(794) Move to Improve: Applying Change Management to Quality Improvement for Patient Mobility in the ICU

Introduction: Early mobility improves quality of life and reduces morbidity in critically ill patients. However, routine assessment and achievement of mobility goals in intensive care unit (ICU) patients remain unclear.
This quality improvement project, guided by John Kotter’s 8-step Change Management process, aims to identify and overcome barriers to patient mobility in our ICU, targeting a 20% increase in patient mobility.

Methods: In an 18-bed medical ICU at a tertiary care center, we assessed daily mobility goals, achievements, and barriers using Johns Hopkins Highest Level of Mobility (JH-HLM) scores and nursing interviews. Interventions targeted patients whose mobility goals were out of bed (OOB) sitting in a chair or ambulating, corresponding to a JH-HLM score of 4 or higher.
Identified barriers led to low/no-cost interventions with an education period of one week. These interventions included nursing education and empowerment on mobility safety and gait-belt usage, physician and advanced practice provider training on entering mobility orders, and signage attached to workstations with a protocol to facilitate discussions of mobility goals and barriers during daily rounds.

Results: Pre-intervention data from 14 weekdays (252 patient-days) showed 26% (n=66) with a JH-HLM score of 4 or higher, of whom 35% (n=23) achieved goal mobilization. Post-intervention data from 10 weekdays (162 patient-days) showed 64% (n=104) with a JH-HLM score of 4 or higher, and of these 50% (n=52) achieved target mobilization. The intervention significantly increased the likelihood of achieving OOB goals (OR = 2.8, 90% CI: [1.76, 4.46], p = 0.0002), as determined by logistic regression.

Conclusions: Our project revealed low baseline levels of achieved mobility among eligible patients. Further our multi-pronged intervention focused on nursing and provider education, as well as an enhanced protocol facilitating daily interdisciplinary discussion and assessment of mobility, successfully increased these mobilization rates. Change Management was crucial to this success, fostering stakeholder collaboration, enthusiasm, and ownership.