An Initiative to Improve the Mobility of the Critically Ill: A Nurse-Driven Protocol

Problem/Background: More than 6 million Americans have a stay in the ICU each year frequently leading to prolonged bedrest and immobility. Research indicates that mobility is the single most important variable in maintaining and preserving short and long term physical function, yet often it's placed at the bottom of an ever-growing list of demands and duties for the Registered Nurse [RN]. Evidence-based mobility protocols remain in infancy with minimal research on their efficacy. We hypothesized that a Nurse-Driven Progressive Mobility Protocol would increase the number of times the Critical Care Nurse engaged the patient in activity. Method: In this single-center, systematic observational study nurse led mobility frequency of 202 intensive care patients was analyzed. Data was abstracted from the electronic medical record and compared to current best practice recommendations. An established mobility protocol from the American Association of Critical-Care Nurses was deemed appropriate. Education was provided to twenty-one critical care nurses followed by protocol implementation. A change statistic was calculated comparing groups 1 and 2, recognizing and accounting for variances. Results: 100% of all Intensive Care patients admitted during the research period were included in the study. Mobility frequency increased from 1.07 times/patient/day to 1.27 times/ patient/day with protocol application. Conclusion: Despite a change in frequency that the nurse employed on patient mobility, it failed to reach statistical significance. Although protocols are often used to ensure best practice with timely quality care this study suggests a nurse led mobility protocol may not be the most effective tool to increasing movement in the critically ill.