Attention to Patients’ Mobility: Low-Tech But Essential

A critical care nurse led a multidisciplinary team to explore the effects of a dedicated ‘mobility team’ on functional and other outcomes in ICU patients.

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

julie kertesz/ via flickr creative common

julie kertesz/ via flickr creative common

It’s long been known that immobility leads to deconditioning. Various studies indicate that muscle strength drops by 3% to 11% with each day of bed rest. As most of us have witnessed firsthand in both patients and family members, it can take months to regain pre–bed rest levels of functioning. For some people, the strength and mobility needed for independence never return.

In this month’s issue, a community hospital critical care nurse led a multidisciplinary team to explore the effects of a dedicated “mobility team” on functional and other outcomes in ICU patients. In “Implementation of an Early Mobility Program in an ICU,” Danielle Fraser and colleagues share what they learned.

The mobility team consisted of a physical therapist, a critical care RN, and an ICU rehab aide. Respiratory therapists worked closely with the team. Patients assigned to the early mobility intervention could progress through four successive levels of movement, from passive range-of-motion exercises to full ambulation.

Compared with ICU patients who received routine care, the patients in the intervention group were more functionally independent at discharge. In addition, this early mobility group also had fewer falls, ventilator-associated events, pressure ulcers, and CAUTIs. They experienced fewer episodes of delirium and lower levels of sedation, and their hospitals costs were lower. And there was a 30% reduction in ICU readmissions!

Remarkably, all of this was accomplished by deploying the mobility team only on the day shift, Monday through Friday. The authors noted an interesting “side effect” of their study: the entire staff’s attention to preserving patients’ strength and mobility increased. Nurses throughout the unit invested more time in exercising their patients, and where possible, getting them out of bed. This probably improved outcomes in both the “routine care” and intervention groups—a win for all patients that went beyond the study itself.

 

About the Author:

Clinical editor, American Journal of Nursing (AJN), and epidemiologist

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