Mrs Felicity Prebble1, Mrs Jennifer Murphy1, Anne Leditschke1
1Mater Health, South Brisbane, Australia
Purpose: The early mobilisation of critically ill patients has recently taken the forefront of intensive care based research. Emerging literature has shown that early mobilisation within the Intensive Care Unit (ICU) can be conducted safely and within a timely manner, if an appropriate assessment and observation takes place by trained staff. Our project aimed to review and analyse the current mobility practices in our Mater Health Services (MHS) ICU through an observational audit, to highlight any frequent barriers to early mobilisation, and ensure compliance with evidence-based clinical guidelines.
Methods: An 8- week observational audit of 140 patients admitted to a mixed medical/respiratory/surgical tertiary ICU (mean age 57.3 ± 41years, mean APACHE III Score 44.12 ± 74.88) was conducted. Outcome measures included length of ICU stay at first active mobility, any adverse events that occurred, and frequent barriers to mobility.
Results: Patients were actively mobilised or transferred out of bed on 188 out of 270 physiotherapy-led interventions (69%). Of these, 140 consisted of active mobility interventions, 22 of which were ventilated patients (16%). 94 episodes (34.8%) were limited by a barrier to further patient participation, with 30.8% due to low GCS/over-sedation, 27.6% due to a cognitive impairment and 25% haemodynamic instability. Adverse events occurred in 3 out of 270 interventions (1.1%). This low rate of adverse events occurring during physiotherapy-guided interventions, was a confirming factor that early mobilisation can be performed safely with a thorough assessment prior and during the treatment.
Conclusion: ICU patients, whilst critically unwell and weak, can be safely mobilised throughout their stay in our unit. Unavoidable adverse events occured in 1% of interventions in ventilated patients. The prioritisation and planning of each patient’s sedation management and mobilisation activity will improve this outcome.
Felicity has worked in the Mater Adults Public Intensive Care Unit since 2010. She is currently undertaking a Simulation fellowship with Mater Education in 2019, and is to complete her Graduate Certificate in Health Professional Education. She is also a sessional academic at the Australian Catholic University in their Cardio-Respiratory subjects, along with clinical education at the Mater.