• Critical care nurse · Aug 2020

    Comparative Study

    Implementation of an Interdisciplinary AACN Early Mobility Protocol.

    • Marilyn Schallom, Heidi Tymkew, Kara Vyers, Donna Prentice, Carrie Sona, Traci Norris, and Cassandra Arroyo.
    • Marilyn Schallom is director, Heidi Tymkew and Donna Prentice are research scientists, Kara Vyers is a research coordinator, and Cassandra Arroyo is lead statistical analyst, Department of Research for Patient Care Services, Barnes-Jewish Hospital, St Louis, Missouri.
    • Crit Care Nurse. 2020 Aug 1; 40 (4): e7-e17.

    BackgroundIncreasing mobility in the intensive care unit is an important part of the ABCDEF bundle. Objective To examine the impact of an interdisciplinary mobility protocol in 7 specialty intensive care units that previously implemented other bundle components.MethodsA staggered quality improvement project using the American Association of Critical-Care Nurses mobility protocol was conducted. In phase 1, data were collected on patients with intensive care unit stays of 24 hours or more for 2 months before and 2 months after protocol implementation. In phase 2, data were collected on a random sample of 20% of patients with an intensive care unit stay of 3 days or more for 2 months before and 12 months after protocol implementation.ResultsThe study population consisted of 1266 patients before and 1420 patients after implementation in phase 1 and 258 patients before and 1681 patients after implementation in phase 2. In phase 1, the mean (SD) mobility level increased in all intensive care units, from 1.45 (1.03) before to 1.64 (1.03) after implementation (P < .001). Mean (SD) ICU Mobility Scale scores increased on initial evaluation from 4.4 (2.8) to 5.0 (2.8) (P = .01) and at intensive care unit discharge from 6.4 (2.5) to 6.8 (2.3) (P = .04). Complications occurred in 0.2% of patients mobilized. In phase 2, 84% of patients had out-of-bed activity after implementation. The time to achieve mobility levels 2 to 4 decreased (P = .05). Intensive care unit length of stay decreased significantly in both phases.ConclusionsImplementing the American Association of Critical-Care early mobility protocol in intensive care units with ABCDEF components in place can increase mobility levels, decrease length of stay, and decrease delirium with minimal complications.©2020 American Association of Critical-Care Nurses.

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