Post-Intensive Care Syndrome (PICS) is an emerging area of research in critical care. PICS is a phenomenon in which patients admitted to an intensive care unit (ICU) develop long-lasting symptoms such as weakness, fatigue, decreased mobility, anxiety, depressed mood, sexual dysfunction, sleep disturbances and other cognitive issues.
PICS can be a life-altering and debilitating diagnosis for patients. A significant predictor for the development of PICS is a patient who experiences delirium during an ICU admission. The Society of Critical Care Medicine has developed a group of interventions to prevent the occurrence of hospital-induced delirium, known as the ICU Liberation Bundle or the ABCDEF Bundle. The bundle includes six elements designed to reduce the length of stay in the ICU and expedite a timely and safe discharge from the ICU. The fifth component of the bundle is early mobility. This remains challenging for nurses in a fast-paced, high-acuity unit like the Rush University Medical Center adult intensive care unit. It is essential to understand that mobility exists on a continuum and that even a passive range of motion benefits someone critically ill. Following a practice gap analysis, the AICU Progressive Mobility Committee, under the leadership of Tia Davis, RN3, identified an opportunity to enhance patient movement. Chart reviews and real-time observations identified that only 25 to 30% of capable patients were mobilized during unit stays.
Recognizing the many facets necessary to promote mobility, the committee set goals to increase clinical nurses, patient care techs, and patients’ education and awareness of mobility benefits. This would ultimately increase the movement of AICU patients. The project held the following goals:
- Increase early mobility in ICU patients
- Improve mobility documentation and use of mobility screening tool
- Improve communication with the interdisciplinary team
- Improve clinician knowledge and proper use of lift equipment and specialty beds
The AICU Progressive Mobility Committee implemented numerous interventions to reach these goals. During fiscal year 2024, weekly activities focused on staff education regarding the benefits of early mobility and the available resources. Committee members wearing specially designed T-shirts emblazoned with the slogan “Mobility is Medicine” led the unit in educational activities. Topics included the safe and appropriate use of various types of lift equipment, criteria for using specialty beds to support verticalization therapy and the “why” behind these best practices. Other interventions included:
- The unit clerk sent “Get Em’ Up” reminders to the clinical staff phones, reminding them to move eligible patients to a chair by 6 a.m.
- A staff survey gathered educational needs and input on areas needing mobility practice support.
- Clinician education on progressive mobility, the screening tool and appropriate electronic medical record (EMR) documentation.
- A bulletin board highlighted team members with mobility expertise.
- A hard stop was built within the electronic admission order set for the provider to indicate patients eligible for mobility.
- Routine audits were performed to evaluate adherence to the interventions.
- The committee recognized staff members who made significant efforts to mobilize patients.
Through the work of the AICU Progressive Mobility Committee, nurses have reported increased knowledge and prioritization of early patient mobilization, including the appropriate use of supports like lift equipment and verticalization therapy. The results of the weekly audits demonstrate adherence to the activity orders and the screening tool in the EMR. In one month, night shift mobility increased by 40%, overall mobility increased by 50%, and compliance with the activity order reached 100%. Most importantly, AICU patients have benefitted from increased mobility.