Year of Publication

2017

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Martha Biddle

Clinical Mentor

Jennifer Drumm

Committee Member

Dr. Melanie Hardin-Pierce

Abstract

Purpose: To evaluate ICU staff’s adherence to a new progressive mobility protocol as part of a quality improvement project in an adult medical-surgical intensive care unit (ICU).

Background: Bedrest can lead to complications for hospitalized patients and current literature supports that mobility within the ICU is safe and feasible for critically ill patients. Current evidence based literature identifies barriers to patient mobilization which can be addressed through implementation of a mobility protocol. Utilization of mobility protocols is one way to improve quality of care and prevent common bedrest complications in the critically ill patient population.

Methods: Retrospective medical record reviews were conducted pre (n=65) and post (n=54) implementation of the mobility protocol to provide descriptive data regarding staff adherence to the protocol and improvement in unit mobility practices. Activity orders, activity occurrences and type, as well as nurses’ documentation of the protocol phase in admission and daily re-assessments were evaluated.

Results: Documentation of activity orders from providers was less than 70% (35 out of 54) after implementation of the protocol. Eighty-one percent (44 out of 54) of the medical records reviewed had mobility phase assessed and documented by nurses on the admission assessment. Shift re-assessment of the patients’ mobility phase was low at 41% (22 out of 54) after implementation of the mobility protocol.

Conclusion: Improvement of utilization of the mobility protocol was seen over a six-month period with expanded mobility activities being documented by nursing staff. Additional refinement of the protocol will require more time and effort from key stakeholders and unit champions to improve staff adherence.

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