儿科重症监护室行动起来！：一项促进危重症患儿早期活动的质量改进干预措施的影响
PICU Up!: Impact of a Quality Improvement Intervention to Promote Early Mobilization in Critically Ill Children.
作者信息
Wieczorek Beth, Ascenzi Judith, Kim Yun, Lenker Hallie, Potter Caroline, Shata Nehal J, Mitchell Lauren, Haut Catherine, Berkowitz Ivor, Pidcock Frank, Hoch Jeannine, Malamed Connie, Kravitz Tamara, Kudchadkar Sapna R
机构信息
1Department of Anesthesiology and Critical Care Medicine, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD.2Department of Pediatric Nursing, Charlotte R. Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, MD.3Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.4Department of Child Life, Charlotte R. Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, MD.5University of Maryland School of Nursing, Baltimore, MD.6Pediatrix Medical Group, Herman-Walter Samuelson Children's Hospital at Sinai, Baltimore, MD.7Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, MD.8Interactive Learning, Johns Hopkins Medicine, Baltimore, MD.
出版信息
Pediatr Crit Care Med. 2016 Dec;17(12):e559-e566. doi: 10.1097/PCC.0000000000000983.
OBJECTIVE
To determine the safety and feasibility of an early mobilization program in a PICU.
DESIGN
Observational, pre-post design.
SETTING
PICU in a tertiary academic hospital in the United States.
PATIENTS
Critically ill pediatric patients admitted to the PICU.
INTERVENTION
This quality improvement project involved a usual-care baseline phase, followed by a quality improvement phase that implemented a multicomponent, interdisciplinary, and tiered activity plan to promote early mobilization of critically ill children.
MEASUREMENTS AND MAIN RESULTS
Data were collected and analyzed from July to August 2014 (preimplementation phase) and July to August 2015 (postimplementation). The study sample included 200 children 1 day through 17 years old who were admitted to the PICU and had a length of stay of at least 3 days. PICU Up! implementation led to an increase in occupational therapy consultations (44% vs 59%; p = 0.034) and physical therapy consultations (54% vs 66%; p = 0.08) by PICU day 3. The median number of mobilizations per patient by PICU day 3 increased from 3 to 6 (p < 0.001). More children engaged in mobilization activities after the PICU Up! intervention by PICU day 3, including active bed positioning (p < 0.001), and ambulation (p = 0.04). No adverse events occurred as a result of early mobilization activities. The most commonly reported barriers to early mobilization after PICU Up! implementation was availability of appropriate equipment. The program was positively received by PICU staff.
CONCLUSIONS
Implementation of a structured and stratified early mobilization program in the PICU was feasible and resulted in no adverse events. PICU Up! increased physical therapy and occupational therapy involvement in the children's care and increased early mobilization activities, including ambulation. A bundled intervention to create a healing environment in the PICU with structured activity may have benefits for short- and long-term outcomes of critically ill children.
目的
确定在儿科重症监护病房（PICU）开展早期活动计划的安全性和可行性。
设计
观察性前后对照设计。
地点
美国一家三级学术医院的PICU。
患者
入住PICU的危重症儿科患者。
干预措施
该质量改进项目包括一个常规护理基线阶段，随后是一个质量改进阶段，此阶段实施了一项多组分、跨学科且分层的活动计划，以促进危重症儿童的早期活动。
测量指标及主要结果
于2014年7月至8月（实施前阶段）和2015年7月至8月（实施后）收集并分析数据。研究样本包括200名年龄在1天至17岁之间、入住PICU且住院时间至少为3天的儿童。到PICU第3天时，“PICU行动起来！”计划的实施使得职业治疗会诊次数增加（从44%增至59%；p = 0.034），物理治疗会诊次数增加（从54%增至66%；p = 0.08）。到PICU第3天时，每位患者的活动次数中位数从3次增加到6次（p < 0.001）。在“PICU行动起来！”干预措施实施后，到PICU第3天时，更多儿童参与了活动，包括主动床上体位调整（p < 0.001）和行走（p = 0.04）。早期活动并未导致不良事件发生。在“PICU行动起来！”计划实施后，最常报告的早期活动障碍是缺乏合适的设备。该计划受到了PICU工作人员的积极认可。
结论
在PICU实施结构化、分层的早期活动计划是可行的，且未导致不良事件。“PICU行动起来！”计划增加了物理治疗和职业治疗对儿童护理的参与度，并增加了包括行走在内的早期活动。在PICU通过结构化活动营造康复环境的综合干预措施可能对危重症儿童的短期和长期预后有益。
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