Implementation strategies to overcome barriers to early mobilisation practices in Zimbabwean and South African public sector ICUs: A Delphi study.

Abstract

Background: Barriers to early mobilisation in healthcare settings encompass various factors, including practical challenges, accountability and the crucial role of leadership.

Objectives: To gain consensus from multidisciplinary team members in South African (SA) and Zimbabwean public sector hospitals to formulate implementation strategies addressing identified barriers for early mobilisation.

Methods: An online two-round modified Delphi study including 23 experts from SA and Zimbabwe was undertaken. The implementation strategies were aligned with the Consolidated Framework for Implementation Research that outlines five areas impacting implementation.

Results: The expert panel included intensive care unit (ICU) clinicians, academics and managers, who participated in both Delphi rounds. The median years of ICU experience was 8.5 (range 5 - 17) years, with 16 (80.0%) having a general ICU background. The panel reached consensus on several strategies to standardise early mobilisation practices in ICUs, including defining specific early mobilisation activities, appointing champion leaders, ensuring timely management of fractures, promoting patient admission to specialised units, creating dedicated physiotherapy positions, and providing skills training for staff responsible for implementing early mobilisation activities in ICUs.

Conclusion: The strategies developed represent an important step toward implementation of early mobilisation in routine ICU patient care.

Contribution of the study: This study provides implementation strategies, aligned with the Consolidated Framework for Implementation Research, to overcome barriers to early patient mobilisation in public sector ICUs. These strategies emanate from consensus reached by a panel of experts and serve as the first step in guiding clinicians towards developing and implementing early mobilisation protocols for their units to promote better-quality patient care in daily clinical practice.