Early Mobilization in Mechanically Ventilated Patients: A QI Project at a Large Teaching Institution

This is a quality improvement project in a medical intensive care unit (MICU) with the aim of increasing the rates of early mobilization in mechanically ventilated patients. In spite of the research showing the benefits to early mobility, many institutions are slow to adopt this practice. Designing and implementing an early mobility protocol in the form of a quality improvement project can facilitate the adoption of this practice in a MICU. The objectives of this project included gaining an understanding of the current state of mobilization of intubated patients in the MICU through retrospective study. Increasing knowledge amongst the nursing staff, medical team, and support staff regarding the benefits and safety of early mobilization of intubated patients. To create an early mobility protocol using a collaborative interdisciplinary approach that could be easily interpreted and implemented by nursing staff in order to facilitate early mobilization. To increase the number of mechanically ventilated patients who ambulate and disseminate findings to hospital staff and management teams for the ICUs throughout the institution. Early mobilization has shown to decrease hospital and ICU length of stay. It has also shown a decrease in rates of delirium and improved functional ability at discharge. Barriers to the implementation of early mobility include safety concerns, sedation, cost, obesity, and time constraints of the staff. Other barriers include a lack of leadership, staffing, training, and referrals for physical therapy. There is evidence to suggest adverse events are uncommon. A three-month retrospective study was performed to identify the frequency of ambulation of mechanically ventilated patients in the MICU. A presentation was given to nursing staff to demonstrate the importance of early mobility. An early mobilization protocol was designed and implemented. A retrospective chart review was used to compare rates of ambulation before and after implementation of the protocol. Results were presented to hospital administration and the University Of Utah College Of Nursing. The rate of mobilization before and after implementation of the protocol was assessed. After implementation of the protocol the rate of mobile patients per 100 ventilated patients increased 117 percent. No adverse events were reported related to the protocol. In summary, an early mobility protocol was designed with the goal of increasing the rate of mobilized ventilated patients in the MICU. Staff members were educated regarding the importance of the protocol. After implementation the rates of patients who had mobility events while on the ventilator increased. This project demonstrated both the benefits and challenges of a collaborative, evidence based approach to changing practice.