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Progressive Mobility (PM): Evidence Based Program Improves Outcomes in Critically Ill Patients Bea Leyden, BSN, MBA, RN, CPHQ, NEA-BC Jefferson Health – Northeast

Progressive Mobility (PM): Evidence Based Program Improves ......Evidence-Based Care •Research supports using the ABCDE Bundle (Balas et al, 2012), where disciplines collaborate

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Page 1: Progressive Mobility (PM): Evidence Based Program Improves ......Evidence-Based Care •Research supports using the ABCDE Bundle (Balas et al, 2012), where disciplines collaborate

Progressive Mobility (PM):

Evidence Based Program

Improves Outcomes in

Critically Ill Patients

Bea Leyden, BSN, MBA, RN, CPHQ, NEA-BC

Jefferson Health – Northeast

Page 2: Progressive Mobility (PM): Evidence Based Program Improves ......Evidence-Based Care •Research supports using the ABCDE Bundle (Balas et al, 2012), where disciplines collaborate

Background

The team’s overarching goal is to prevent

complications of reduced mobility in critically

ill patients. Our goals included:• LOS in ICU: Reduce LOS by 5%

• Mean Days on Ventilator: Reduce mean days by 10%

• Ventilator Associated Events: Reduce by 25%

• Hospital Acquired Pressure Injures (Stage II or Greater)- target of

zero occurrences

• Falls with Injury (utilizing National Database of Nursing Quality

Indicators Injury definitions including Minor Injuries) – target is

zero occurrences

• Staff Injuries related to Patient Handling – target is zero

occurrences

Page 3: Progressive Mobility (PM): Evidence Based Program Improves ......Evidence-Based Care •Research supports using the ABCDE Bundle (Balas et al, 2012), where disciplines collaborate

The Senior Leadership Team (SLT) supported this initiative

since its inception.

• Nursing staff attended a national critical care conference

and learned about several best practices including PM.

• Presented a proposal to SLT to initiate a PM program and

received approval.

• SLT supported the initiative and related purchases such as

specialty walkers and ceiling mounted patient lifts.

• PM Program has been able to demonstrate cost savings and

improved outcomes.

Leadership Commitment

Page 4: Progressive Mobility (PM): Evidence Based Program Improves ......Evidence-Based Care •Research supports using the ABCDE Bundle (Balas et al, 2012), where disciplines collaborate

Methodology

• Utilized the IOWA

Model for

implementation of

evidence based

practice

• Developed an A3

work plan utilizing

DMAIC

methodology

(Define, Measure,

Analyze, Improve,

Control)

• Monitored key

outcome metrics

3/22/2018

Page 5: Progressive Mobility (PM): Evidence Based Program Improves ......Evidence-Based Care •Research supports using the ABCDE Bundle (Balas et al, 2012), where disciplines collaborate

Evidence-Based Care

• Research supports using the ABCDE Bundle (Balas et al,

2012), where disciplines collaborate to reduce sedation,

immobility and delirium.

• The bundle is a 6-step process:

• Awakening ventilated patients

• Breathing trials

• Coordinated efforts between nurses and respiratory therapists

to decrease sedation/analgesics while attempting spontaneous

breathing trials,

• Delirium assessment including prevention and treatment, and

finally

• Early mobilization and ambulation.

Page 6: Progressive Mobility (PM): Evidence Based Program Improves ......Evidence-Based Care •Research supports using the ABCDE Bundle (Balas et al, 2012), where disciplines collaborate

Evidence-Based Care

Early mobilization is a key component of the

ABCDEF Bundle and reduces complications of

ICU stays, such as

• ventilator associated events)

• length of days on the ventilator

• length of stay in the ICU.

Page 7: Progressive Mobility (PM): Evidence Based Program Improves ......Evidence-Based Care •Research supports using the ABCDE Bundle (Balas et al, 2012), where disciplines collaborate

The Plan

• Chose a PM protocol with 5 phases,

which progressively increases activity

(Vollman, 2010; Bassett et al, 2012)

• Collaboration: Created a

multidisciplinary task force

• Developed a pilot and implementation

plan

• Reviewed and purchased equipment and

piloted this program on our unit.

• Implemented pilot in the Torresdale ICU

– March, 2016

• Rolled out Program to other campuses

Page 8: Progressive Mobility (PM): Evidence Based Program Improves ......Evidence-Based Care •Research supports using the ABCDE Bundle (Balas et al, 2012), where disciplines collaborate

Results

Page 9: Progressive Mobility (PM): Evidence Based Program Improves ......Evidence-Based Care •Research supports using the ABCDE Bundle (Balas et al, 2012), where disciplines collaborate

ICU Length of Stay compared pre and post Progressive Mobility

Program Implementation

= initially 0.56 day decrease (estimated $500,000 savings per

month)

= now 0.84 day decrease (estimated $750,000 savings per

month)

3.92

3.36

3.08

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

PRE POST POST 2017

ICU LOS Pre/Post PMP

Page 10: Progressive Mobility (PM): Evidence Based Program Improves ......Evidence-Based Care •Research supports using the ABCDE Bundle (Balas et al, 2012), where disciplines collaborate

Mean Ventilator Days compared pre and post Progressive

Mobility Program Implementation = 1.14 day decrease

$$$ - estimated $117,000 per month

6.62

5.48

0

1

2

3

4

5

6

7

PRE POST

Mean Ventilator Days Pre/Post PMP

Page 11: Progressive Mobility (PM): Evidence Based Program Improves ......Evidence-Based Care •Research supports using the ABCDE Bundle (Balas et al, 2012), where disciplines collaborate

# of Ventilator Associated Events compared 5 months pre and

post Progressive Mobility Program Implementation

= was 70% reduction

= now over 80% reduction

11

3

2

0

2

4

6

8

10

12

PRE POST POST 2017

VAEs Pre/Post PMP Implementation

Page 12: Progressive Mobility (PM): Evidence Based Program Improves ......Evidence-Based Care •Research supports using the ABCDE Bundle (Balas et al, 2012), where disciplines collaborate

# of Unit Acquired Pressure Injuries in prevalence study

compared pre and post Progressive Mobility Program

Implementation

= NO INJURIES

4

00

1

2

3

4

5

PRE - 2016 POST - 2017 YTD

UAPI Pre/Post PMP

Page 13: Progressive Mobility (PM): Evidence Based Program Improves ......Evidence-Based Care •Research supports using the ABCDE Bundle (Balas et al, 2012), where disciplines collaborate

Since Implementation

• Nurse Driven Protocol

• Created Nurse Driven Order Set

• Created documentation in electronic

medical record

• Replication

• Implemented in other ICUs in our

organization

• Monitoring Outcomes

• Continue monitoring

Torresdale/Bucks/Frankford outcomes

• No pressure injuries, fall injuries,

ventilator associated pneumonias

Page 14: Progressive Mobility (PM): Evidence Based Program Improves ......Evidence-Based Care •Research supports using the ABCDE Bundle (Balas et al, 2012), where disciplines collaborate

• Multidisciplinary team continues to

meets to review data, identify

opportunities and create plans to

address

• Skills labs – include mobility in

scenarios and in annual competencies

• Team developing mobility program

for acute care areas to complement

this initiative and maintain optimal

mobility throughout the patient’s

hospitalization

Sustainability

Page 15: Progressive Mobility (PM): Evidence Based Program Improves ......Evidence-Based Care •Research supports using the ABCDE Bundle (Balas et al, 2012), where disciplines collaborate

References• AACN practice alert: delirium assessment and management. AACN website.

http://www.aacn.org/WD/practice/docs/practicealerts/delirium-practice-alert-

2011.pdf.

• Balas M, et al. Safety and efficacy of the ABCDE bundle in critically-ill patients

receiving mechanical ventilation. Crit Care Med. 2012;40(suppl: abstr 1).

• Barr J, et al. Clinical practice guidelines for the management of pain, agitation,

and delirium in adult patients in the intensive care unit. Crit Care Med.

2013;41:263-306.

• Olsen K, et al. The ABCDE bundle reduces the incidence of delirium in non-

mechanically ventilated patients. Crit Care Med. 2012:40(suppl: abstr 5).

• Olsen K, et al. The ABCDE bundle reduces the incidence of delirium in non-

mechanically ventilated patients. Crit Care Med. 2012:40(suppl: abstr 5).

• Schweickert WD, et al. Early physical and occupational therapy in mechanically

ventilated, critically ill patients: a randomised controlled trial. Lancet.

2009;373:1874-1882.

• Titsworth WL, et al. The effect of increased mobility on morbidity in the

neurointensive care unit. J Neurosurg. 2012;116:1379-1388.

3/22/2018

Page 16: Progressive Mobility (PM): Evidence Based Program Improves ......Evidence-Based Care •Research supports using the ABCDE Bundle (Balas et al, 2012), where disciplines collaborate