Objective: Prospective quality improvement project to evaluate the impact of a training programme to promote nurse-led mobilisation of intubated critically ill patients.
Methods: This project involved an educational programme to upskill nurses and overcome the barriers/challenges to nurse-led mobilisation. Initial strategies focused on educating and upskilling nurses to attain competency in active mobilisation. Subsequent strategies focused on positive reinforcement to achieve a culture shift. A pre- and post-intervention audit was used to evaluate its effectiveness.
Results: A baseline audit showed that ∼9% of ventilated patients were mobilised. Several barriers were identified. Twenty-three nurses underwent training in actively mobilising ventilated patients. This increased their confidence levels and there was reduction in reported barriers. However, the rate of active mobilisation remained low (9.7%). Subsequently, a programme of positive reinforcement with rewards and visual reminders was introduced, which saw an increase in the number of nurse-led mobilisations of both ventilated patients (from 9.7% to 34.8%; p=0.0003), and non-ventilated patients (29.5% versus 62.9%; p=<0.0001).
Conclusion: It is safe and feasible to train nurses to perform active mobilisation of ventilated patients. However, to promote a culture change, training and competency must be combined with a multi-pronged approach including reminders, positive reinforcement and rewards.
Keywords: Critical care; Mobilisation; Quality improvement project; Ventilated patient.
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