Date of Graduation

Summer 8-9-2023

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

Kaiser cohort MSN capstone

First Advisor

Dr. Liesel Buchner

Second Advisor

Leslie Bigler

Abstract

Abstract

Problem: Within the intensive care unit (ICU) environment, the inconsistent implementation of early mobility practices poses a significant challenge, resulting in suboptimal patient outcomes. This quality improvement project addressed the critical issue of lower mobility scores and the barriers faced in promoting early mobilization due to the complex nature of the ICU, including the patient population and therapeutic interventions.

Context: Situated in a 327-bed hospital, the 20-bed ICU caters to critically ill patients with diverse diagnoses, such as stroke, heart failure, sepsis, and Covid pneumonia. The ICU staff comprises registered nurses (RNs), patient care technicians (PCTs), and other interdisciplinary staff. The intervention entailed educating the staff on documenting mobility, implementing a regional mobility protocol, and utilizing the evidence-based A to F (A2F) bundle. The project aimed to enhance mobility metrics in the ICU from an average score of 1.5 to 2.3 by a designated deadline.

Measures: The outcome measure for this project was achieving the Average Daily Mobility (ADM) score of 2.3. The process measures included daily mobility reports, audits verifying accurate mobility documentation per the electronic health record, and reviewing missed mobility opportunities. The balancing measure was identifying any adverse events related to mobility in the ICU, such as falls and accidental hemodynamic line removal or extubations.

Results: ADM mobility increased from an average of 1.5 to 2.1. The target of 2.3 was not met during this quality improvement project. However, a significant increase was seen, and improvement is expected to continue.

Conclusion: While failing to meet the targeted goal, the quality improvement project positively impacted the ICU mobility scores. Utilization of tools and workflows, as well as an increased focus on mobility, will be continued by the ICU Liberation Committee (ILC), and further improvements to this project will be identified and implemented to continue early mobility improvements in the ICU.

Keywords: Early mobility, ICU, A2F bundle, patient outcomes, quality improvement, multidisciplinary team.

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