Probing progressive mobility

The inherent nature of healthcare often involves the moving of critically ill patients – get it wrong and the repercussions could be literally life changing. But with the right knowledge and practice, it doesn’t need to be.

As evidence grows in support of the practice of early and progressive mobility for ICU patients, what is the best way for nurses to deal with the challenge of mobilizing the most critically ill patients?

Courtne Thurlkill, RN BSN,Director of Nursing, Warm Springs Specialty Hospital of Victoria, Victoria, TX

There are multiple challenges in mobilizing critically ill patients; the culture and/or physical environment of the ICU may be the biggest challenge. The multidisciplinary leadership of the unit should strive to eliminate as many challenges for the staff as possible; the availability of essential equipment is one. Healthcare disciplines with mobility as a common goal and value will promote patient-focused care ensuring a culture of mobility. Standardized protocols or order sets with explicit patient safety parameters have been shown to increase mobility more regularly and help promote the culture of mobility.

What do you see as the benefits of a progressive mobility therapy program?

Lori Olson, Assistant Director, Nursing, Sunnyside Care Center, Lake Park, MN

First and foremost, it is the benefit the patient receives from care that is patient-focused. More often than not, critical care focuses on the emergent tasks at hand to stabilize the patient until feasible to transfer to a lower level of care. With patient-focused care, we must look at and address the iatrogenic effects of the care we provide. The benefits of progressive mobility include, but are not limited to, the financial impact for organizations in the decrease in ICU and hospital length of stay, prevention of complications of immobility like polyneuromyopathy, and increased patient involvement in care with improved progression.

What are the advantages of using continuous lateral rotation therapy? In your view, what are the key elements of a successful CLRT program?

Karen Wells, Director of Clinical, CHS Home Care, Muncie, IN

Some of the advantages of CLRT reported in the literature are for the treatment and/or prevention of pulmonary complications such as acute respiratory distress syndrome, ventilator-associated pneumonia, maintenance of skin integrity, mobilization of pulmonary secretions, and decreased length of stay in intensive care.

Key elements of successful program are continuity in the application and utilization of rotational therapy.  The multidisciplinary health care providers should come to consensus on patient population criteria for use, guidelines or a standardized order set that includes parameters for rotation, pulsation and percussion therapies, discontinuance of CLRT, and outcome metrics.   Each institution should examine outcome metrics in their institutional experience with CLRT for efficacy. 

Patient repositioning forms the basis of many of our work-related injuries. How can a progressive mobility approach help alleviate this key health and safety issue?

Tamera Corsaro, Clinical Nurse Manager, Spaulding Rehabilitation Hospital, Boston, MA

Early progressive mobility has the potential to limit the severity of deconditioning, thus dependence the patient may have on the staff.  When the progression of mobility is based upon the patient's medical history, hemodynamic stability, mental status, and core muscle strength, safety for both the staff and patient is inherent.  Cohesive teamwork and coordination of activity is required.  Education on proper body mechanics and incorporation of safe patient handling techniques is of the utmost importance, not to mention the associated compliance.  Access to appropriate equipment such as walkers, chairs, portable ventilators, and beds that facilitate repositioning and allow full chair position with floor egress to facilitate standing are paramount.       

Biography

Amelia Ross is the Clinical Nurse Specialist for Pulmonary/Critical Care and Dr. Peter Morris is the Medical Director of the MICU at Wake Forest University Baptist Medical Center.  They are conducting research funded by the National Institute of Nursing Research to evaluate best practice for early ICU rehabilitation strategies for acute respiratory failure patients.