Wasilowsky, Bonnie, BSPA-HCA, RN, CNRN

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Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingMobilizing Mechanically Ventilated NeurosciencePatients - A Clinical Practice Guideline to ‘Get Upand Go’Bonnie Wasilowsky BSPA-HCA, RN, CNRNLehigh Valley Health Network, Bonnie.Wasilowsky@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/patient-care-services-nursingPart of the Circulatory and Respiratory Physiology Commons, Critical Care Nursing Commons,Medical Specialties Commons, Neurosciences Commons, Rehabilitation and Therapy Commons,and the Statistics and Probability CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtWasilowsky, B. (2014, March 8-11). Mobilizing mechanically ventilated neuroscience Patients - A clinical practice guideline to ‘get up and go’.Poster presented at: The Practice with Purpose and Passion 46th Annual Educational Meeting, Anaheim, CA.Wasilowsky, B, (2014, October 30). Mobilizing Mechanically Ventilated Neuroscience Patients - A Clinical Practice Guideline to ‘Get Up andGo’. Poster presented at: Research Day 2014, Lehigh Valley Health Network, Allentown, PA. © 2014 Lehigh Valley Health NetworkReferences:1.	 	Kress,	JP.	(2009).	Clinical	trials	of	early	mobilization	of	critically	ill	patients.	Critical Care Medicine,	37(supplemental),	S442-S447.2.	 	Needham,	DM.,	Korupolu,	R.,	Zanni,	JM.,	Pradhan,	P.,	et	al.	(2010).	Early	physical	medicine	and	rehabilitation	for	patients	with	acute	respiratory	failure:	a	quality	improvement	project.	Archives of Physical Medicine and Rehabilitation,	91,	536-542.	3.	 	Schweickert,	WD.,	Pohlman,	MC.,	Pohlman,	AS.,	et	al.	(2009).	Early	physical	and	occupational	therapy	in	mechanically	ventilated,	critically	ill	patients:	A	randomized	controlled	trial.	Lancet,	373,	1874-1882.	Identify mobility challenges faced by critically ill neuroscience patients and the subsequent anatomic and physiologic consequences.Etiologies of Immobility	 •		Fatigue			 •		Muscle	wasting			 •		Hemodynamic	instability			 •		Respiratory	compromise	and	↓ oxygen	reserves			 •		Neurological	monitoring	equipmentMobility Challenges	 •		Issues	impacting	mobility		 	 	 –		Hemiplegia	of	extremities	 	 	 –		Hemiparesis	of	extremities	 	 	 –		Joint	subluxation		 	 	 –		Spatial	neglect			 	 	 –		Cognition	impairment		 	 	 –		Intolerance	to	activityPotential Negative Outcomes	 •		DVT	 •		Pressure	ulcers	 •		Pneumonia	 •		Falls Abstract Neuroscience	patients	often	require	mechanical	ventilation,	thus	inhibiting	patient	mobilization	beyond	turning	and	repositioning.	Bedrest	prompts	a	decline	in	muscle	strength	by	1	-	1.5	%/day	and	total	muscle	mass	up	to	50%	in	two	weeks.	These	statistics	prompted	staff	to	develop	a	multidisciplinary	clinical	practice	guideline	for	mobilizing	mechanically	ventilated	patients.	The	guideline	incorporates	collaborative	plans	and	actions	for	nursing,	respiratory	and	rehabilitation	services	to	assist	ventilated	neuroscience	patients	to	“get	up	and	go.”	A	pre-mobilization	evaluation	determines	readiness	and	termination	criteria	to	grant	team	members	autonomy	to	start	and	stop	mobilization.	Over	the	18	months	since	guideline	inception	in	the	neuroscience	ICU,	there	have	been	decreases	in	ventilator	associated	pneumonias,	ventilator	days,	length	of	stay,	and	falls.	This	poster	details	mobility	challenges	faced	by	critical	neuroscience	patients,	guidelines	for	mobilizing	mechanically	ventilated	patients	and,	through	case	studies,	pragmatic	strategies	learners	can	incorporate	to	mobilize	ventilated	neuroscience	patients	in	any	setting.	Objective #1Disclosure Information:The	poster	presenter	has	nothing	to	disclose. Discuss criteria that must be assessed to determine readiness for mobilization of the mechanically ventilated patient. Hemodynamic	 •		Stable	heart	rhythm			 •		Blood	pressure	within	ordered	parametersRespiratory	 •		Rate	<	30	breaths/minute	during	over	breathing	of	set	ventilator	settings			 •		Oxygen	saturation	>	90%	on	mechanical	ventilation	settings		 •		Ventilator	oxygen	setting	<	50%Neurological	 •		Non-dependence	on	ventriculostomy			 •		Stable	ICP,	CPP,	neurological	examinationPresence & Consensus - All of the Following	 •		Registered	Nurse			 •		Respiratory	Therapist	 •		Physical	Therapist			 •		Occupational	Therapist	 •		Attending	Provider	(agreement,	but	not	present)	Objective #2 Review two case studies which demonstrate that early and consistent mobilization prevents muscle wasting and complications and enhances patients’ physiological well-being. Case Studies#1 - Young adult patient with Guillian Barre experiencing severe muscle weakness and ventilator dependent respiratory failure	 •		Early	use	of	tilt	table	to	improve	muscle	tone	 •		Early	mobilization	out	of	bed		 •		Ambulation	while	on	tracheotomy	collar		 •		Return	to	full	function	at	3	month	follow-up#2 - Middle-aged patient with Hunt Hess Grade IV subarachnoid hemorrhage; muscle wasting due to critical nature of disease and prolonged bedrest	 •		Active	and	passive	range	of	motion	to	limit	wrist	and	foot	drop	 •		Tilt	table	when	hemodynamic	stability	achieved	 •		OOB	techniques:	ceiling	lift,	stand	pivot	&	weight	bearing		 •		Transfer	to	rehabilitation	hospital		 •		Minimal	ADL	assist	required	at	6	month	follow-upObjective #3MagnetTM	Since2002Lehigh Valley Health Network, Allentown, PAMobilizing Mechanically Ventilated Neuroscience Patients -A Clinical Practice Guideline to ‘Get Up and Go’Bonnie Wasilowsky, BSPA-HCA, RN, CNRN

Mobilizing Mechanically Ventilated Neuroscience Patients - A Clinical Practice Guideline to ‘Get Up and Go’

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Mobilizing Mechanically Ventilated Neuroscience Patients - A Clinical Practice Guideline to ‘Get Up and Go’

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