Delirium in mechanically ventilated patients is a significant problem. At Good Samaritan Hospital, the incidence of delirium in mechanically ventilated patients was found to be 78%, which is similar to results found by other researchers. Delirium is associated with longer lengths of stay on the mechanical ventilator, in the ICU, and hospital, as well as higher ICU mortality and healthcare costs.
The use of an early mobility protocol has demonstrated effectiveness in decreasing delirium and ventilator stay with minimal risk or harm to patients. The objective of the project was to answer a population-intervention-comparison-outcome-time question (PICOT): In (P) critically ill, mechanically ventilated patients, what is the effect of (I) an early mobilization protocol (as (C) compared to no intervention) on (O) delirium and intensive care unit length of stay over the course of three months (T)?
Champions for each discipline were selected to form a multidisciplinary team. An early mobility protocol and implementation plan, utilizing the Evidence-Based Performance Improvement Model was developed. High fidelity human simulation and small tests of change with actual patients helped build teamwork as well as establish a pattern of safety. Retrospective chart review was utilized to collect outcomes such as incidence and duration of delirium as assessed by the Confusion Assessment Method- ICU, length of stay including ventilator, ICU and hospital, as well as the occurrence of adverse events during early mobility. Descriptive statistics as well as independent sample T-tests and chi-squared methods were used to analyze the data. Fifty-eight patients were included in analysis. Early mobility was implemented in 53% of the patients. Incidence of delirium was high in all patients (91%). Results were attributed to inaccuracy of delirium assessment, analgesia and sedation practices, as well as build of the electronic medical record. There was no statistical significance in ventilator, ICU, and hospital length of stay as well as incidence and duration of delirium between those who had early mobility and those that did not. There were no adverse events during 67 sessions of early mobility. The implementation of early mobility was successful and was sustained one year later.
Campbell, M. R. (2014). The Effect of an Early Mobility Protocol in Critically Ill Mechanically Ventilated Patients on Incidence and Duration of Delirium and Length of Stay. . Wright State University, Dayton, OH.