Implementation of an Early Mobility Toolkit: A Quality Improvement Project
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Authors
Kaufman, Andrea
Issue Date
2023-04-27
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Issue
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Manuscript
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Keywords
Early Mobility , Liberation Bundle
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Abstract
Purpose: The purpose of this quality improvement project was to implement an early mobility toolkit in the Cardiovascular Intensive Care Unit (CVICU) utilizing the Banner Mobility Assessment Tool (BMAT), 6 Clicks Tool and the Johns Hopkins-Mobility Goal Calculator (JH-MGC) as part of the current Liberation Bundle to help decrease ICU acquired muscle weakness (ICUAW), ventilator days, delirium and hospital length of stay.
Background: Adults admitted to the ICU often experience a 25-50% decline in functional status through their hospital course (Devlin et al., 2018). In addition to ICUAW, ICU patients may experience an increase in ventilator days, hospital length of stay and delirium (Devlin et. al, 2018). The key to combating these complications is early mobility. The use of early mobility is not a new concept to the critical care environment; however, it is not fully utilized due to numerous barriers. These barriers include the frame of thought that patients are too sick to move, the presence of multiple lines and drains, and lack of coordination with other staff (Dirkes & Kozlowski, 2019). To combat these barriers the use of early mobility protocols within an ICU Liberation Bundle provides better outcomes (Dirkes & Kozlowski, 2019).
Sample/Setting: 20 Bed CVICU.
Methods: Mobility tool kit: BMAT was documented within EPIC and physical therapy performed the 6 clicks tool and filled out the paper JH-MGC to give the patients and nurses a mobility goal for the day. Approximately 665 patient records were used in these analyses, representing the study period, the fall prior and the winter prior.
Results: The median length of stay in the CVICU for 3 months prior to the study was 4.015 days and during the study period it was 4.22 days. The median ventilator hours for the Fall prior were 20.3 hours and during the study period it was 21.1 hours. A Mann Whitney U test indicated that these differences were not statistically significant. The relative risk of discharge to home during the study period compared to the 3 months prior was 1.12, while for acute rehab it was .76, showing that there was a modestly increased chance of home discharge and a modestly decreased chance of discharge to acute rehab. The Winter the year prior to and during the study period showed a relative risk for home of 1 and for acute rehab it was 1.92, indicating that patients were nearly twice as likely to be discharged to acute rehab during the study period compared to the winter prior. The relative risk of delirium days during the study period and the Fall prior showed a relative risk of 1.03 meaning there was little change in delirium. The staff participation of the bundle within the study period showed an increase greater than 14% each month of the study period with a greater than 75% compliance in charting two BMATs a day.
Conclusion: Though there was no statistically significant change, there was a clinical change where staff participated in the bundle and the relative risk of discharge home was close to one. The intervention shows promise, and the facility is looking to implement the mobility tool kit across its other 4 ICUs.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University