilization, which is the documentation of vertical lift and lift device usage on all ICU patients with Level I and II current level of function, and mobilizing two intubated patients that meet the established criteria. The balancing measures are the identified patient falls and staff injury related to mobilizing patients.

Results: The implemented interventions positively impacted the outcomes. The ICU care team met the Outcome Metrics – AMM and PM reached target for three consecutive months (November 2019 – January 2020) after the project implementation. The Process Metrics were also met. Lift Device Utilization scores on 6 out 8 months were maintained at or above target of 75% from October 2019 through May 2020. Every day for a period of eight weeks, the ICU care team mobilized two intubated patients daily that meet the criteria. There were no staff or patient injuries related to mobilizing patients.

Conclusions: The mobility project was a success and it resulted in notable changes and improvements in practices in mobilizing patients. By continuing the initiatives, the ICU care team is able to improve patient care experience, expedite patient recovery times, and help patients back to physical independence (Olavides, 2020). The overall extraordinary interdisciplinary engagement and commitment of the care team to mobilizing patients have added utmost value to the ICU in preventing patient harm and improving clinical outcomes.

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