Implementation of an Interdisciplinary AACN Early Mobility Protocol
Open Access
- 1 August 2020
- journal article
- research article
- Published by AACN Publishing in Critical Care Nurse
- Vol. 40 (4), e7-e17
- https://doi.org/10.4037/ccn2020632
Abstract
Increasing mobility in the intensive care unit is an important part of the ABCDEF bundle. Objective To examine the impact of an interdisciplinary mobility protocol in 7 specialty intensive care units that previously implemented other bundle components. A staggered quality improvement project using the American Association of Critical-Care Nurses mobility protocol was conducted. In phase 1, data were collected on patients with intensive care unit stays of 24 hours or more for 2 months before and 2 months after protocol implementation. In phase 2, data were collected on a random sample of 20% of patients with an intensive care unit stay of 3 days or more for 2 months before and 12 months after protocol implementation. The study population consisted of 1266 patients before and 1420 patients after implementation in phase 1 and 258 patients before and 1681 patients after implementation in phase 2. In phase 1, the mean (SD) mobility level increased in all intensive care units, from 1.45 (1.03) before to 1.64 (1.03) after implementation (P < .001). Mean (SD) ICU Mobility Scale scores increased on initial evaluation from 4.4 (2.8) to 5.0 (2.8) (P = .01) and at intensive care unit discharge from 6.4 (2.5) to 6.8 (2.3) (P = .04). Complications occurred in 0.2% of patients mobilized. In phase 2, 84% of patients had out-of-bed activity after implementation. The time to achieve mobility levels 2 to 4 decreased (P = .05). Intensive care unit length of stay decreased significantly in both phases. Implementing the American Association of Critical-Care early mobility protocol in intensive care units with ABCDEF components in place can increase mobility levels, decrease length of stay, and decrease delirium with minimal complications.Keywords
This publication has 49 references indexed in Scilit:
- ICU Early MobilizationCritical Care Medicine, 2013
- Implementation of the Pain, Agitation, and Delirium Clinical Practice Guidelines and Promoting Patient Mobility to Prevent Post-Intensive Care SyndromeCritical Care Medicine, 2013
- Implementing the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility Bundle into Everyday CareCritical Care Medicine, 2013
- ICU Early Physical Rehabilitation ProgramsCritical Care Medicine, 2013
- Liberation and animation for ventilated ICU patients: the ABCDE bundle for the back-end of critical careCritical Care, 2010
- Early Mobility and Walking Program for Patients in Intensive Care Units: Creating a Standard of CareAmerican Journal of Critical Care, 2009
- Early intensive care unit mobility therapy in the treatment of acute respiratory failure*Critical Care Medicine, 2008
- Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priorityCritical Care Medicine, 2008
- Early activity is feasible and safe in respiratory failure patients*Critical Care Medicine, 2007
- Effects of Physical Training on Functional Status in Patients With Prolonged Mechanical VentilationPTJ: Physical Therapy & Rehabilitation Journal, 2006