Year of Publication

2017

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Carol Thompson

Clinical Mentor

Dr. Esther Dupont-Versteegden

Committee Member

Dr. Melanie Hardin-Pierce

Abstract

Abstract

Background: Immobilization is a commonly observed problem for adults in the intensive care unit (ICU) that may lead to ICU delirium, ICU associated weakness, increased length of hospital stay, and increased mortality17. Therefore, early mobilization has become an increasingly imperative priority regarding the treatment plan for patients in the ICU. Mobilization is often delayed or completed on a subjective provider basis due to scarcity of resources and outdated evidence-based knowledge7. This examination of adherence to an evidence-based protocol helps to assess efficiency of therapeutic outcomes regarding early ambulation of surgical thoracic patients in the critical care setting.

Objectives: The objectives of this retrospective electronic medical record review were to examine adherence to an early mobilization protocol in the University of Kentucky’s cardiovascular intensive care unit (CVICU; ambulation, range of motion, sitting on edge of bed, etc.) and to identify associations between early mobilization and the number of CVICU days and hospital length of stay.

Methods: A six-month retrospective cross-sectional analysis was completed on surgical thoracic subjects who stayed inpatient in the 32-bed CVICU between January 1, 2016 through July 1, 2016. Forty electronic medical records were analyzed for this study.

Results: The percentage of surgical thoracic patients in the CVICU who exhibited adherence to the early mobilization protocol was 77.5% of the total population. The results indicated that both the length of hospital stay (P = .04) and length of ICU stay (P =.01) were significantly different between patients who were adherent vs non-adherent. Regression analysis shows that independent variables such as gender (P >.99), age (P = .90), number of co-morbidities (P =.60) and diagnosis (P =.40) did not show statistical significance in relation to adherence of the protocol.

Discussion: Adherence to the University of Kentucky cardiovascular-thoracic early mobilization protocol is associated with decreases in hospital and ICU lengths of stay of surgical thoracic patients. This study has future implications for the multidisciplinary team of nursing, physicians, hospital administration, and therapists surrounding the positive patient outcomes and cost-effectiveness associated with the adoption and utilization of early mobility initiated in the ICU. Additional studies with larger sample sizes may be warranted to assess further confounding variables and barriers that may be associated with hindrance of adherence to the protocol.

Key words: Early mobilization, thoracic, intensive care unit, ambulation, critical care, physical therapy

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