Analysis of adherence to an early mobilization protocol in an intensive care unit: Data collected prospectively over a period of three years by the clinical information system.
MEDICINA INTENSIVA (ENGLISH EDITION) 2022;
47:203-211. [PMID:
36344338 DOI:
10.1016/j.medine.2022.03.005]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
To determinate the adherence and barriers of our early mobilization protocol in patients who had received mechanical ventilation >48h in routine daily practice through clinical information system during all Intensive Care Unit (ICU) stay.
DESIGN
Observational and prospective cohort study.
SETTING
Polyvalent ICU over a three-year period (2017-2019).
PATIENTS
Adult patients on mechanical ventilation >48h who met the inclusion criteria for the early mobilization protocol.
INTERVENTIONS
None.
MAIN VARIABLES OF INTEREST
Demographics, adherence to the protocol and putative hidden adherence, total number of mobilizations, barriers, artificial airway/ventilatory support at each mobilization level and adverse events.
RESULTS
We analyzed 3269 stay-days from 388 patients with median age of 63 (51-72) years, median APACHE II 23 (18-29) and median ICU stay of 10.1 (6.2-16.5) days. Adherence to the protocol was 56.6% (1850 stay-days), but patients were mobilized in only 32.2% (1472) of all stay-days. The putative hidden adherence was 15.6% (509 stay-days) which would increase adherence to 72.2%. The most common reasons for not mobilizing patients were failure to meeting the criteria for clinical stability in 241 (42%) stay-days and unavailability of physiotherapists in 190 (33%) stay-days. Adverse events occurred in only 6 (0.4%) stay-days.
CONCLUSIONS
Data form Clinical Information System showed although adherence was high, patients were mobilized in only one-third of all stay-days. Knowing the specific reason why patient were not mobilized in each stay-day allow to develop concrete decisions to increase the number of mobilizations.
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