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The American journal of medicine


BACKGROUND: Pressure ulcer formation continues to be problematic in acute care settings, especially intensive care units (ICUs). Our institution developed a program for early mobility in the ICU using specially trained nursing aides. The goal was to impact hospital-acquired pressure ulcers incidence as well as factors associated with ICU deconditioning by using specially trained personnel to perform the acute early mobility interventions.

METHODS: A 5-point mobility scale was developed and used to establish a patients' highest level of activity achievable during evaluation. A mobility team was created consisting of skin-care prevention/mobility nurses and a new category of worker called a patient mobility assistant. Each level has a corresponding plan of care (intervention) that was followed and adjusted according to the patient's progress and nursing evaluation. Data collection included the type of interventions at each encounter, mobility and skin assessments, new hospital-acquired pressure ulcer, the current mobility level, Braden score, rate of ventilator-associated pneumonia, ICU length of stay, and hospital readmission. Staff was also surveyed about their attitudes toward mobilization and perception of mobility barriers; a prepilot and a postpilot survey were planned.

RESULTS: During the 1-year study interval, 3233 patients were enrolled from the medical intensive care unit (MICU). The 2011 preimplementation MICU hospital-acquired pressure ulcer rate was 9.2%. After 1 year of employing the mobility team, there was a statistically significant decrease in the MICU hospital-acquired pressure ulcer rate to 6.1% (P = .0405). Hospital readmission of MICU patients also significantly decreased from 17.1% to 11.5% (P = .0010). The mean MICU length of stay decreased by 1 day. There were no safety issues directly or indirectly associated with these interventions.

CONCLUSIONS: Use of this mobility program resulted in a 3% decrease in the most recalcitrant patients in the MICU. This corresponds to a decrease of 1.2 per 1000 patient days. It is definitely both statistically and clinically significant. We believe this lays the groundwork for further work in this area. We have shown that properly trained nonlicensed professionals can safely and effectively mobilize patients in the ICU setting. This can represent a cost-effective way to introduce early mobility in the ICU setting.

Medical Subject Headings

Adolescent; Adult; Aged; Early Ambulation; Female; Humans; Incidence; Intensive Care Units; Male; Middle Aged; Nursing Assessment; Nursing Assistants; Outcome Assessment (Health Care); Pilot Projects; Pressure Ulcer

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