The neurological ICU at Cleveland Clinic’s main campus completed phase 2 of an early progressive mobility protocol study. Kate Klein, MS, RN, ACNP-BC, CCRN, presented findings at the 9th annual Nursing Research Conference at Cleveland Clinic in May.
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“About three to four years ago, a lot of our patients were not getting out of bed and that seemed problematic to us,” says Klein, an acute care nurse practitioner in neurocritical care. “Early mobility is one of the interventions that is really good for a patient’s recovery.” As in other patient populations, early mobility in neurological ICU patients reduces the risk of hospital-acquired conditions, avoids prolonged hospital stays due to weakness and deconditioning, and lessens patients’ rehabilitation needs after discharge.
Malissa Mulkey, MSN, CCRN, CCNS, who works in the neurological ICU, drafted early mobility protocols. Prior to their implementation on Cleveland Clinic’s main campus in February 2012, the unit participated in phase 1 of the study: It collected pre-implementation data measuring patients’ mobility on a scale of one to 16. One indicates a patient in bed with passive range of motion, while patients on level 16 can walk with assistance or independently. “We wanted to study what sort of impact mobilizing patients early has on clinical outcomes,” says Klein. (For more information on the protocol, read the “News in Neurology” article in the Spring 2012 issue of Notable Nursing newsletter.)
Phase 2 ran from May to September 2012. During that time, the neurological unit purchased a mobile lift for patients. Nurses received abundant education on the protocol and using the mobile lift and the unit’s beds, which feature progressive mobility features. Nurses then relied on the protocol to lead them as they advanced patients through increasing degrees of mobility. Research nurses gathered information on clinical outcomes and surveyed patients prior to discharge on their level of depression, anxiety and hostility. At the conclusion of phase 2, Klein compared the differences between pre- and post-implementation data.
The results have not been published yet, but Klein says the findings are positive. “Instituting an early progressive mobility protocol resulted in significant improvement in level of mobility achieved, ICU and hospital length of stay,” she says. “There were favorable trends toward improvement with other clinical outcomes, such as depression and anxiety, yet more research is needed.”
Phase 3 of the study, which just began, will measure the sustainability of the protocol. “Once the education is done and the newness wears off, how will that impact early mobility?” says Klein. “We’re hoping that nurses who participated in phase 2 will mentor new nurses and carry on the protocol.”