Early Mobility Program takes hold across Health System
It’s a Catch-22 situation. A critically ill patient must rest. But resting can mean new complications such as pressure ulcers, pneumonia, weakness or malnutrition. Now the Early Mobility Program at the University of Michigan Health System has critically ill patients out of bed early—and hospitals across the country are taking notice.
“Even though patients are on a ventilator, we can still get them up and walking. It may look awkward, but it works. Many patients actually prefer it. They don’t want to be tied down. New medical literature supports that this is a safe and feasible thing to do,” says Don Packard, MSPT, adjunct lecturer and a member of the lean team who developed the program.
The nursing teams on the Critical Care Medical Unit (CCMU) on 6D and the Surgical Intensive Care Unit (SICU) on 5D worked with Physical Therapy and physicians to develop new care plans that move patients earlier and more often.
For example, now Physical Therapy automatically does a physical therapy consultation for all ICU patients, to get things in motion right from the beginning.
“And bed rest orders have been replaced with progressive mobility orders,” says Sharon Dickinson, MSN, critical nurse specialist, SICU. Mobility is started as quickly as possible beginning with range of motion on all the limbs and progressing to getting the patient out of bed and walking.
Dickinson said SICU wanted to bring down their rate of pressure ulcers (PU). As a result of SICU’s new early mobility protocol—which Dickinson dubbed “Moving and Grooving”—SICU has seen a decrease in PU: from 15.8% for theirs patient in the month of February 2010 to a 0% in both January and February 2011.
CCMU saw similar results. During a six-month period, 38% of patients were discharged to home; after Early Mobility, the number rose to 58%. In addition, the average number of days that patients were on the ventilator dropped from 8.07 to 6.40 with Early Mobility; ICU length of stay (LOS) fell from 8.44 to 6.36 days; and hospital LOS dropped from 22.33 to 16.37 days.
“Early mobility is hard work, but the positive impact is undeniable,” says Noel Baldwin, RN, clinical care coordinator, CCMU. “Patients regain a sense of control and normalcy when they’re up and moving. Seeing is believing.”
The program is taking hold across the Health System from the step-down moderate care unit (8D) to Trauma Burn. “Our aim is to see it spread facility wide,” says Packard.
Beaumont and Detroit Medical Center are among the hospitals that have made site visits to U-M to learn about the program.
Packard and Baldwin have shared the approach with other teaching hospitals during national University Health Consortium and Society of Critical Care Medicine meetings, respectively.
The December issue of Critical Care Nurse Quarterly, edited by Dickinson and Leah Shever, PhD, RN, director of nursing research, quality and innovation, will feature U-M’s successes in early mobility.