Education, Research, and Quality Improvement: Education, Research, and Quality Improvement II |

Mobilization of Patients in Respiratory Step Down Unit: A Novel Nurse-Driven Protocol FREE TO VIEW

Navitha Ramesh, MD; Janvi Paralkar, MD; Aileen Tanafranca; Mary Harris, MD
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Mount Sinai Beth Israel, New York, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):622A. doi:10.1016/j.chest.2016.08.714
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SESSION TITLE: Education, Research, and Quality Improvement II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Mobilization in intensive care units has been demonstrated to improve functional ability and reduce ICU and hospital length of stay in adult patients. Early mobilization has shown to be safe in the ICU setting. There is limited data regarding mobilization of patients in intermediate care units/respiratory step down units(RSDU).

METHODS: Setting: Urban teaching hospital with a 12 bed RSDU with a nursing to patient ratio of 1:3. The patient population included mechanically ventilated patients downgraded from MICU and patients with hypoxic or hypercapnic respiratory failure requiring non-invasive ventilation. Our nurse- driven protocol was implemented with the 4E’ s approach- Engage, Educate, Execute and Evaluate. The focus was on five main aspects based on weight bearing status of the patient and eligibility of mobilization. 1. Passive range of motion activities in non-ambulatory patients, 2. Edge of bed 3. Sit to stand 4. Out of bed to chair 5.Independent ambulation. Beginning October 2014, Nursing and Patient Care Associates underwent 30 minute training sessions with a Physical Therapist on how to safely mobilize and ambulate patients. The pilot project was then initiated in April 2015. Patients were considered eligible for physical therapy if there were no contraindications to bedside therapy. A data collection sheet was completed daily for every patient in the RSDU for one month.

RESULTS: Out of 26 patients admitted to the RSDU, the average age was 68.8 years with more male (83.3%) patients than female (16.7%). There was a good distribution among various races, majority being Caucasians. Of our 26 patients, there were 84 total nurse-driven physical therapy encounters. These sessions mostly included passive range of motion within the bed or out of bed to chair. During these 84 sessions, there were 11 adverse effects including desaturation to less than 88% and tachycardia with a heart rate greater than 130, which resolved with rest. There were no serious adverse effects in our patient cohort.The average length of stay for these patients was 6.7 days (excluding two outliers who stayed in the RSDU for over 4 months due to social reasons) with an 8.3% chance of readmission within 30 days. The majority of the patients admitted to the step down unit were either discharged home (41.7%) or to skilled nursing facilities (37.5%).

CONCLUSIONS: Nurse driven mobilization protocols are useful in busy urban hospitals which do not have adequate physical therapy staff for each patient. As the nurses are aware of the clinical condition of the patient, they were able to individualize their physical therapy approach, while sure each patient was mobilized daily, sometimes several times a day. Based on our small patient cohort, we would recommend this approach in respiratory step down units where patients are more complicated than regular medical patients.

CLINICAL IMPLICATIONS: Nursing performed mobilization protocol in a RSDU is safe and feasible, without significant adverse events. Further studies are needed to define measures to evaluate the effect of mobilization of patients in the intermediate care setting. Individualized mobilization plans should be created for each patient every day.

DISCLOSURE: The following authors have nothing to disclose: Navitha Ramesh, Janvi Paralkar, Aileen Tanafranca, Mary Harris

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