While discussing my evidence-based practice change of early mobility with my mentor, we discussed many financial, quality, and clinical aspects of my project. The aspect that may prove to be the most difficult in my project is the financial aspect. In order to properly implement a protocol on mobility of ICU patients, education is a priority. As an ICU nurse, if my manager told me we were now expected to engage in early mobility of our patients I would be terrified. My mentor and I discussed the needed education and agreed that having a physical therapist spend some time with nurses on developing mobility plans would be the best way to demonstrate mobility expectations. This may require additional pay for the nurses, and possibly physical therapists. Along with hands on education, having nurses on both day shift and night shift become mobility champions would provide needed resources for the nurses. This too would require additional pay for the education time spent in training. While there would be some upfront costs associated with the implementation of my project, the end result would produce improved patient outcomes and a decrease in costs due to a reduction in hospital length of stay for the patients involved. According to Ronnebaum, Weir, and Hilsabeck (2012), an early mobility protocol resulted in a savings of $22,000 per patient (Ronnebaum, Weir, & Hilsabeck, 2012).
The Institute of Medicine defines quality as “the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (Agency for Healthcare Research and Quality, 2012). Improving patient outcomes, such as reduced time in ICU and in the hospital, is one quality aspect of my project. Implementing early mobility directly impacts quality by reducing complications such as DVT, pressure ulcers, and muscle wasting seen in bedrest.
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The clinical aspect of early mobility in ICU patients will probably be the most challenging part due to the assessment and change in practice needed. There are many barriers associated with my evidence-based practice project such as safety concerns, time constraints, and availability of support staff. While discussing this with my mentor we agreed that education and support from the physical therapy department and physicians will be an important factor in the clinical changes needed to implement the plan. Early mobility requires nurses to mobilize patients either by range of motion, assisting with in-bed activities, and even assisting with out of bed activities such as walking. At Banner Estrella most critically ill patients are on bedrest, so this may be a challenging clinical change.
Agency for Healthcare Research and Quality. (2012). Understanding quality measurement. Retrieved from Agency for Healthcare Research and Quality: https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/chtoolbx/understand/index.html
Ronnebaum, J., Weir, J., & Hilsabeck, T. (2012). Earlier Mobilization decreases the length of stay in the intensive care unit. Journal of Acute Care Physical Therapy, 204-210.