Early Mobility for ICU Patients: An Evidenced-based Practice Project

Northwest Nazarene Marisa Yoder RN, BSN

University

Introduction Search Strategy Implementation Plan

• Intensive care unit (ICU) patients are at significant
risk for physical, mental, and emotional
deconditioning, leading to long-term deficits.
• Early mobility can reduce days on ventilator,
shorten hospital stays, and reduce days of delirium
(VUMC,2022).
• However, few protocols without limitations that
prevent mobilizing patients early.
Databases: Elsevier, Google Scholar, Medline, and EBSCO
Keywords: Early rehabilitation, functional status, ICU delirium, nurse
driven mobility, early mobility programs, recovery of mechanically
intubated, and mobility protocol.
Results: 30 articles identified, 8 met inclusion criteria, and 6 selected
because contained mobility protocols and reported outcomes for
immobility on ICU patients.
• The EBP project team will develop and implement a nurse
driven mobility protocol using the Iowa EBP model for early
mobilization in ICU patients to be evaluated over a six-
month period using the Iowa EBP model.
• Staff would receive education prior to the start of the
project. Data would be collected before and after protocol
start.
• Staff will complete a weekly survey to report on protocol
effects in the unit.

PICO Levels of Evidence Table

In adult ICU patients, does a nurse-driven protocol
compared to no mobility protocol shorten the time a Research Article Type of Study Level/Quality of Evidence
patient is immobile over a 6-month period?
Systematic Review with
Castro-Avila et al. (2015) I, High
Meta-Analysis
Retrospective Longitudinal
Fraser et al. (2015) III, High
EBP Model Study
Iowa Evidence-based Practice Model Iowa EBP, Retrospective
Linke et al. (2020) Pre- and Post- Intervention V, High
Data Collection

Bi-National Prospective,
The Team Study
Multi-Centre Observation III, Good Evaluation/Sustaining Methods
Investigators (2015) • Pre- and post- project will include average Richmond
Cohort Study
agitation sedation (RASS), mobility events, and more from
Systematic Review with electronic charting records.
Zhang et al. (2018) I, High
Meta-Analysis • At the end of the six-months, the plan will be to have ICU
Cross-Sectional National staff continue using the mobility protocol long term.
Zhang et al. (2022) III, High • Shift evaluations will be completed daily during rounding
Survey
events to trigger if mobility is indicated.
• Following evaluation, the protocol will be rolled out to the
remaining health system ICUs.
Summary of Evidence • This will be the key indication of a sustained project.
Patients who participated in early mobilization programs walked an
average of 41 feet further and spent two fewer days on mechanical
ventilation compared to standard care(Castro-Avila et al., 2015). References
• See separate handout.