Overcoming a Culture of Immobility in the ICU

Michal Marach

Changing Your ICU’s Mobility Culture

When it comes to early mobility programs, putting research into practice can sometimes challenge the status quo. Hospital policies historically have encouraged critically ill patients to limit movement,¹ a practice that still persists in some ICUs today. One literature review found that 60 percent of studies noted cultural barriers to early mobility implementation.²

This culture may result in a systematic lack of access to the physical therapy programs that could help patients heal.¹ Let’s look at how to overcome it — and why it is critical to do so.

The Importance of Early Mobility

What’s involved in early mobility?

With early mobility, patients engage in physical activity usually within 24 to 48 hours after patient admission. Depending on the patient’s abilities, it may begin with passive in-bed exercises, progress to sitting up and standing, and eventually to walking.

What’s wrong with a lack of mobility?

A growing body of research shows that a lack of mobility in the ICU may have lasting adverse effects on a patient’s mental, emotional, and physical health. Fifty percent of ICU patients experience physical impairment, with half unable to return to their previous levels of activity.¹ Eighty percent experience cognitive effects, sometimes lasting years.¹

How early mobility helps

Early mobility may help mitigate the cognitive, physical, and psychological effects associated with critical illness.¹For example, those who experience such interventions spend fewer days in the hospital, show better functional outcomes, wean off the ventilator earlier, and have reduced chances of delirium.¹ Explore the technological solutions that may encourage early mobility.

Why “early” mobility

In the past, patient mobilization often occurred only after patients healed.¹ We now understand that mobilization can play a critical role earlier in the healing process — within 48 hours of admission.³ For example, early mobility may help prevent ICU-acquired weakness,⁴ which sets in within four to seven days of ICU admission.⁵

Creating a Culture of Mobility

ICUs have fostered a culture of mobility through a variety of initiatives such as reeducation, engagement, multidisciplinary execution, and evaluation.¹Let’s take a look at some ways to support a culture of mobility in your ICU.

Get your team excited about the potential of early mobility.

Explore the fact sheet on the positive outcomes of early mobility.
Share the video on one patient-turned physician’s success story.

Show that early mobility is safe.

Read the case studies on how other ICUs have safely and successfully implemented early mobility.
Explore how technological developments, such as mobile-ready ventilators, can foster safe mobilization events.

Practice preventative patient health for mobilization readiness.

Explore the ventilation technologies that may help you address patient-ventilator asynchrony, reduce infections and the need for sedation, and set the stage for mobilization.

Make it a multidisciplinary effort.

Use an advocacy guide to recruit a multiprofessional team for greater reach.

Consider technology to support mobilization efforts.

Use technology that is closely tied to patient physiology. It can ensure you have reliable data to execute and evaluate mobilization events.

Show the economic potential of early mobility.

Use the ICU savings calculator to determine the potential cost savings for your ICU.
Read case studies on how past ICUs have saved by implementing early mobility.

Optimize patient breathing support.

Consider ventilators that allow patients to breathe more naturally.
Explore the literature on how to reduce agitation and aid in mobilization readiness.

Create an early mobility program that works for your ICU.

Establish standardized protocols and structure mobility into daily rounds.
See the guide to progressive mobility.

Get the team communicating.

Use communication guides to get your team on the same page.
Explore the infographic on common equipment challenges.

What We’re Doing

At Medtronic, we created the Reduce Immobility. Start Early. (RISE) initiative to assist you with all the above stages of implementing an early mobility program. On our site you’ll find personal videos, synthesized research, support technologies, and more.

Explore the Early Mobility resources:

Main hub: Read the latest research on early mobility, as well as information personalized to your role.

Documentary: Watch the story of one patient turned doctor on a mission to get patients moving.

Educational resources: Find information to help you get an early mobility program off the ground — from a primer on benefits to an early mobility cost savings calculator.

Mobility technologies: Get both patients and clinicians the mobility support they need with technology designed to move.

Visit the RISE website to explore videos, interactive infographics, equipment, and more.

References:
1. Early Mobility Guide for Reducing Ventilator-Associated Events in Mechanically Ventilated Patients. AHRQ Publication No. 16(17)-0018-4-EF. 2017.
2. Dubb R, Nydahl P, Hermes C, et al. Barriers and strategies for early mobilization of patients in intensive care units. Ann Am Thorac Soc. 2016;13(5):724–730.
3. Morris PE, Goad A, Thompson C, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med. 2008;36(8):2238–2243. doi: 10.1097/CCM.Ob013e318180b90e.
4. Vasilevskis EE, Ely EW, Speroff T, Pun BT, Boehm L, Dittus RS. Reducing iatrogenic risks: ICU-acquired delirium and weakness — crossing the quality chasm. Chest. 2010;138(5):1224–1233. doi: 10.1378/chest.10-0466
5. For mechanically ventilated patients. Nordon-Craft A, Moss M, Quan D, Schenkman M. Intensive care unit–acquired weakness: implications for physical therapist management. Phys Ther. 2012;92(12):1494–1506. doi: 10.2522/ptj.20110117

Topic: Intensive Care Unit