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Running Head: Translational Research1Translational ResearchTiffany BennettWestern Governors University
Translational Research2The patient population of the Intensive Care Unit (ICU) are among the sickest in each hospital. In recent years the ABCDE bundle, or Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility, is an evidence-based practice that has been implemented to reduce ICU-acquired delirium, immobility, sedation, and days requiringmechanical ventilation (Stolldorf, Dietrich, Chidume, Mcintosh, & Maxwell, 2018). A local ICU has adopted this model and focuses on weaning sedation and ventilator settings in order to begin Spontaneous Breathing Trials (SPT) as soon as possible to reduce amount of time spent with mechanical ventilation (MV). This unit assesses for delirium every shift and the nurses work with physicians to prevent and manage signs of delirium. The one area this local ICU fails at is with Early Mobilization of all appropriate patients whether receiving mechanical ventilation or not. Professional Practice DescriptionDue to the critical status of many of ICU patients, immobility or bedrest is commonplaceuntil the patient has been deemed stable to leave the ICU. Many studies have shown prolonged immobility in the ICU can to lead to increased muscle weakness, prolonged mechanical ventilation, and longer hospitalizations (Nuwi & Irwan, 2018). Early Mobilization (EM) is defined as “any activity performed beyond the range of motion within 48 hours of the onset of mechanical ventilation” (Fontela, Forgiarini, & Friedman, 2018). EM within the ICU setting is proven to have a positive effect on “physical function, muscle strength, length of stay, duration of mechanical ventilation, and quality of life” (Nuwi & Irwan, 2018) after discharge. The physicians at the local ICU encourage EM as soon as possible and most patients receive a physical and occupation therapy consult order within 24-48 hours of admission to the ICU. With
Translational Research3this knowledge, the nurses on the unit do not mobilize patients early or often, especially those with mechanical ventilation beyond turning every two hours. This ICU does not have a dedicated EM protocol or screening tool to include or exclude patients from EM. Nurses at this local hospital have also identified multiple barriers preventing EM of ventilated patients. Barriers include time, safety concerns and lack of training in mobilizing patients receiving mechanical ventilation or vasopressors. The current practice of this unit needs to be updated to follow current evidence-based practice. As part of the ABCDE bundle, EM has been shown to help decrease incidences of delirium within the hospital as well as aid in reduction of days requiring sedation, ventilator support and total days spent in ICU and hospital. Currently nurses who do attempt to mobilize patients early do so rarely and only with quickly stabilized patients, non-ventilated patients. By implementing EM and incorporating EBP