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Now that I have completed some further research and assignments for my evidence-based project my proposed solution has evolved to the development of a nurse-driven mobility protocol.

Many times patients are admitted to the ICU and placed on bedrest due to illness or invasive lines/tubes/drains. The risks associated with bedrest leads to complications such as DVT, decreased cardiac output, and pressure ulcers (Ronnebaum, Weir, & Hilsabeck, 2012). Many studies have demonstrated that mobility of ICU patients is safe and results in multiple benefits for patients.

Creating a protocol that includes an assessment of mobility criteria, utilizing the existing Bed Mobility Assessment Tool (BMAT), and allowing nurses to order physical therapy will increase the number of patients participating in mobilization.

The assessment of mobility criteria would be a task that fires immediately after the patient is admitted to ICU with the goal of mobilization within 72 hours, this would prevent decondition that generally happens after 72 hours of bedrest (Drotlet, et al., 2013). The assessment would include criteria such as vitals and medications that may prevent the patient from participating in therapy. Utilizing the BMAT also allows the nurse to assess the current mobility level.

Based on the assessments, the nurse may begin mobilization activities with the patient or order physical therapy to evaluate. When I first envisioned my plan I wasn't sure how to implement early mobility, but through advanced research I have read about protocols that have worked for other ICUs. Many protocols strictly involve the use of physical therapists, this is not needed for all patients.

If a nurse assesses a patient and determines they are safe to participate in mobility exercises, the nurse should be able to assist in that process. For more critical patients, such as those that are intubated, a physical therapist should be involved in the mobility plan. By evaluating the patient population in Banner Estrella's ICU and advancing my research I have come to my current ideas on early mobility of ICU patients.

References

Drotlet, A., Dejulio, P., Harkless, S., Hendricks, S., Kamin, E., Leddy, E., & Williams, S. (2013). Move to imporve: The feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings. Physical Therapy, 197-207.

Ronnebaum, J., Weir, J., & Hilsabeck, T. (2012). Earlier Mobilization decreases the length of stay in the intensive care unit. Journal of Acute Care Physical Therapy, 204-210.