Progressive mobility team’s efforts decrease mechanical ventilator days
TEAM: ICU Progressive Mobility
ENTRY SUBMITTED BY: Amanda J. Golino, MSN, RN, CCRN, CCNS, clinical nurse specialist
Decreased mechanical ventilator days have been clinically proven to have a wide range of positive effects on the critically ill patient. These effects can include decreased delirium, a decrease in ICU length of stay and overall hospital stay, and decreased mortality. After reviewing the literature, the ICU Progressive Mobility (PM) team at Loudon Medical Center developed a formal Progressive Mobility program with standard work that addressed the unit’s unique workflow challenges.
Our question was: “In adult patients on an intensive care unit, does the use of a progressive mobility protocol for ventilated patients decrease mechanical ventilator days?”
The team was awarded a grant to fund the evidence-based project. The grant paid for clinical nurses to work on the project outside of regular work hours.
Our goals included:
Decrease mechanical ventilator days.
Establish standard work for mobility in our ICU.
Educate the nursing staff on Progressive Mobility.
Include a family advisor to develop specific patient and family education about mobility.
During the course of the project, a standardized work flow was developed, and clinical staff was educated by PM nurse fellows. The team identified that there was a need for patient and family education, including a brochure explaining progressive mobility, signage for the waiting room, a step chart for the patient’s room. Passive range-of-motion (PROM) handouts were developed with the help of a patient/family advisor, nursing, and physical and occupational therapists. An educational video reviewing PROM exercises for families was also created and uploaded to the hospital’s YouTube account.
Quality of application of the workflow, including nursing documentation in the EMR, was monitored through daily rounds on vented patients by a team member. A tracking log was developed and audited by the nurse fellows to determine what PM step patients achieved. This was then communicated in a central location on the nursing unit to facilitate mobility between physical, occupational, and respiratory therapy as well nursing handoff. The team met weekly during the project duration to process feedback, address barriers, and revise workflow as needed.
Average ventilator days for June-August of 2014 were 5.33 compared to 4.52 for June-August of 2015, indicating a decrease of nearly one ventilator day. Our greatest impact on mechanical ventilator days was seen in mechanical ventilator length of stay for patients on ventilators greater than 14 days; decreasing from 7 patients in 2014 to 2 in 2015.
The cost of an intensive care unit bed at our institution is $3, 283 per day; fifty-nine patients were mobilized in our project during the three month project timeline. This cost savings associated with reducing mechanical ventilator days was significant for our institution.
In addition to reducing ventilator days, the team found that patients were being advanced further in their mobility goals. At project onset, the team progressed 33% of vented patients past Bedrest (Step 1) compared to 75% past Bedrest (Step 1) at completion.
Lessons learned include the recommendation to form an interprofessional team to organize, develop, educate, and implement a Progressive Mobility program. The presence of a patient/family advisor was vital to ensuring the initiative was family centric. Ongoing communication during the project was critical in addressing barriers and championing successes. During the project changes needed to be made quickly as the need arose. Six months after completion, the team continues to meet to discuss mobility and make changes as need to improve the process and communicate effectively.