What are the barriers to mobilising ICU patients in a low-sedation high-mobilisation unit? An observational study
Date
2018-03-06
Authors
Brock, Christopher
Marzano, Vince
Wang, Jiali
Neeman, Teresa
Green, Margot
Mitchell, Imogen
Bissett, Bernie M.
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Elsevier
Abstract
Introduction: Mobilisation of intensive care (ICU) patients reduces ICU and hospital length of stay, attenuates ICU-acquired weakness, and reduces mortality 12 months post-discharge. Despite these benefits, the prevalence of mobilisation in ICU is low (12–54%). In 2012 we showed that our mobilisation rate at The Canberra Hospital (TCH) was high (54%) and our barriers to mobilisation included avoidable factors such as femoral lines and timing of procedures. These barriers may have changed with time and staff turnover.
Objectives: We sought to describe our current mobilisation practice at TCH ICU, and identify current barriers to mobilisation and factors associated with successful mobilisation.
Methods: A four-week prospective clinical audit was conducted (October–November 2016) in our 31-bed ICU, capturing 202 patients (105 medical, 83 surgical, 14 trauma) comprising 742 patient days. The frequency and intensity of mobility events, and patient neurological, haemodynamic and respiratory status was extracted from the MetaVision database. Generalised linear mixed models were used to describe associations between demographics, clinical factors and successful mobilisation.
Results: 73% of patients were mobilised on 51% of patient days. Active mobilisation, bed to chair active transfer and bed to chair passive sling transfer occurred on 22%, 16% and 13% of patient days respectively. The most common barriers preventing mobilisation were drowsiness (18%), haemodynamic/respiratory contraindications (17%), medical orders (14%), and patient non-compliance (11%). No serious adverse events were recorded. Glasgow Coma Score (OR = 1.53, 95%CI 1.32–1.78), and male sex (OR = 1.83, 95%CI = 1.06–3.13) were predictors of successful mobilisation, but not age (OR = 1.01, 95%CI 0.99–1.03) or disease severity (APACHEII, OR = 1.03, 95%CI 0.99–1.07).
Conclusion(s): In TCH ICU, mobilisation rates remain high relative to international prevalence data. The most frequent barriers to mobilisation were drowsiness and haemodynamic/respiratory contraindications. These barriers may be unavoidable. High GCS and male sex were associated with successful mobilisation, but not disease severity or age.
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Australian Critical Care
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Journal article
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2037-12-31
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