On a recent trip to Arizona I met Woody, a patient at the Banner Gateway/ MD Anderson hospital. Woody is a 72 year old, retired long distance truck driver who has been battling leukemia for over a year. When we met, Woody had already been in the Oncology ICU for over a week after undergoing stem cell transplant, and he was quite frustrated. Whenever he wanted to get up and walk he had to put on his call light, wait for staff who then had to get his walker and get an extra helper to pull along his IV pole and oxygen caddy while he ambulated. He often waited for up to thirty minutes and sometimes by the time enough staff was available he had “run out of steam.” Woody trialed the LIVENGOOD PACE for five days and by the second day he was deemed safe to be up walking independently with the PACE. He would unplug the PACE cord from the wall and he was good to go. He would often do 5 laps around the unit with his iPAD on the PACE playing music while he walked. Having a handy place to plug in his iPAD meant a lot to him and hearing the upbeat music made him, and everyone around him smile. Woody would stop any nurse who was available and tell them all about the PACE and how great it felt to be independent.
The PACE is designed to simplify ambulation by keeping all of the patient’s equipment with them wherever they go. The increase in mobility ease and efficiency makes the hospital experience significantly better for both patient and staff. Everything changed after Woody had his hands on the PACE.
It is no secret patient mobility is tied to results. A Johns Hopkins study found that early mobility in the ICU vastly improves patient outcomes and can save hospitals up to $1,300 per patient by decreasing their stay up to 22 percent.
The fact is, it is impossible for staff to meet the mobility needs of every patient, so tools like the LIVENGOOD PACE prove invaluable in increasing the frequency of mobilization; increasing patient mobility and decreasing length of stay; increasing staff efficiency and patient satisfaction, and helping hospitals save money.
The hardest part about losing weight isn’t always losing it, it can often be maintaining the loss. The same is true with most big changes, especially when the change involves multiple people.
Many ICU departments are starting early mobility programs because it has proven to be ” best practice” for their patients. Starting a mobility program is tough and takes a lot of planning, discipline and enthusiasm from the staff. The trend I see is that programs start out strong and then often fizzle out.
Maintaining a strong early mobility program takes continuous effort and I would like to offer some suggestions on how to be successful. It is important to have champions both when a program starts and while it is maintained. Champions should be available on each shift and should serve as a point of education and guidance. ICU rounds should always have a line item for mobility and even if a patient isn’t being mobilized yet, there should be a discussion about mobility and when it might be appropriate. Mobility should be on a pre-printed order sheet which will act as a stimulus for doctors when writing and checking off orders. Equipment which makes mobility more efficient should be readily available and easy to use. P.T. should have a daily presence in the ICU. Programs should have a clear exclusion criteria and if a patient isn’t mobilizing the only excuse should be that they meet these criteria. The programs I see succeed are those with a constant driving force from management. Mobility becomes an expectation for patients and not a choice made by staff.
80% of the sickest patients in the ICU will suffer from delirium. They have multiple risk factors that include immobility, medications for pain and sedation, and interrupted circadian rhythms, just to name a few. Delirium in the ICU will complicate the patients stay and can lead to many adverse outcomes. Patients who suffer from delirium will often be combative, pull out catheters, be unable to participate in therapy, and they may even self-extubate. These adverse outcomes can be hard on patients, families and ICU staff. Education about delirium should be provided to family members when applicable. ICU delirium will also increase the total cost of a patient’s stay.
ICU staff should have a system in place for assessing delirium such as the CAM-ICU. Their CAM-ICU score should be reported regularly in the EHR and during rounds. If staff is consistently reporting on delirium they can aim their interventions towards minimizing any adverse outcomes. Interventions will range from reducing certain medications, increasing mobility during the day , reducing stimulation at night, and to introducing cognitive therapy with an Occupation Therapist.
Delirium in the ICU is prevalent and also somewhat preventable. By tracking and addressing the following six risk factors our patients will have less complications: sleep deprivation, immobility, visual impairment, hearing impairment, cognitive impairment and dehydration.
You might ask yourself what a physical therapist does in the ICU. That is a great question. The role of a P.T. in the ICU will vary from facility to facility. Some facilities have a dedicated P.T. who spends the day mobilizing patients, doing progressive resistance exercises and acting as the expert for positioning and prevention of contractions. Other facilities order a P.T.consult only when a patient is extubated and active. Continue reading
Are you looking to start an ICU early mobility program? If so, there are many factors that you’ll need to consider. One thing you need to think about is the current culture in your ICU. Is the culture to sedate all ICU patients, for patients to stay in bed? Is the staff ready for and supportive of a change? How well do the different departments work together? Are P.T.’s and O.T’s actively involved in the treatment of your ICU patients? Continue reading
We’ve all woken up early in the morning really needing to pee, but are so tired that we try to just lie there a little longer. We all know that the second we finally commit to getting out of bed we can rush to the bathroom. I bet you’ve never thought of that as a luxury. For millions of people who are in the hospital every day, it’s just that. Continue reading
On a recent trip to trial the LIVENGOOD PACE at Tulane Medical Center I had the pleasure of meeting Sarah. Sarah was a patient in the neurological ICU who had been on a ventilator for 3 weeks. During the placement of cervical traction she experienced heart failure. After being resuscitated she had to be intubated. The staff had good intentions of getting Sarah out of bed but equipment management was difficult. Consequently, she stayed in bed most days and occasionally, at best, made it to a chair. Continue reading