Authors (including presenting author) :
Tsang HC(1), Lam KN(2), Choi CM(1), Tam KL(1), Tang KL(1), Tang PY(2), Yeung WY(2), To YL(1), Sun TF(3)
Affiliation :
(1)Physiotherapy Department, (2)Intensive Care Unit, (3)Hospital Chief Executive Office, North District Hospital
Introduction :
Early mobilization (EM) for patients with critical illness has been reported to reduce ICU-acquired weakness, shorten hospital stay and improve functional recovery. A 2-year trial of EM involving physicians, nurses and physiotherapists was implemented in a 15-bed ICU in an attempt to translate clinical evidence into practice.
Objectives :
To examine the feasibility and safety of EM for ICU patients in a local hospital.
Methodology :
According to a mobilization protocol and triage pathway designed by the physiotherapists, patients were assessed every morning for the feasibility to mobilize and triaged to receive either on-the-bed or out-of-bed exercise with the assistance from nursing staff. Results of the first year trial were reviewed and the program was refined in the next year.
Result & Outcome :
Among 769 patients admitted to the ICU in 2017, 13% patients were contraindicated to any form of mobilization. 67% were given passive mobilization, 15% were able to sit out of bed, 5% were able to stand while 1% were able to walk with assistance. Gaining the experiences in the first year, ward staff became more familiar with the mobilization procedures and techniques and they were also less worrisome towards EM. To further enhance patients’ progress on mobilization, a weekly ward round among physicians, nurses and physiotherapists was implemented. Of the 764 patients admitted to the ICU in 2018, 12% patients remained contraindicated to mobilization. The percentage of patients given passive mobilization dropped to 53% as more patients were progressed to the next levels of mobilization. Patients who were able to sit out of bed increased to 25%, those who were able to stand increased to 7% while 3% of them were able to walk with assistance. No adverse incident was reported during the 2-year trial. Conclusion:
EM for ICU patients is feasible and safe. The practice took time to allow related personnel to familiarize and cultivate change. The implementation of the daily ward round enhanced inter-professional communication, facilitated colleagues to work out solutions for the barriers and aligned common goals for mobilization.
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