动起来：使用早期活动方案提高重症和中症监护环境下患者活动能力的可行性。

Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings.

机构信息

Central DuPage Physician Group, 25 N Winfield Rd, Winfield, IL 60190, USA.

出版信息

Phys Ther. 2013 Feb;93(2):197-207. doi: 10.2522/ptj.20110400. Epub 2012 Sep 13.

DOI:10.2522/ptj.20110400

PMID:22976447

Abstract

BACKGROUND

Prolonged bed rest in hospitalized patients leads to deconditioning, impaired mobility, and the potential for longer hospital stays.

OBJECTIVE

The purpose of this study was to determine the effectiveness of a nurse-driven mobility protocol to increase the percentage of patients ambulating during the first 72 hours of their hospital stay.

DESIGN

A quasi-experimental design was used before and after intervention in a 16-bed adult medical/surgical intensive care unit (ICU) and a 26-bed adult intermediate care unit (IMCU) at a large community hospital.

METHOD

A multidisciplinary team developed and implemented a mobility order set with an embedded algorithm to guide nursing assessment of mobility potential. Based on the assessments, the protocol empowers the nurse to consult physical therapists or occupational therapists when appropriate. Daily ambulation status reports were reviewed each morning to determine each patient's activity level. Retrospective and prospective chart reviews were performed to evaluate the effectiveness of the protocol for patients 18 years of age and older who were hospitalized 72 hours or longer.

RESULTS

In the 3 months prior to implementation of the Move to Improve project, 6.2% (12 of 193) of the ICU patients and 15.5% (54 of 349) of the IMCU patients ambulated during the first 72 hours of their hospitalization. During the 6 months following implementation, those rates rose to 20.2% (86 of 426) and 71.8% (257 of 358), respectively.

LIMITATIONS

The study was carried out at only one center.

CONCLUSION

The initial experience with a nurse-driven mobility protocol suggests that the rate of patient ambulation in an adult ICU and IMCU during the first 72 hours of a hospital stay can be increased.

摘要

背景

住院患者长时间卧床会导致身体机能下降、行动不便，并可能延长住院时间。

目的

本研究旨在确定一种护士主导的活动方案是否能提高患者在住院前 72 小时内活动的比例。

设计

在一家大型社区医院的 16 张成人内科/外科重症监护病房（ICU）和 26 张成人中级护理病房（IMCU）中，采用了干预前后的准实验设计。

方法

一个多学科团队制定并实施了一个带有嵌入式算法的活动医嘱集，以指导护士对活动能力进行评估。根据评估结果，该方案授权护士在适当情况下咨询物理治疗师或职业治疗师。每天早上都会审查活动状态报告，以确定每位患者的活动水平。对年龄在 18 岁及以上、住院时间超过 72 小时的患者进行回顾性和前瞻性图表审查，以评估该方案的效果。

结果

在实施“行动改善”项目之前的 3 个月中，ICU 中有 6.2%（193 例中的 12 例）和 IMCU 中有 15.5%（349 例中的 54 例）的患者在住院前 72 小时内活动。在实施后的 6 个月中，这一比例分别上升至 20.2%（426 例中的 86 例）和 71.8%（358 例中的 257 例）。