Early Mobilization in ICU Care Coordination
Sary Valles
Farmingdale State Collage
October 9, 2014

Early Mobilization in ICU Care Coordination The situation of Length of Stay (LOS) is a complex issue of the healthcare environment. Each patient requires the effort of many different resources-both people and equipment- before they are clinically fit to go home or more to the next stage of their healthcare journey. Failure to coordinate and synchronize resources across the entire patient journey results in a major loss of optimal care for the patient as well as wasted expense. For the patient the consequences of this delay can be dire. One solution to this growing epidemic is being initiated in the Intensive Care Unit (ICU) at NSHLIJ Southside Hospital. Early mobilization coordinate care model is currently in place in the ICU. Early mobilization of critical care patients has been known to improve quality of care, provide a better experience for patients and most importantly reduce LOS. The Six Sigma Project of Early Mobilization came about due to the data collection from the assistant nurse manager of the ICU. The collective data was the sent to Quality Management. The increase of LOS in the ICU needed to receive considerable attention for a change to occur. Once the need was identify, a team of healthcare professionals as well as administrators were assembled to tackle this growing issue. The initial meeting consisted of the key members of the early mobilization six sigma project. The participating key members included the director of Critical Services, the head physician assistant from the Cardiac Intensive Care unit (CICU), the nurse manger from ICU, the assistant nurse manger of ICU, the manger of Quality Management, the manger of Physical Therapy, the head therapist of Occupational Therapy, an ICU am- flex nurse, an ICU pm- flex nurse, a CICU am-flex nurse, an ICU nurse assistant, the ICU intensive, the head of Respiratory Department, a respiratory therapist, and the head of the Social Work Department. The assembly of the multidisciplinary team occurred in the boardroom at Southside Hospital. Once the issue of increased LOS in the ICU was identified and the multidisciplinary team was assembled, a systemic process of identifying the key components of early mobilization needed to be developed. An algorithm was introduced to clarify the benefits and hazards of early mobilization. The first part of the algorithm consisted of identify what constituted early mobilization. Many of participating members felt that early mobilization meant ambulating patients. In the ICU, ambulation of patients is a rarity. The algorithm clarified early mobilization can range from simple range of motion (ROM) to ambulating ventilator-depend patients. Establishing a baseline function status for each patient is an important part of early mobilization. Determining the task (transfer, reposition, ambulating, and toileting) is essential tool for patients mobility. The second part of the algorithm detailed the need to identify when early mobilization can be attempted. Upon admission of the critical care patient, as well as the support of the clinical staff, early mobilization can be as early as the day of admission. Productive interdisciplinary rounds in the ICU also assist in early mobilization as well. The third part of the algorithm spoke to the need of when and if equipment was need to the critical care patient to participate in functional movement. If the patient requires only ROM, a staff member is needed at bedside. The shortage of equipment becomes an issue when aggressive mobilization is needed. The process of trying to find equipment can be cumbersome and subsequently lead to not optimizing the patients’ mobility. One suggestion to rectify this issue is to plan early mobilization a day in advance in order to have the necessary equipment available. Part three and part four of the algorithm dealt with the risk and benefits of early mobilization. One of the concerns that were address was changing culture in the ICU. Many of the nurses are intimidated at the idea of ambulating vent-depended patients. The fear of harming the patients is a justifiable concern that many of the staff ICU nurses have. Reeducation and supplying safe adequate staff will encourage a change in the culture in the ICU. Part Five of the algorithm was the goal of early mobilization. This part identified the specific progression of patients’ goals and developing an individual mobility care of plan. Encouraging family members to mobilize the patient when appropriate will aid in the progression of the patients goal. The six and finally part of the algorithm details the implementation of early mobilization. Based on the implementation of the algorithm, mobility must be scaled and be progressive. Mobility is the responsibility of all team members including patients and family. ICUs are complex systems which may be inadequate to support needed changes. Teamwork and collaboration in the ICU often is non-existent between disciplines. To effect change, needed cooperation of multiple disciplines, including physicians, nurses, respiratory therapist, and physical therapist are required. Sense of urgency needs to be established for patients in need of early mobilization. Successful transformation requires a guiding coalition of multiple disciplines who share a commitment to change. Limited staffing and safety concerns continue to be a barrier of early mobilization in the ICU. Creating a vision which includes reduction of sedation, prioritizing activity and encouraging sleep will help eliminate some safety concerns. Crossing-training staff as well as hiring new registered nurses will aide in the empowerment of acting out the created vision of early mobilization. Early mobilization in ICU can be safe and is associated with several benefits including functional mobility and improved quality of life. Early mobilization may reduce ICU and hospital readmission; reduce duration of mechanical ventilation, and decrease ICU and hospital LOS. Implementation of early mobilization program is feasible by engaging a multidiscipline team to identify and address barriers and to accomplish meaningful changes in the ICU culture. Early mobilization is essential in improving patient’s outcome. Public Health focuses on preventing disease and injury by promoting a healthy life style. It promotes healthy individuals, family and communities. Early mobilization also promotes the care and prevention of diseases. It plays a crucial role in helping and improving patients’ physical health after a critical illness. Embracing early mobilization can make an importance difference to patients’ recovery and future.

REFERENCE

Kress, J. P. (2009). Clinical trials of early mobilization of critically ill patients.Critical care medicine, 37(10), S442-S447. Schweickert, W. D., Pohlman, M. C., Pohlman, A. S., Nigos, C., Pawlik, A. J., Esbrook, C. L., ... & Kress, J. P. (2009). Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet (London, England), 373(9678), 1874-1882.