Date of Graduation

Summer 8-13-2021

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Abstract

Problem: In a large tertiary medical center in Northern California, the patients in the 20-bed ICU achieved averaged maximum mobility (AMM) scores well below the regional target. These patients had longer lengths of stay in the ICU and spent more days on ventilators, as compared to patients in other ICUs in the region. Barriers to mobilization included patient diagnosis, sedation practices, staff burnout, insufficient staffing, a knowledge deficit around the safety and benefits of mobility, lack of standard workflows, and lack of interdisciplinary collaboration.

Context: A microsystem assessment focused on metrics-that-matter to determine the focus of this quality improvement project. This assessment revealed a lack of knowledge of the benefits of mobility and a culture where mobility was not prioritized. Mobilizing patients was not a collaborative effort nor a topic of interdisciplinary communication. This ICU ranked last in the region among 21 medical centers for AMM in the ICU.

Interventions: A multidisciplinary mobility committee identified barriers to mobility in the ICU and designed a standard work plan to overcome these barriers. The interventions implemented included a patient care technicians (PCT) mobility worksheet, verification of documentation, identifying the gap in knowledge and educating staff members, a visual aid, and a unit-specific mobility protocol. The daily performance metrics were shared with the staff on a visual huddle board to increase staff awareness of the current state.

Measures: The outcome measure for this project was the AMM. Process measures included verification of appropriate documentation of mobility in the electronic medical record and the percent of patients mobilized in the ICU. The balancing measure was the occurrence of adverse events related to mobility in the ICU, including accidental extubation, inadvertent decannulation of venous and arterial access lines, and patient falls.

Results: Each intervention implemented resulted in a week-over-week increase in the AMM. These increases were not cumulative and the AMM goal of 2.8 was not me. The maximum weekly average maximum (WAM) achieved during this study was 1.8. The average percent mobilized during the study was 80%. There were no adverse events that occurred because of mobilizing patients during the study.

Conclusions: Mobility in the ICU should remain a focus of the multidisciplinary team. Despite not achieving the desired results, the interventions positively impacted mobility efforts and improved staff engagement and interdisciplinary collaboration. Use and refinement of the tools and workflows implemented by the mobility committee should continue, as needed, to meet the needs of the patients and staff. Further efforts should be made to identify and overcome additional barriers to mobilizing patients in the ICU.

Keywords: mobility, intensive care, critical care, length of stay, ABCDEF bundle

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