Implementing Early Mobility Guidelines in Medical Intensive Care Unit

Patient early mobility has emerged as a safe and effective strategy to alleviate ICU-acquired weakness in critically ill individuals. Local Problem: In our local hospital's 25-bed Medical Intensive Care Unit (MICU), patients frequently experience sedation and prolonged bedrest, contributing to muscular dystrophy, extended mechanical ventilation, prolonged hospitalization, and, ultimately, elevated mortality rates. Methods: To address this challenge, we developed and implemented an early mobility guideline program for MICU nurses during a focused 6-week period. The project measures included guideline utilization documentation and the use of targeted pre- and post-implementation surveys that assessed nurse comfort and confidence levels when conducting early mobilization, plus barriers to implementation. The analysis included descriptive and inferential statistics, including the Chi-square and Mann-Whitney U test. Interventions: The early mobility guidelines included education and resources for identifying and mobilizing patients who qualified for this program. Results: Independent sample groups included 51 nurses who completed the pre-survey and 39 post-survey participants. The post-implementation nurses reported a statistically significant increase in confidence in mobilizing patients on mechanical ventilators and vasopressors. However, project results also highlighted challenges with implementation and sustainability. Our process measures revealed that the guidelines were implemented for 65% of qualifying patients during the day and 42% during night shifts, with a charting completion frequency of the ICU mobility scale ranging between 20-40%. A prominent barrier identified in both surveys was the absence of a secondary staff member to assist with patient mobilization. Conclusion: While the early mobility guideline program demonstrated some effectiveness, sustaining its impact necessitates additional measures. Proposals for dedicated mobility personnel assignment or the enforcement of a more strategic audit system for patient mobility charting would be vital to ensuring the continued success of the guidelines and fostering a long- term culture of patient early mobility.