Early ICU mobility improves outcomes


By Debra AnscombeWood, RN A


cross the country, nurses working in interdisciplinary teams recognize the dangers of immobility in critically ill patients and the benefits of getting these patients up and moving, improving outcomes.


“The literature is rich with the benefits ofwhy it’s important to get patients


out of bed,” saidCosme F.Taipe,BSN,RN,CCRN, clinical programcoordina- tor atNewYork-PresbyterianWeillCornellMedical Center inNew York. “It’s the right thing to do for our patients,” said Taipe, who works on themedical center’s earlymobility program.


Benefits for patients Benefits include decreased time on mechanical ventilation, less delirium, less skin breakdown, greater lung expansion and less risk of pneumonia. Other advantages include improved circulation, less chance of deep vein thrombosis, less constipation and reduced debilitation. All of these positive points lead to fewer complications, shorter ICU and hospital stays and improved patient satisfaction. Anne Pohlman, MSN, APN-CNS, CCRN, FCCM, at the University


of Chicago Medicine Critical Care Clinical Research program, was involved in one of the early studies, “Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomized controlled trial,” published May 2009 in The Lancet. That study found 59%of patients in the earlymobility cohort were functional at discharge compared with 35% in the control group. “Doing this from the beginning is the difference between going home


and going to acute rehab at discharge,” Pohlman said. Progressive movement—from passive and active range of motion to


sitting on the side of the bed to walking—keeps the muscles moving and avoids the loss of muscle mass resulting from immobility, said Cynthia Fine, MSN, RN, CRRN, clinical coordinator for early mobilization in the ICUatNewYork-Presbyterian/ColumbiaUniversity Medical Center in New York. “Our goal is to get them asmobile as we can, looking at their baseline,”


Fine said. If patients walked prior to admission, the teamaims to ensure they are walking again before they leave.


Patient and family response Nurses must educate family members about the benefits. Taipe said once they understand, the families start to look forward to the mobilization and find it gives them hope. Some patients, Taipe said, have called the mobility effort the best part


of their stay, reporting that it helped them feel better as they are able to do a little more each day.


Team commitment For successful early mobility, every discipline—rehabilitation therapists, respiratory therapists, pharmacists, physicians and nurses—must take part, because early mobility requires coordination and flexibility. They


18 Visit us at NURSE.com • 2016


discuss the plan and set the schedule on rounds or during a huddle. The “Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit,” published in Critical Care Medicine, recommend a team approach and the use of checklists. “It requires the buy-in of all disciplines that this is


a priority,” Pohlman said. Nurses take several steps before getting the patient up. Nurses turn off the sedation prior to a spontaneous


breathing trial and getting the patient up. They admin- ister painmedication prior tomobilization. Then nurses monitor the patient’s condition, lines and breathing tubes as the activity progresses. “We couldn’t do this if it wasn’t for everybody


[working together],” Taipe said. Even so, early mobility represents a huge culture


change in the ICUand not one that happens overnight, Fine said. “Nurses are able to talk more with patients. We get speech-language pathologists involved early when we suspect the patient may have dysphagia, so we can determine the proper type of diet and liquids.” While early mobility of patients represents a change from the past, she indicated that it’s one worthmaking in every ICU across the country. “It should be everywhere; we should be getting people


up and moving,” Fine said. “There are many good reasons to do it and not many not to do it.” •


Debra AnscombeWood, RN, is a freelance writer.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46