Analysis of adherence to an early mobilization protocol in an intensive care unit: Data collected prospectively over a period of three years by the clinical information system

Abstract

Objective: To determinate the adherence and barriers of our early mobilization protocol in patients who had received mechanical ventilation >48h in routine daily practice through clinical information system during all Intensive Care Unit (ICU) stay.

Design: Observational and prospective cohort study.

Setting: Polyvalent ICU over a three-year period (2017-2019).

Patients: Adult patients on mechanical ventilation >48h who met the inclusion criteria for the early mobilization protocol.

Interventions: None.

Main variables of interest: Demographics, adherence to the protocol and putative hidden adherence, total number of mobilizations, barriers, artificial airway/ventilatory support at each mobilization level and adverse events.

Results: We analyzed 3269 stay-days from 388 patients with median age of 63 (51-72) years, median APACHE II 23 (18-29) and median ICU stay of 10.1 (6.2-16.5) days. Adherence to the protocol was 56.6% (1850 stay-days), but patients were mobilized in only 32.2% (1472) of all stay-days. The putative hidden adherence was 15.6% (509 stay-days) which would increase adherence to 72.2%. The most common reasons for not mobilizing patients were failure to meeting the criteria for clinical stability in 241 (42%) stay-days and unavailability of physiotherapists in 190 (33%) stay-days. Adverse events occurred in only 6 (0.4%) stay-days.

Conclusions: Data form Clinical Information System showed although adherence was high, patients were mobilized in only one-third of all stay-days. Knowing the specific reason why patient were not mobilized in each stay-day allow to develop concrete decisions to increase the number of mobilizations.

Keywords: Adherence to protocols; Adherencia a protocolos; Clinical information systems; Critical illness; Early mobilization; Enfermedad crítica; Intensive care unit; Movilización precoz; Safety; Seguridad; Sistemas de información clínica; Unidad de cuidados intensivos.