Early Mobilization of Patients in the Intensive Care Unit: A Quality Improvement Evidence-Based Project.

Abstract

Background: At an urban public acute care hospital, a gap existed in the safety and efficacy of early mobilization (EM) of intensive care unit (ICU) patients, with the need for an evidence-based intervention. A literature review revealed that a nurse-driven mobility protocol could safely achieve early mobility in ICU patients. This quality improvement project aims to utilize a nurse-driven mobility protocol to determine its effects on EM of ICU patients. Objective: The purpose of this quality improvement project is to determine if the implementation of an early mobility program using the Bedside Mobility Assessment Tool (BMAT) would impact patient mobility compared to standard practice over eight weeks in the ICU setting of an urban Hospital in New York City. Method: The Bedside Mobility Assessment Tool (BMAT) was used to conduct a pilot project on all critically ill patients aged ≥18 years admitted to the 17-bed ICU in an acute care hospital. Kotter's Eight-Step Change Process underpinned by the Plan-Do-Study-Act method of change was used to implement and guide the change process. Result: A nonrandomized convenience sampling of patients was used to attain a total of N = 306 patients (n = 133 preintervention and n = 173 implementation). Between the preimplementation (patients previously mobilized using standard practice) and implementation groups (patients mobilized using BMAT), there was a statistical significance in mobilization rates observed with pre-implementation (n = 56, 42%) and postimplementation mobility rates (n = 132, 76%). Conclusion: EM of critical patients in the ICU using a nurse-driven protocol with the BMAT assessment tool proved efficacious in promoting early patient mobility activities in this setting. This project should be continued and disseminated to other units.