Date of Conferral

2017

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Oscar Lee

Abstract

In the United States, adult ICU patient care consumes $90 billion annually, or 1% of the gross national product. In the ICU, about 40% of the patients are mechanically ventilated resulting in an 11% greater length of stay (LOS) that requires 35% more resources. And, an estimated 60% of these patients are adversely impacted for as long as five years following discharge. Patient immobility while ventilated contributes to poor quality and financial outcomes. The Institute of Healthcare Improvement (IHI) reports on average early patient mobility (EPM) reduces a 4.5-day LOS by as much as 1.3 days; and reduces the risk for complications such as ventilator associated pneumonia, thromboembolisms, and pressure ulcers. The purpose of this evidence-based practice (EBP) quality improvement project was to evaluate an EPM program based to improve interdisciplinary collaboration and care coordination. The introduction, development, and evaluation of this project were guided by the Iowa Model and the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility (ABCDE) bundle. The EPM program was implemented in a 20-bed ICU in a 400-bed hospital as the Mobilization Criteria / Algorithm for Critical Care Patients (MCACCP). Retrospective data was collected for six months from the electronic health record and evaluated with a web-based analytics tool. The project resulted in a 1.2-day decrease in ICU LOS and a 6.7% reduction in ventilator days. The average daily census decreased from 16.2 in 2015 to 14.7 through 2016. EBP research supports the benefit of early mobility of ICU patients to reduce complications, ventilator days, LOS, and the overall cost for care. This project demonstrates standardizing clinical practice based on EBP guidelines and protocols translates into improved teamwork, patient outcomes, and organization metrics.

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