scholarly journals Multidisciplinary, early mobility approach to enhance functional independence in patients admitted to a cardiothoracic intensive care unit: a quality improvement programme

2021 ◽  
Vol 10 (3) ◽  
pp. e001256
Author(s):  
Prasobh Jacob ◽  
Poonam Gupta ◽  
Shiny Shiju ◽  
Amr Salah Omar ◽  
Syed Ansari ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Quality Improvement ◽  
Substantial Reduction ◽  
Functional Independence ◽  
Early Mobilisation ◽  
Early Mobility ◽  
Patient Transfers ◽  
Early Activity

Early mobilisation following cardiac surgery is vital for improved patient outcomes, as it has a positive effect on a patient’s physical and psychological recovery following surgery. We observed that patients admitted to the cardiothoracic intensive care unit (CTICU) following cardiac surgery had only bed exercises and were confined to bed until the chest tubes were removed, which may have delayed patients achieving functional independence. Therefore, the CTICU team implemented a quality improvement (QI) project aimed at the early mobilisation of patients after cardiac surgery.A retrospective analysis was undertaken to define the current mobilisation practices in the CTICU. The multidisciplinary team identified various practice gaps and tested several changes that led to the implementation of a successful early mobility programme. The tests were carried out and reported using rapid cycle changes. A model for improvement methodology was used to run the project. The outcomes of the project were analysed using standard ‘run chart rules’ to detect changes in outcomes over time and Welch’s t-test to assess the significance of these outcomes.This project was implemented in 2015. Patient compliance with early activity and mobilisation gradually reached 95% in 2016 and was sustained over the next 3 years. After the programme was implemented, the mean hours required for initiating out-of-bed-mobilisation was reduced from 22.77 hours to 11.74 hours. Similarly, functional independence measures and intensive care unit mobility scores also showed a statistically significant (p<0.005) improvement in patient transfers out of the CTICU.Implementing an early mobility programme for post-cardiac surgery patients is both safe and feasible. This QI project allowed for early activity and mobilisation, a substantial reduction in the number of hours required for initiating out-of-bed mobilisation following cardiac surgery, and facilitated the achievement of early ambulation and functional milestones in our patients.

scholarly journals Quality Improvement Methodology to Optimize Safe Early Mobility in a Pediatric Intensive Care Unit

2020 ◽  
Vol 6 (1) ◽  
pp. e369
Author(s):  
Neha Gupta ◽  
Amber Sones ◽  
Maegan Powell ◽  
Johanna Robbins ◽  
Stephanie Wilson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Early Mobility

scholarly journals Quality improvement: The delivery of true early mobilisation in an intensive care unit

2016 ◽  
Vol 5 (1) ◽  
pp. u211734.w4726 ◽  
Author(s):  
Zoe van Willigen ◽  
Nikki Collings ◽  
Dominic Richardson ◽  
Rebecca Cusack
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Early Mobilisation

scholarly journals Behavior of the functional independence domains in patients submitted to the revascularization of the myocardium during intensive care unit stay

2018 ◽  
Vol 8 (2) ◽  
pp. 175-182
Author(s):  
André Luiz Cordeiro ◽  
André Raimundo Guimarães ◽  
Thiago Araújo Melo ◽  
Jefferson Petto ◽  
Mansueto Gomes-Neto ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Myocardial Revascularization ◽  
Functional Independence ◽  
Preoperative Period ◽  
Icu Stay ◽  
Stay Time ◽  
The Mean ◽  
Functional Independence Measurement

INTRODUCTION: Functional Independence Measurement (MIF) is used to evaluate the functional status of patients being divided into domains and should be applied in patients undergoing cardiac surgery due to their high potential for deleterious effects. OBJECTIVE: To analyze the behavior of MIF domains in patients submitted to myocardial revascularization. MATERIALS AND METHODS: This is a cohort study. At the time of hospital admission, the functionality was evaluated through the MIF and computed the six domains. After the surgery on the day of discharge from the Intensive Care Unit (ICU), the MIF was again applied for comparison with the preoperative period and correlation with the length of stay in the ICU. RESULTS: A total of 38 patients were analyzed: 21 (55.3%) men, mean age was 57.3 ± 13.3 years. The mean ICU stay was 2.9 ± 1.3 days, with a FIM of 125.7 ± 0.5 and a mean of 87.4 ± 16.8 (p <0.001). In relation to the domains, a reduction was observed in all of them, with the exception of Communication from 14 to 13.1 ± 2.1 (p = 0.24) and Cognition 20.9 ± 0.1 to 19.2 ± 4, 4 (p = 0.24). However, there was a strong correlation between ICU stay time with the communication domains (r -0.76 and p <0.01) and cognition (r -0.77 and p <0.01). CONCLUSION: It is concluded that the functionality is reduced due to cardiac surgery and that the time spent in the ICU is directly related to the worsening of communication and cognition.

scholarly journals 1263: QUALITY IMPROVEMENT METHODOLOGY TO OPTIMIZE SAFE EARLY MOBILITY IN A PEDIATRIC INTENSIVE CARE UNIT

2020 ◽  
Vol 48 (1) ◽  
pp. 608-608
Author(s):  
Neha Gupta ◽  
Amber Sones ◽  
Maegan Powell ◽  
Johanna Robbins ◽  
Stephanie Wilson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Early Mobility

A Questionnaire Survey of Paramedic Staff Who Experienced Passive Orthostatism for Early Mobilisation in Intensive Care Unit Patients After Cardiac Surgery

2018 ◽  
Vol 27 ◽  
pp. S588-S589
Author(s):  
Yasuaki Takahashi ◽  
Masahiro Nakashima ◽  
Yukio Umeda ◽  
Yasumasa Kumazaki ◽  
Teruki Mori ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Questionnaire Survey ◽  
Early Mobilisation

Safety First: An Ambulation Protocol for Patients With Pulmonary Artery Catheters

2021 ◽  
Vol 41 (1) ◽  
pp. 45-52
Author(s):  
Stephanie Sharma ◽  
Ma Andrea Lupera ◽  
Alice Chan ◽  
Michael Nurok ◽  
Lianna Z. Ansryan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Quality Improvement ◽  
Adverse Events ◽  
Pulmonary Artery ◽  
Pulmonary Artery Catheter ◽  
Improvement Project ◽  
Catheter Migration ◽  
Pulmonary Artery Catheters

Background Patients with indwelling pulmonary artery catheters have historically been excluded from participating in early mobility programs because of the concern for catheter-related complications. However, this practice conflicts with the benefits accrued from early mobilization. Objective The purposes of this quality improvement project were to develop and implement a standardized ambulation protocol for patients with a pulmonary artery catheter in a cardiac surgery intensive care unit and to assess and support safe ambulation practices while preventing adverse events in patients with pulmonary artery catheters. Methods From October 2016 through October 2017, this single-center quality improvement project developed and analyzed the implementation of a safe patient ambulation protocol in the cardiac surgery intensive care unit. Frontline nursing staff and the interdisciplinary team were educated on a standardized protocol that facilitated patient ambulation. Data analyzed included distance of ambulation, catheter migration, presence of cardiac dysrhythmias, and adverse events during ambulation. Results During this 1-year project, 41 patients participated in 94 walks for a total distance of 13 676.38 m. There were no reported episodes of cardiac dysrhythmia, accidental occlusion of the pulmonary artery, catheter migration, or pulmonary artery rupture related to ambulation with a pulmonary artery catheter. Conclusions The use of a standardized ambulation protocol can successfully result in safe mobilization of patients with indwelling pulmonary artery catheters.

scholarly journals A multidisciplinary early mobility model for cardiac patients in coronary intensive care unit

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
S Matharsa ◽  
D Selvamani ◽  
R Thakur ◽  
P Mathew ◽  
M Thomas ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Early Mobilization ◽  
Quality Improvement Project ◽  
Second Phase ◽  
Improvement Project ◽  
Early Mobility ◽  
Number Of Patients ◽  
Ventilated Patients

Abstract Funding Acknowledgements This is an unfunded project Background Early mobilization is considered as a complex task in an intensive care unit (ICU) and patients are often on prolonged bed rest leading to physical deconditioning. Intensive care early mobility programs have been recognized to be safe and have shown positive outcomes. However, implementing early mobility program as a standard of care remains a challenge. Coronary Intensive Care Unit (CICU) provides complex care for cardiac critically ill patients. In February 2018, the CICU multidisciplinary team (MDT) started a quality improvement project to implement early mobility program in the unit. Purpose This project aimed to investigate the feasibility of implementing an Early Mobility Protocol in CICU to increase the number of patients mobilized to more than 95%. Secondary objective was to explore the impact of the protocol on the mobility level of the patients at the time of discharge or transfer from the CICU. Methods A multidisciplinary mobility task force including Physicians, nurses, physiotherapists and respiratory therapists was formed to analyze the barriers in implementing an early mobility program. A staff survey was conducted to identify the need for a standard early mobility protocol. Root cause analysis and Pareto analysis was done. An evidence based early mobility protocol was developed and implemented. All non-mechanical ventilated patients were included in the first phase and all mechanical ventilated patients were included in the second phase of the project. A standard ICU Mobility scale (IMS) was used for scoring the mobility level of the patients. This quality improvement project is based on "Institute for Healthcare Improvement" model. Periodical staff education and training programs about early mobilization were conducted to improve staff confidence. Change ideas were implemented using multiple Plan Do Study Act cycles. Results The total number of patients included from 1st March 2018 till 31st December 2019 was 2356. This included both the genders. In March 2018, only 68% of non-mechanical ventilated patients were mobilized, that reached to 88% by November 2018. This gradually increased to 100% in May 2019 and is currently sustained at 100%. In November 2019, only 50% of mechanical ventilated patients were mobilized which gradually increased to 66.66% and 75% in middle and end of December 2019. The mean IMS score at discharge or transfer from CICU was "8". From patient-family experience survey, 93.75% of patients perceived that the program was helpful in regaining mobility and 96.25% of patients felt that the program helped in regaining their autonomy. Conclusion The result shows that it is safe and feasible to implement an early mobility program in a Coronary Intensive Care Unit. A standardized mobility protocol can lead to efficient mobilization practice facilitating early transfers from ICUs without any complications. This could further enhance the collaboration of the MDT members leading to culture change in ICUs.

Overcoming nursing barriers to intensive care unit early mobilisation: A quality improvement project

2017 ◽  
Vol 40 ◽  
pp. 44-50 ◽  
Author(s):  
Oluwatobi O. Hunter ◽  
Elisabeth L. George ◽  
Dianxu Ren ◽  
Douglas Morgan ◽  
Margaret Rosenzweig ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Quality Improvement Project ◽  
Early Mobilisation ◽  
Improvement Project
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