Laurel Metzler, MD
assistant professor
Methodist Le Bonheur Childrens Hospital
Memphis, Tennessee
Disclosure information not submitted.
David Templeton
Medical Student
University of Tennessee Health Science Center - College of Medicine, United States
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Kylie Schall
Medical Student
University of Tennessee Health Science Center - College of Medicine, United States
Disclosure information not submitted.
Lauren Wideman
Medical Student
University of Tennessee Health Science Center - College of Medicine, United States
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Carissa Crawford
Registered Nurse
Methodist Le Bonheur Children's Hospital
Memphis, Tennessee, United States
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Sonya Armstrong
Registered Nurse
Methodist Le Bonheur Children's Hospital, Tennessee, United States
Disclosure information not submitted.
Nanecia Willis
Registered Nurse
Methodist Le Bonheur Children's Hospital, United States
Disclosure information not submitted.
Brittany Dedwylder
Registered Nurse
Methodist Le Bonheur Children's Hospital, United States
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Kathryn Hunter
Registered Nurse
Methodist Le Bonheur Children's Hospital, United States
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Meredith Norton
Certified Child Life Specialist
Methodist Le Bonheur Children's Hospital, United States
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Anna Epstein
Certified Child Life Specialist
Methodist Le Bonheur Children's Hospital, United States
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Aristea Wells
Physical Therapist
Methodist Le Bonheur Children's Hospital, United States
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Jennifer Kramer, MD
MD, Assistant Professor
University of Tennessee Health Science Center Le Bonheur Children's Hospital, United States
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Rebekah Shappley, MD, FAAP
MD, Assistant Professor
University of Tennessee Health Science Center LeBonheur Children's Medical Center, United States
Disclosure information not submitted.
Title: CHEER (Collaborating to Help Everyone Effectively Recover): Early Mobility in a Tertiary PICU
INTRODUCTION: The culture of immobility in pediatric critical care patients prompted a quality improvement project encouraging early mobility and ICU liberation in a tertiary PICU. Aims are designed to evaluate trends in mobility and associated ICU liberation strategies. The focus is on process improvement to increase adherence to early mobility practices within the critical care complex under the assumption that this will improve outcomes.
Methods: Surveys about patient care were distributed on day and night shifts, creating a baseline snapshot of the current states of mobility in the PICU, IMCU, and CVICU. For the CHEER study, we described baseline patient characteristics, mobility efforts, barriers to early mobility, delirium levels, sleep disturbances, family engagement, and overnight benzodiazepine and opiate use.
Results: 43 patients in 77 encounters were identified in IMCU (14), PICU (21), and CVICU (8). Patient ages ranged between 0-18+ years with 17/43 patients aged 0-1 year. Of the 36 patients identified on the day shift, 44.4% were mechanically ventilated and 5.6% were on vasoactive medication. ICU mean and median LOS were 49.5 and 13.5 days. 16.7% received continuous sedation (2.8% opiates, 11.1% benzodiazepine, 8.3% dexmedetomidine, 2.8% ketamine) and 5.6% used antipsychotics. Delirium scores were reported in 61.1% (IMCU 72.7%, PICU 58.8%, CVICU 50%) with 31.8% positive for delirium. 44.4% had PT/OT consults ordered (IMCU 42.9%, PICU 28.6%, and CVICU 50%), and 13.9% and 8.3% received therapy by PT and OT. 86.1% received mobilization by RN (IMCU 72.7%, PICU 94.1%, and CVICU 87.5%). Sleep interruptions were common; 20.9% by X-ray, phlebotomy, or bath from 10pm- 5am. Common perceived barriers to mobility were endotracheal tube 6.9%, post-op restrictions 6.9%, and deep sedation 6.9%. Nurses reported that potential safety event occurred during activity in 8.3% of mobility efforts (change in heart rate >20%, change in blood pressure >20%, decrease in oxygen saturation >15%, and dislodgment of tracheostomy tube).
Conclusions: Many patients are mobilized by nurses and therapists, but delirium and sleep interruptions are common. Mobility barriers include sedation and endotracheal intubation. Safety event concerns were noted, and will be monitored, educated for, and avoided as mobility efforts advance.