INTENSIVE CARE UNIT K R I S T E N C L I F F O R D , R N , B S N - - PowerPoint PPT Presentation

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INTENSIVE CARE UNIT K R I S T E N C L I F F O R D , R N , B S N - - PowerPoint PPT Presentation

Mar 17, 2023 168 likes •380 views

STRONG TODAY, STRONGER TOMORROW: CREATING A CULTURE OF EARLY MOBILITY IN THE MEDICAL INTENSIVE CARE UNIT K R I S T E N C L I F F O R D , R N , B S N R N 4 , F C C S KRISTEN CLIFFORD BIO B.S.N .N Oa Oaklan land d Un Univ iversi

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STRONG TODAY, STRONGER TOMORROW: CREATING A CULTURE OF EARLY MOBILITY IN THE MEDICAL INTENSIVE CARE UNIT

K R I S T E N C L I F F O R D , R N , B S N R N 4 , F C C S

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KRISTEN CLIFFORD BIO

  • B.S.N

.N Oa Oaklan land d Un Univ iversi sity ty

  • Rochester, Michigan
  • Regist

ister ered ed Nurse se 4, Medical ical ICU CU

  • 9 Years
  • Qu

Quali lity ty Improvement ent Analyst lyst (Q (QIA) A)

  • 1.5 years
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SLIDE 3

VANDERBILT UNIVERSITY MEDICAL CENTER

  • Nashvil

ille le, , TN

  • 1,0

1,000+ 00+ Beds ds

  • 2 mil

illion ion encoun unters per year

  • Level 1 Trauma
  • Medi

dical ICU

  • 35 beds
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SLIDE 4

WHAT IS A QIA??

  • Chart reviews/debriefs and Event Analysis
  • C.diff
  • CLABSI
  • CAUTI
  • Falls
  • Hospital wide committees/projects
  • Unit based quality improvement projects
  • Unit Rounding on Quality Bundle Compliance
  • Staff Education
  • Research – EBP to bedside
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WHY EARLY MOBILITY?

  • Muscle strength declines 3-11% with each day of bedrest.
  • ICU Acquired Weakness (ICUAW) can start within the first few

days of critical illness.

  • ICUAW can lead to immobility and result in loss of strength,

endurance, and bulk.

  • Immobility contributes to poor performance on falls and

hospital acquired pressure ulcers.

  • Morbidity, mortality, length of stay (LOS) and cost of care may

be affected by ICUAW.

  • Developing a culture of early mobility as standard care can

improve patient outcomes.

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ABCDEF is a standard bundle of ICU measures that includes spontaneous…… Assessment for and manage pain Both Spontaneous Awakening Trials (SAT) and Spontaneous Breathing Trials (SBT) Choice of sedation and analgesia Delirium monitoring and management Early mobility Family engagement

ICU Delirium and Cognitive Impairment Study Group Gordon R. Bernard, MD Nathan E. Brummel, MD, MSCI Timothy D. Girard, MD, MSCI

  • E. Wesley Ely, MD, MPH

ABCDEF AND EVIDENCE BASED PRACTICE

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PURPOSE

The purpose of this project was to increase early mobility and make it standard care in the Medical Intensive Care Unit (MICU) to improve patient

  • utcomes through a campaign “Strong

Today, Stronger Tomorrow MICU Early Mobility.”

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STRATEGY AND IMPLEMENTATION

  • Awareness increased with Early Mobility Protocol, using Johns Hopkins

Highest Level of Mobility (JH-HLM) Scale

  • Education created for all bedside nurses, care partners, respiratory,

physical and occupational therapy.

  • Nurses presented patient’s mobility during morning rounds with ICU

team to facilitate orders.

  • To ensure patients were being mobilize, an early mobility tracker (JH-

HLM scale) was used to monitor daily mobility. (3 month time period)

  • This scale was completed during every shift.
  • Educational handouts for families regarding passive ROM

Evaluation metrics include: 1) Staff perceptions of early mobility 2) Quality metrics of unit acquired pressure ulcers and falls. The campaign was launched in Nov 2016.

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SLIDE 9
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10

COMPLETE EARLY MOBILITY SURVEY

  • Email of the

URL to link you to the survey

  • 14 questions

(less than 5 minutes)

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SLIDE 11

11

PRESENT MOBILITY IN AM ROUNDING WITH MD’S

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SLIDE 12

12

EARLY MOBILITY TRACKER

  • Tracking sheet is to be

filled out daily by day and night shift, just

  • ne simple line
  • Multidisciplinary –

Filled out by Nursing and PT/OT

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SLIDE 13

INSENTIVES FOR STAFF

  • Launch

ch party y for day and nights htshif ift

  • Monthl

thly y Mobility ility Cham ampion pion for 1 yea ear r – Au B Bon Pa Pain Gift t Card

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RESULTS

  • Daily mobilization of 65.85% (349/550)
  • 90 MICU staff responded to the baseline survey, 34 completed the 6-month

follow up.

  • There was an improvement in staff belief in ability to safely mobilize patients

(X2, p < .001)

  • Patients mobilized once a shift more often (X2, P = .068).
  • Monthly fall and pressure ulcer rates declined post implementation.
  • 1 year post implementation - Average patients mobilized once a shift - 88%
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SLIDE 15

1 2 3 4 # of Falls Months hs 2016 - 2017

# of MICU CU Falls s Pre and Post t Initi tiat ation

  • n of Early Mobility

ty

Initiation of Early Mobility November 2016

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0.5 1 1.5 2 2.5 3 3.5

# of MICU CU Pa Patien ents ts with HAPU Pre and Post t Initi tiat ation

  • n of Early Mobility

ty

Initation of early mobility (Nov 16th)

  • ccurred after Survey
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8 4 3 4 3 1 1 1 1 2 3 4 5 6 7 8 9

November December January

# of Press ssure ure Ulcers ers

Month th

# of MICU CU HAPU FY 15 – FY 17

FY 15 FY 16 FY 17

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SLIDE 18

IMPLICATIONS FOR PRACTICE

Use of multiple strategies to improve a culture

  • f Early Mobility was successful in hardwiring

early mobility as standard care and increased

  • wnership among nursing staff. These

strategies (education, monitoring, reminders and feedback) may be used to improve other problems that affect patient outcomes.

Printed with permission

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MOVING FORWARD

  • Epic Documentation –

John Hopkins Highest Level of Mobility (JH- HLM) Scale

  • Mosaic Study
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QUESTIONS

Kristen.Clifford@vumc.org ICUdelirium.org