Reducing ICU Delirium by Promoting Early Mobility

Abstract
Delirium is described as an acute confusional state characterized by fluctuating mental status, inattention, and either altered level of consciousness or disorganized thinking (Barr et al., 2013). In the intensive care unit (ICU), delirium has been shown to occur in 60% to 80% of mechanically ventilated patients and 40% to 60% of nonventilated patients. According to the most recent Pain, Agitation, and Delirium (PAD) Clinical Practice Guidelines from the American College of Critical Care Medicine (2013), early mobility is recommended to reduce delirium
Project Purpose: The purpose of the project was to educate nurses about the implementation of an evidence based early mobility protocol to reduce the incidence of delirium in the adult ICU setting. The project also identified barriers to implementing early mobility protocols.
Method: A quality improvement project included a five-step approach; 1) assessed current nursing knowledge about early mobility and protocol implementation; 2) educated unit-based critical care nurses about the early mobility protocol; 3) provided nurses with an Early Mobility Worksheet for documentation of protocol implementation; 4) accessed the electronic medical record of those patients mobilized and trended delirium; 5) The delirium data was compared to the baseline group (pre-education) to identify if there was a reduction in delirium
Results: Analysis was run excluding patients in the post-education group who were mobilized the day of or the day before ICU discharge. It was felt that the mobility intervention was not likely have an effect on delirium during the short time the patients remained in the ICU. After analysis, there was a statistically significant difference between the two groups (mean (SD) pre 44.1% (35.2%) versus post 20.5% (28.3%); p=0.045).
Discussion: The findings indicate that the earlier patients are mobilized in the ICU the better the delirium outcomes.