(P137) A NURSE-DRIVEN, FAMILY-ENGAGED EARLY MOBILITY PROGRAM IN THE CARDIAC INTENSIVE CARE UNIT

Background/Purpose: Engaging family members in direct care of their relative is a recommended approach to health care delivery. Family members are often interested in being more involved in care but lack the guidance and opportunity to participate in care. Bedside nurses play a key role in family member instruction and support in involvement in care. There is little known about whether engaging families in mobilization is safe and feasible. The objective of this study was to evaluate whether a nurse-driven, family engagement approach to early mobilization in the cardiac intensive care unit (ICU) is safe, feasible, and associated with beneficial outcomes.

METHODS/RESULTS: The electronic record of patients admitted to the cardiac ICU at two academic tertiary care hospitals in Montreal, Canada were reviewed prior to and following implementation of an early progressive mobility program. Mobility was measured using the validated Level of Function (LOF) scale, which ranges from 0 (bed immobile) to 5 (able to walk > 20 meters). Nurses assessed the patient’s mobility status and assigned three mobility activities based on the patient’s current LOF per nursing shift. Family members were encouraged by bedside nurses to participate in the patient’s mobilization. Family members were provided a written pamphlet and links to instructional videos in English and French describing how to perform the LOF-specific mobility activities. Outcomes prior to and following initiation of the program were compared.
There were 1,983 patients included (630 pre-intervention; 1,353 post-intervention; Table). The mean patient age was 68.4 years old and 38.3% were females. The early mobility intervention was associated with an increased functional status from admission (LOF 3.2) to cardiac ICU discharge (3.9; P=0.001). There were 13,082 mobility activities performed out of a possible 18,173 activities prescribed (72.2%). Mobility activities occurred during 78.1% of nursing shifts compared to 45.5% prior to the intervention. There were 48 adverse events during mobilization (0.4% of all mobilization activities) with no major adverse events requiring clinical intervention. There was no difference in discharge home or readmission rates, although there was decreased in-hospital mortality in the intervention group. The lower in-hospital mortality rate was preserved over time (mortality in pre-intervention group, 6.7%; first 12- months of intervention, 4.9%; second 12-months of intervention, 4.2%).

CONCLUSION/IMPLICATIONS FOR PRACTICE: Nurse-driven, family engaged mobilization is safe, feasible, and associated with a reduced rate of in-hospital mortality. Further randomized studies are needed to confirm this finding.