Early Mobilization Program Algorithm

Assessment of the patient to begin early mobility protocol:

  1. Awaken:  Assessment of Sedatives
  2. Breathing: Assess for patients readiness to terminate mechanical vent
  3. Coordinate:   After assessment of sedatives and breathing combined: Awakening & Breathing Controlled Trial
  4. Delirium:  Is the RASS high 2* to agitation? Is the patient delirious? Assess for Delirium CAM-ICU
  5. Exercise/Early Mobility: Generate a PT/OT/SLP therapy order (see consult generating sheet)

*Remember that mobility is not just ambulating someone on the vent; it is mobilizing the mind and body to reconnect to personal goals one step at a time. Mobility starts today!

 

Critial Care Early Mobilization Protocol for the ICU Patient:

  1. The Intensivist and Nurse-in-Charge every evening should identify those patients who may be candidates for Early Mobilization the following AM.
  2. The patients identified for Early Mobilization should refer to the Early Mobilization Protocol3. Appropriate therapy consultations will be made

4. The candidates for Early Mobilization will be provided during Hands-off-Communication amongst the nursing and physician staff during change of shift.

5. The AM Intensivist will confirm, based on their clinical assessment and bio-physiologic data, the patient can be mobilized by the Team (the team may include but is not limited to. Physical Therapy, Occupational Therapy, Patient Care Assistant and Critical Care Nurse).

6. The Early Mobilization Team will round in their respective units to get confirmation from the Nurse-in-Charge when confirmed by the Intensivist.

 

Critical care Earlv Mobilization protocol for the Mechanically ventilated patient:

1. The Intensivist and Nurse-in-Charge every evening should identify the mechanically ventilated patients who may be candidates for Early Mobilization the following AM.

2. The patients identified for Early Mobilization should refer to the ABCDE protocol

3. The evening Critical Care staff’s responsibility is to confirm the Awakening Trial (See algorithm above).  Breathing trial and the Coordination Evaluation is implemented.

4. To provide adequate cooperation for mobilization a Delirium Assessment must be performed on each patient who may be potentially enrolled.

5. Appropriate therapy consultations will be made.

6. The candidates for Early Mobilization will be provided during Hands-off-Communication amongst the nursing and physician staff during change of shift.

7. The AM Intensivist will confirm, based on their clinical assessment and bio-physiologic data, the patient can be mobilized by the Team (the team may include but is not limited to Respiratory Therapy, Physical Therapy, Occupational Therapy, Patient Care Assistant and Critical Care Nurse).

8. The Early Mobilization Team will round in their respective units to get confirmation from the Nurse-in-Charge when confirmed by the Intensivist.

**Note if the patient is to be weaned a few hours before mobilization is to occur, mobilization will be held as to assure the patient adequate energy to successfully wean.

**Note this protocol does not exclude those patients who are orally intubated.

 

 

Procedure for RASS Assessment

1. Observe patient a. Patient is alert, restless, or agitated, (score 0 to +4)

2. If not alert, state patient’s name and say to open eyes and look at speaker.

b. Patient awakens with sustained eye opening and eye contact. (score -1)

c. Patient awakens with eye opening and eye contact, but not sustained, (score -2)

d. Patient has any movement in response to voice but no eye contact, (score -3)

3. When no response to verbal stimulation, physically stimulate patient by shaking shoulder and/or rubbing stemum.

e. Patient has any movement to physical stimulation. (score -4)

f. Patient has no response to any stimulation. (score -5)

 

<download PDF file>

REFERENCE:

NSUH Early Mobilization Protocol.

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