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Background: Early mobilization of patients in intensive care units (ICUs) improves patient recovery, but implementation remains challenging. Protocols may enhance the rate of out-of-bed mobilizations., Aim: To evaluate the effect of implementing a protocol for early mobilization on the rate of out-of-bed mobilizations and other outcomes of ICU patients., Study Design: Multicentre, stepped-wedge, cluster-randomized pilot study., Methods: After a control period, five ICUs were allocated to the implementation of an inter-professional protocol for early mobilization in a randomized, monthly order. Mobilization of ICU patients was evaluated by monthly 1-day point prevalence surveys using the ICU Mobility Scale. The primary outcome was the percentage of patients mobilized out of bed, defined as level 3 on the ICU Mobility Scale (sitting on edge of bed) or higher. Secondary outcomes were mechanical ventilation, delirium and ICU- and hospital-days, as well as unwanted safety events., Results: Out-of-bed mobilizations increased non-significantly from 36·2% (n = 55) of 152 patients during the control period to 45·8% (n = 55) of 120 patients during the intervention period (difference 9·6%; 95% confidence interval -2·1 to 21·3%). Of 55 mobilized patients per group, more patients were mobilized once per day during the intervention period (intervention: n = 41 versus control: n = 23 patients). Multiple daily mobilizations decreased (control: n = 32 control versus intervention: n = 14 patients). Secondary outcomes, such as days with mechanical ventilation, delirium and in ICU and hospital, did not significantly differ. Adherence to the protocol was >90%; unwanted safety events were rare., Conclusions: Implementing a protocol for early mobilization of ICU patients showed a trend towards more patients being mobilized. Without additional staff in participating ICUs, a significant increase in ICU mobilizations was not to be anticipated. More research should address whether more staff would increase the number of frequent mobilizations and if this is relevant to outcomes., Relevance to Clinical Practice: Implementing inter-professional protocols for mobilization is feasible and safe and may contribute to an increase of ICU patients mobilized out of bed., (© 2019 British Association of Critical Care Nurses.)

Unlabelled: Patients admitted to the ICU are at risk of immobility and an early and important physical deconditioning., Objective: To develop and to implement an early and safe protocol for ICU patients' mobilization., Methodology: The Evidence Based Practice Model for Staff Nurses was used. It encompasses Assessment, Problem Identification, Planning, Implementation and Evaluation, Integration and Maintenance in Practice., Results: The research team (Advanced Practice Nurse and expert clinical nurses), along with the medical team and rehabilitation service, identified the need to develop the protocol. For its elaboration, a literature search on the data bases PubMed, CINA-HL and Cochrane Library was performed; a questionnaire was administered and structured observations were conducted. For the implementation training sessions were offered to nurses, posters were placed in the unit and protocol was included in the computer program. Finally, an assessment of the knowledge, perceptions and practices of nurses in the unit and a recording of adverse events related to the mobilization will take place., Conclusions: The development and implementation of a protocol for early mobilization of ICU patients has facilitated the integration of this care in daily practice. This model of evidence-based practice allows nurses an active part in changing the culture in terms of the integration of research into practice.

This evidence-based project was undertaken to implement research-based preventive protocols to decrease the negative outcomes associated with delirium/acute confusion. After implementation, the medical-surgical unit experienced a 62% reduction in falls and a 100% decrease in sitter usage the first year. The use of medications known to cause acute confusion was decreased by more than 50%. Since implementation, the fall rate as well as the use of restraints has decreased by 25%.

Although the complications of immobility are well-described in the literature, critically ill patients are often subjected to prolonged periods of bed rest. Nurses, by virtue of their expertise in preventing iatrogenic complications, are in an ideal position to prevent the adverse outcomes associated with immobility. This article describes how nurses can use a mobility protocol to increase the activity of critically ill patients in a timely manner that may prevent the infirmity and suffering that is caused by unnecessarily long periods of bed rest.

Growing interest in reducing costs for patients requiring long-term mechanical ventilation has led to development of different care delivery models. This article describes the development and implementation a respiratory care process model focusing on best practices and improvement in care, including early mobility. To implement the care process model, the authors had to make significant changes in the respiratory ICU (RICU), which included changes in how the RICU staff worked together. ICU culture was transformed in a way that resulted in improved and consistent care, including early mobility, while stabilizing or even decreasing cost. Involvement of front-line staff in early mobility and other components of the care process model resulted in the development of a culture of safety and teamwork.