Early Mobilization In Pediatric Transplant Patients
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The purpose of this quality improvement (QI) project was to increase mobilization attempts and electronic medical record documentation of attempts in pediatric auto-islet and kidney transplant patients through the creation and implementation of a standardized pediatric mobilization protocol. Patients requiring intensive care suffer from cardiovascular and pulmonary deconditioning, decreased muscle mass, changes in the inflammatory cascade, delirium, and alterations in skin integrity (Wieczorek, Burke, Al-Harbi, & Kudchadkar, 2015). The incidence of delirium and weakness is negatively associated with a patient’s ability to survive a critical illness during hospitalization and has high associations with poor long-term functional, physical, and cognitive outcomes. Early mobilization, activity that enhances central and peripheral perfusion, circulation, ventilation, alertness and muscle metabolism, occurs in the first two to five days of a critical illness. The setting was the University of Minnesota Masonic Children’s Hospital. The sample included auto-islet and kidney transplant patients ages 3-19 cared for in the pediatric intensive care unit (PICU) in the initial 72-hour post-operative period. A retrospective chart review provided baseline documentation practices for a six-month time period. Following this review, a mobilization protocol was created. The nursing staff received education regarding early mobilization through email communication, staff meetings, and flyers posted around the unit. An electronic survey assessed nurses’ perceived barriers to early mobilization and practices prior to and after the protocol education and implementation. After protocol implementation, a real-time chart review in a five-month period was collected from August-December 2019. The data collection was limited to auto-islet and kidney transplant patients in the initial 72-hour post-operative period to qualify for early mobilization. In all days observed, patient ambulation increased in the post-implementation period. Mobilization was more consistently documented and performed throughout the patients’ stay post-implementation. The charting practices improved after staff education sessions. Real-time charting improved from 22% to 85%. The protocol aided in a 63% increase in real time charting. The number of mobilization attempts and perceived number of mobilization attempts displayed a modest increase after protocol implementation. The discussion of early mobilization and its importance increased dramatically on the PICU. A decreased length of stay was seen in the pediatric population through this study with the implementation of a physical therapy driven mobility protocol.
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