PICU in Motion: Constructing an Evidence Based Protocol for Early Mobility in a Pediatric Intensive Care Unit

Early mobility during a hospital stay is known to decrease length of stay, intubation days, sedation days, morbidity, and mortality. An interdisciplinary team was built at a free standing children's hospital to include physical therapy (PT), nursing, wound care, respiratory therapy (RT), and physicians. The team met to discuss the best ways to approach early mobility in a pediatric intensive care unit (PICU) with the overall goal to decrease length of stay, sedation days, and intubation days. These meetings identified barriers as well as strategies for success. Criteria for early mobility eligibility began to evolve. Strategies began with weekly huddles to include PT and PICU physicians to assess the needs of each patient. Need assessments were conducted to assess nursing knowledge and availability of resources. The results were surprising. Nurses did not understand the concept of early mobility or the resources available for patient movement. Fear of patient harm was a prominent concern for nursing staff as well as the lack of staff to help with movement. The creation of an early mobility policy and protocol was evident. Nurses needed guidance on which patients met the eligibility requirements. The interdisciplinary team discussed these issues and created an early mobility protocol, adapting the John Hopkins PICU UP! Program, to meet the needs of our PICU staff and patients.