Introduction: A nurse-driven protocol enables nurses to engage in mobilization based on patients’ highest level of functional capacity. Nurses can implement mobility interventions that adhere to the criteria outlined in the protocol prior to receiving primary care provider orders. This is beneficial for patients by reducing delays in care.
Methods: A retrospective chart analysis was conducted for an early mobility protocol quality improvement project. Project implementation occurred between September 21, 2020 to November 17, 2020. The Agency for Healthcare Research and Quality (AHRQ) Medical Screening Algorithm guidelines was used to evaluate patient’s appropriateness to engage in mobilization maneuvers. A pre- and post- Johns Hopkins Patient Mobilization Attitudes and Beliefs survey identified barriers to mobilizing inpatients. The AHRQ Progress Mobility Algorithm enhanced mobilizing patients to activity level – 3 within 48 hours of admission to the MICU and nurses will perform active/passive range of motion three times a day.
Results: There were 158 patients in the pre-implementation group and 95 patients in the post-implementation group. In the post-implementation group only, the level of mobility did significantly increase from intake (M = 1.44, SD = 1.77) to leaving the ICU (M = 2.04, SD = 1.81), U = 510, p < .0001. Within the first 48 hours of arriving in the ICU, 29 out of 95 patients (30.5%) reached at least level-3 of mobility. Forty-seven patients were at level 0 at admission to the ICU unit which decreased to twenty-nine upon leaving. The number of range of motion sessions completed with a drop-off across the day. The nurses’ at 9AM completed 351 range of motion (ROM) sessions, followed by 305 sessions at 3PM, and 212 sessions at 9PM.The Johns Hopkins Mobilization Attitudes and Beliefs survey showed (3 out of 26 items) significant increases in agreement with the statement (Question 14 [p = 0.015], Question 24 [p = 0.014], Question 11 [p = 0.016]).
Conclusions: Immobility can be detrimental to a patients’ wellness and subsequently increase their risk for additional complications. The utilization of an early mobilization protocol and medical screening tools reduced gaps in knowledge and subsequently equipped nurses to integrate early mobilization and passive/active ROM into daily practice.
