Evaluation of the optimal physiotherapy-led mobilisation on critical care following the implementation of a mobility guideline.

Purpose

Every patient on critical care should be assessed daily for the potential to begin functional rehabilitation including mobilisation.

Levels of agitation and sedation, as measured by the Richmond Agitation and Sedation Score (RASS) and consciousness measured by the Glasgow Coma Scale (GCS), can impact on the type of activity delivered by physiotherapy. A new mobility guideline was initiated on the general intensive care unit (ICU) to maximise patient rehabilitation within the limitations of their RASS score.

The purpose of this evaluation is to establish that the maximum level of rehabilitation/mobility was safely performed within each patient's physical, medical and cognitive abilities.  

...for November,
no patients achieved their target level of mobility.
...for December
80% of patients achieved their maximum level of rehabilitation as per the guideline.
...for January
64% of patients achieved their maximum level of rehabilitation as per the guideline.
Implementing a mobility guideline
seems to improve the maximum achievable level of rehabilitation.

Approach

A one day data collection point was taken on three consecutive months where every patient was assessed for the following: RASS/GCS at time of physiotherapy, any contraindications to rehabilitation, highest level of rehabilitation delivered as per the mobility guideline, the type of rehabilitation/mobility performed and any comments.

A traffic light colour coding system was adopted.

  • Green: compliant with mobility guideline.
  • Yellow: partially compliant with mobility guideline.
  • Red: Non-compliance with mobility guideline.
  • An additional white code denoted contraindications to mobilisation.

Data for the three months was reported in a descriptive and tabular format.  

Outcomes

In November four patients were “Red” and 2 were “Yellow”. An additional four were white due to contraindications. So for November, no patients achieved their target level of mobility.

In December only one patient was “Red” and four were “Green”. An additional three had contraindications to mobility. So for December 80% of patients achieved their maximum level of rehabilitation as per the guideline.

Finally in January two were “Red”, two were “Yellow” and seven were “Green”. Only two in January had contraindications to mobility. So for January 64% of patients achieved their maximum level of rehabilitation as per the guideline.  

As the mobility guideline was implemented, taking into account the patients RASS/GCS, there was an improvement in the proportion of patients mobilised by physiotherapy to the maximum level indicated. Thus causing the proportion of patients who did not receive appropriate mobility to reduce. This enhanced mobility occurred despite the patients having a higher degree of sedation with a RASS around the -3 mark for December and January.

Implications

Implementing a mobility guideline seems to improve the maximum achievable level of rehabilitation. Sedation level, as measured by the RASS, or degree of consciousness, as measured by GCS, can limit the type of mobility possible but this does not need to be a barrier to mobility or the patient's rehabilitation.

Fund acknowledgements

No funding was received for this project.

Additional notes

This work was presented at Physiotherapy UK 2019.