Authors (including presenting author) :
MokSC(1),TsangYN(1), WongYCP(1), YeungCH(1),LamKT(1), SiuSL(1), YuSL(1), NgaiYK(1), LeungSK(1)
Affiliation :
(1) Intensive Care Unit
Introduction :
In the Intensive Care Unit (ICU), patients often experience extended periods of bed rest and immobility due to sedation or restraint, leading to an increased risk of ICU-acquired weakness, such as muscle atrophy and loss of strength.
Early Mobilisation (EM) presents a viable solution to mitigate these effects, enhancing muscle strength, functional independence, and reducing ventilator dependency and ICU stay duration.
Our goal is to establish and incorporate an EM protocol within our department. We initiated a pilot Early Mobilisation program from May 1st to December 31st, 2023. The results were positive and encouraging, demonstrating the benefits of early mobilisation in improving patient outcomes.
Building on this success, we are now focused on fostering an environment that encourages early mobilisation, seamlessly integrating it into our care approach. As of February 1st, 2025, we have fully integrated the EM program into our daily care. This includes integrating all EM record forms into a paperless system and incorporating them into the ICU Clinical Information System (CIS).
Objectives :
1. Enhance Patient Recovery: By implementing an Early Mobilisation (EM) protocol, we aim to promote patient mobility through five levels of exercise. This will enhance muscle strength, functional independence, and overall patient outcomes.
2. Reduce Complications: Our EM protocol targets the reduction of complications associated with prolonged bed rest. This includes decreasing the risk of ICU-acquired weakness, reducing ventilator dependency, and shortening ICU stay duration.
3. Monitor Complications and Progress: We will monitor any complications that occur during the EM program, assess the level of exercise improvement over a 3-day program, and measure muscle power or handgrip force for short-term patient outcomes.
4. Paperless System Integration: We will integrate all EM record forms into a paperless system and incorporate them into the ICU Clinical Information System (CIS). This will streamline documentation and improve efficiency.
5. Improve ICU Care Quality: By integrating EM into daily care practices, we strive to improve the overall quality of ICU care. This involves fostering an environment that encourages early mobilisation and seamlessly incorporating it into our care approach.
6. Continuous Monitoring and Evaluation: To ensure that our EM practices remain evidence-based and patient-centered, we will continuously monitor and evaluate our protocols. This will help us refine our practices and maintain high standards of care.
Methodology :
1) Evidence-Based Practices: We developed the early mobilisation protocol by summarising and applying evidence-based practices from Suzuki et al., 2022; Morris et al., 2008; Himanshu & Rita’s case report; and Hodgson et al., 2014. This ensures the program is grounded in research and best practices. We also used these sources to develop and set up exclusion criteria, signs of intolerance, and contraindications.
2) Outcome Measures:
a) Short-term:
-Patient-centered: Limb power score, muscle strength (handgrip force)
-Program-centered: Assessing exercise improvement within the first three days of the program, monitoring the level of exercise and improvement,
and regularly checking for adverse events, side effects, incidents, or complications during the early mobilization (EM) program. Reasons for
withholding the program, such as contraindications or pending medical procedures, are also documented.
b) Long-term: Duration of mechanical ventilation (MV)/ventilator-free days, length of stay (LOS) in the ICU.
3) Documentation and Integration: We integrated EM record forms into a paperless system and incorporated them into the ICU Clinical Information System (CIS) for streamlined documentation and improved efficiency. A work folder was set up to remind staff to comply with the program.
4) Education and Training: Regular briefings and reminders were provided, especially targeting ICU newcomers, to ensure they are well-equipped to support early mobilisation.
5) Continuous Evaluation: The program is continuously evaluated to ensure it remains evidence-based and patient-centered, refining practices as needed.
Result & Outcome :
Results of the pilot study from May to December 2023:
1) Patient Recruitment:
- A total of 110 patients were recruited between May and December 2023.
2) EM Program Duration:
- The program was completed over 270 days, with a patient ratio of 3 days:2 days:1 day being 63:34:13.
3) Compliance:
- GCS, RASS, and limb power assessments had 100% compliance.
- Handgrip force measurement was recorded in 38 cases, with approximately 35% compliance.
4) Exercise Levels:
- Improvement and maintenance of exercise levels were as follows:
May: 73.3%. June: 71.5%. July: 100%. August: 95.6%. September: 100%. October: 75%. November: 91.7%. December: 70%
5)Side effects: Five patients exhibited signs of intolerance. One patient reported tiredness, one reported wound pain, and two were agitated. Two patients required termination of the program. Prompt actions and nursing care were provided, preventing further deterioration of their conditions.
6) The new EM program, which incorporates the EM paper form into the ICU Clinical Information System (CIS), will be re-implemented on 1st February. Following data collection, the new data will be analysed, compared, and then submitted or presented in the next phase.
