CSI Summary
Available only to registered AACN.org users.
Project Topic
Early mobility in the ICU
Hospital UnitIntensive Care Unit (ICU)
CSI Participants
Emily Decker, BSN, RN
Macey Messina, BSN, RN
Kelsey Ruby, BSN, RN
Christi Schmitz, BSN, RN
Project Goals/Objectives
- To implement nurse-driven mobility protocol in the ICU with 90% charting compliance
Project Outcomes
- Increased staff awareness of the benefits of early mobility
- Created an appropriate and useful mobility tool to facilitate documentation
- Reduced incidence of hospital-acquired pressure injuries (HAPI) 33% (from three to two)
- Maintained zero cases of ventilator-associated pneumonia (VAP)
Project Overview
As an ICU with variable clinical acuity and very high staff turnover, our CSI team realized early mobility was getting pushed to the backburner. We wanted to come up with a protocol and standard of care that would easily guide staff and encourage early mobility for optimal patient outcomes.
After reviewing current evidence-based practice protocols and meeting with interdisciplinary staff in our hospital, we created a protocol that was appropriate for our patient population. We educated the ICU staff and other interdisciplinary colleagues about the protocol, and worked with our IT team to simplify mobility charting.
Data collection proved challenging due to our electronic health record (EHR) having cumbersome forms and multiple places to chart mobility. Six months after kickoff, our requested IT changes were only partially complete. Audit reports were extremely time-consuming due to the multiple required places to chart. Electronic audit reports and hospital data took eight months to receive and were then found to be erroneous and incomplete. Our charting compliance did not improve, but efforts to streamline the EHR and audit reports are still in process.
On the positive side, we were able to show improvement in HAPIs and maintain zero VAPs. Qualitatively, staff reports understanding the importance of implementing early mobility in their patients. We will continue to encourage staff to perform and document early mobility activities.
Permission to Reuse Materials
The materials associated with this AACN Clinical Scene Investigator (CSI) Academy project are the property of the participating hospital noted above, not AACN. Requests to use content contained in the CSI team’s summary, presentation or toolkit should be directed to the hospital. We suggest reaching out to the hospital’s Communications, Marketing or Nursing Education department for assistance.
Disclaimer
The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.