What are the barriers to mobilising ICU patients in a low-sedation high-mobilisation unit? An observational study

dc.contributor.authorBrock, Christopher
dc.contributor.authorMarzano, Vince
dc.contributor.authorWang, Jiali
dc.contributor.authorNeeman, Teresa
dc.contributor.authorGreen, Margot
dc.contributor.authorMitchell, Imogen
dc.contributor.authorBissett, Bernie M.
dc.date.accessioned2019-11-26T01:48:42Z
dc.date.issued2018-03-06
dc.date.updated2023-12-10T07:17:27Z
dc.description.abstractIntroduction: 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.
dc.format.mimetypeapplication/pdfen_AU
dc.identifier.issn1036-7314en_AU
dc.identifier.urihttp://hdl.handle.net/1885/186659
dc.language.isoen_AUen_AU
dc.publisherElsevier
dc.rights© 2017 Published by Elsevier Ltd.
dc.sourceAustralian Critical Care
dc.titleWhat are the barriers to mobilising ICU patients in a low-sedation high-mobilisation unit? An observational study
dc.typeJournal article
local.bibliographicCitation.issue2en_AU
local.bibliographicCitation.startpage131en_AU
local.contributor.affiliationBrock, Christopher, College of Health and Medicine, ANUen_AU
local.contributor.affiliationMarzano, Vince, Canberra Hospitalen_AU
local.contributor.affiliationWang, Jiali, College of Business and Economics, ANUen_AU
local.contributor.affiliationNeeman, Teresa, Administrative Division, ANUen_AU
local.contributor.affiliationGreen, Margot, The Canberra Hospitalen_AU
local.contributor.affiliationMitchell, Imogen, College of Health and Medicine, ANUen_AU
local.contributor.affiliationBissett, Bernie M., Canberra Hospitalen_AU
local.contributor.authoremailu4321232@anu.edu.auen_AU
local.contributor.authoruidBrock, Christopher, u5983414en_AU
local.contributor.authoruidWang, Jiali, u5298171en_AU
local.contributor.authoruidNeeman, Teresa, u4321232en_AU
local.contributor.authoruidMitchell, Imogen, u4549604en_AU
local.description.embargo2037-12-31
local.description.notesImported from ARIESen_AU
local.identifier.absfor110317 - Physiotherapyen_AU
local.identifier.absseo920299 - Health and Support Services not elsewhere classifieden_AU
local.identifier.ariespublicationu5369653xPUB49en_AU
local.identifier.citationvolume31en_AU
local.identifier.doi10.1016/j.aucc.2017.12.054en_AU
local.identifier.thomsonIDWOS:000427566100061
local.identifier.uidSubmittedByu5369653en_AU
local.publisher.urlhttps://www.sciencedirect.comen_AU
local.type.statusPublished Versionen_AU

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