Author Of 2 Presentations
QUALITY IMPROVEMENT INTERVENTION TO PROMOTE EARLY MOBILIZATION IN THE PICU: NURSES' AND PHYSICIANS' OPINIONS AND PERCEIVED BARRIERS
Abstract
Background
Immobility negatively affects muscle function, circadian rhythm, and potentially increases the risk of delirium. Early mobilization (EM) of critically ill adults has been found safe and effective.
Objectives
We evaluated the opinions and barriers of nurses and physicians to EM before and after implementation of an EM program.
Methods
A questionnaire was distributed to PICU nurses and physicians before (December 2017) and after (October 2018) implementation of an EM program. Descriptive statistics were used.
Results
Ninety-four (59.1%) and 71 (48.6%) members of the PICU staff completed the survey, respectively before and after implementation. During both periods, the general opinion was that early mobilization is beneficial for critically ill children. The largest perceived benefits were shorter durations of ventilation and PICU stay, lesser use of sedatives, and improved day-night cycle (80.3-100%) during both periods. Patients’ family satisfaction with EM had increased from 17% before to 32.4% after implementation. Before implementation, time constraint (64%), physiological instability (63%), risk of endotracheal tube dislocation (63%), loss of indwelling central venous catheter (60%), lack of equipment (53%), and increased workload (51%) were ranked as important barriers to EM. After implementation, only time constraint (73%), and risk of endotracheal tube dislocation (51%) were perceived as important barriers (p<0.001). Support of physical therapists for EM was perceived as significantly higher after implementation: 33% vs. 76% (p<0.001).
Conclusion
All nurses and physicians considered EM as important for critically ill children. Further, our research demonstrates that most of the perceived barriers had been resolved after implementation of EM.
QUALITY IMPROVEMENT INTERVENTION TO PROMOTE EARLY MOBILIZATION IN CRITICALLY ILL CHILDREN.
Abstract
Background
Immobility negatively affects muscle weakness, circadian rhythm, and potentially increases the risk of delirium. Providing early mobilization (EM) during the Intensive Care Unit (ICU) stay has shown effective in adults.
Objectives
We determined the feasibility and safety of the implementation of an EM program in a Pediatric ICU (PICU).
Methods
A prospective pre-posttest implementation study was conducted in patients admitted on a PICU for at least 3 days. This quality improvement project involved a usual care baseline phase, followed by a quality improvement phase implementing a multicomponent, multidisciplinary protocol for early mobilization of critically ill children. Primary outcome was the number of mobilization activities. Secondary outcomes were prevalence of delirium, consumption in sedatives, and mobilization related adverse events.
Results
In total, 61 children (pretest) and 56 children (posttest) were included, with a median age of 28 months (IQR 10-103) and 38.5 months (IQR 7-152), respectively. The median number of mobilization activities increased from 5 (IQR 3-7) to 6 (IQR 4-8) (p<0.0001). Among children who were ventilated, there was an increase in the proportion who participated in sitting in a chair: 27% vs. 54% (p<0.029). The delirium rate was not different between the pretest and posttest (15.3% vs. 14.0%; p=0.842). Further, there were no differences in median midazolam day doses (2.8 vs. 2.9 mg/kg; p=0.799) and morphine doses (0.18 vs. 0.22 mg/kg; p=0.797). No mobilization related adverse events were documented after implementation of the EM program.
Conclusion
Implementation of a structured EM program in PICU patients is feasible and resulted in no adverse events.
Presenter of 1 Presentation
QUALITY IMPROVEMENT INTERVENTION TO PROMOTE EARLY MOBILIZATION IN THE PICU: NURSES' AND PHYSICIANS' OPINIONS AND PERCEIVED BARRIERS
Abstract
Background
Immobility negatively affects muscle function, circadian rhythm, and potentially increases the risk of delirium. Early mobilization (EM) of critically ill adults has been found safe and effective.
Objectives
We evaluated the opinions and barriers of nurses and physicians to EM before and after implementation of an EM program.
Methods
A questionnaire was distributed to PICU nurses and physicians before (December 2017) and after (October 2018) implementation of an EM program. Descriptive statistics were used.
Results
Ninety-four (59.1%) and 71 (48.6%) members of the PICU staff completed the survey, respectively before and after implementation. During both periods, the general opinion was that early mobilization is beneficial for critically ill children. The largest perceived benefits were shorter durations of ventilation and PICU stay, lesser use of sedatives, and improved day-night cycle (80.3-100%) during both periods. Patients’ family satisfaction with EM had increased from 17% before to 32.4% after implementation. Before implementation, time constraint (64%), physiological instability (63%), risk of endotracheal tube dislocation (63%), loss of indwelling central venous catheter (60%), lack of equipment (53%), and increased workload (51%) were ranked as important barriers to EM. After implementation, only time constraint (73%), and risk of endotracheal tube dislocation (51%) were perceived as important barriers (p<0.001). Support of physical therapists for EM was perceived as significantly higher after implementation: 33% vs. 76% (p<0.001).
Conclusion
All nurses and physicians considered EM as important for critically ill children. Further, our research demonstrates that most of the perceived barriers had been resolved after implementation of EM.