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.