Date Available

4-9-2025

Year of Publication

2025

Document Type

DNP Project

Degree Name

Doctor of Nursing Practice

Faculty

Dr. Sheila Melander

Committee Member

Alexis Fields

Abstract

Background: Many intensive care unit (ICU) patients are critically ill and require ventilator support, and they often do not receive any progressive mobility interventions until after they are liberated from the ventilator or receive transfer orders out of the ICU. Current literature suggests that patients in the ICU face deconditioning, increased ventilator days, development of deep vein thrombosis, pressure ulcers, pulmonary embolism, muscular atrophy, and increased days in the ICU which can be attributed to a lack of mobility. Current evidence-based research identifies that utilization of a progressive mobility protocol is one way to improve patient outcomes and reduce common complications in critically ill ICU patients, such as one less day in the ICU along with 34 less ventilator days and a potential annual savings of $2.9 million USD per year. This paper will discuss the impact of a progressive mobility protocol among ICU patients at Ballad Health’s Johnson City Medical Center.

Purpose: To evaluate the efficacy of a progressive mobility protocol among adult ICU patients and their outcomes, utilizing an EPIC chart review both pre and post protocol implementation and identify a gap for improvement.

Methods: A quasi-experimental retrospective chart review, with randomization during a one-month period, was conducted pre (n=77) and post (n=99) implementation of the progressive mobility protocol. Key variables examined were patient ventilator free days, length of mechanical ventilation, ICU length of stay, hospital acquired infections including associated ventilator, urinary catheter and central line infection rates, as well as patient mobility, rapid responses, and Charleson comorbidity index (CCI) scores related to prolonged ventilation due to immobility.

Results: Ventilator free days worsened by 1.3 days in total (25 out of 117), patient infection rates increased by 3 percent (7 out of 25), and mechanical ventilator days increased by 2 days while utilizing the progressive mobility protocol. Patient ICU length of stay was 11 days in patients that utilized the progressive mobility protocol compared to 3 days in the control group. Within the intervention group, 24 percent of patients had a rapid response called (6 out of 25) compared to 19.56 percent in the control group (18 out of 92). CCI scores were lower in the intervention group, 3 compared to 5.

Conclusion: The findings from this project show no statistically significant differences with utilization of a progressive mobility protocol when compared to current practice standards. The key limiting factors of this study were provider implementation variability and sample power size. Power analysis algorithms hold promising forecasts for PMP utilization in the ICU for healthcare system, however a larger sample size and duration of study is needed to achieve current research and literature findings. Moreover, further staff training is needed to improve adherence to the existing protocol before its application across the healthcare enterprise.

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