In any hospital, the Intensive Care Unit (ICU) is a place of high stress and critical care. One of the most important aspects of caring for patients in the ICU is ensuring that they are mobile and have opportunities to move around as much as possible. This helps promote blood flow, prevents bedsores, and reduces stress levels. In this blog post, we will discuss some of the most successful practices for moving ICU patients safely and effectively.
What is patient mobilization?
Patient mobilization is the process of moving a patient from their bed to another location and back again. This can be done with the help of a caregiver or a mobile device such as a wheelchair or stretcher.
Typical patient mobilization locations include the bed, bathroom, and chair. In order to safely move a patient, it is important to assess their condition and abilities. Patients who are weak or unsteady on their feet may need more assistance than those who are stronger.
The first step in mobilizing a patient is to carefully transfer them from their bed to the desired location. There are a few different techniques that can be used, depending on the situation. One popular method is called the log roll. This involves rolling the patient onto their side, then carefully transfer them to the other side. This should only be done by trained caregivers, as it can be dangerous for patients who are not stable, especially in the ICU.
Another common method is to use a mobile device such as a wheelchair, recliner chair, or stretcher. These devices can be helpful for transporting patients between locations, such as from the ICU to the hospital floor. They can also be used for short-term mobility, such as getting a patient out of bed for a bit of exercise.
It is important to keep in mind that not all patients are able to mobilize safely. Patients who are on oxygen or have other medical devices attached should not be moved without proper assistance. Likewise, patients who are in severe pain or experiencing seizures should not be moved without consultation from a doctor.
Why is it important to mobilize hospital patients?
Patient mobilization is important for a variety of reasons. First, it helps to promote blood flow and prevent bedsores. When patients are immobile, they are at risk for developing pressure ulcers, also known as bedsores. These sores can be painful and difficult to heal, so it is important to prevent them from developing in the first place.
Mobilizing patients also helps to reduce stress levels. Being in the ICU can be a very stressful experience, and patients may feel anxious or claustrophobic. Getting out of bed and moving around can help to reduce these feelings of stress and anxiety. This activity also helps with ICU Delirium as well.
Finally, patient mobility helps to keep patients active and engaged. This is important for both their physical and mental health. Keeping patients active can help to reduce the risk of depression, anxiety, and other mental health conditions.
What is mobility protocol? Why is early mobility in ICU?
Early mobility is a protocol that encourages patients to start moving as soon as possible after admission to the ICU. This is important because it helps to prevent the complications that can occur from immobility, such as bedsores and blood clots.
Early Mobilization in ICU guidelines
The Agency for Healthcare Research and Quality (AHRQ) uses a combination of the Nurse-Driven Early Mobility Screening Algorithm and Early Mobility Protocol. The goal of this protocol is to reduce the length of stay in the ICU and improve patient outcomes.
ICU Mobility Scale
The ICU Mobility Scale is a tool that can be used to assess a patient’s ability to safely participate in early mobility. The scale ranges from 0 to 10, with 0 being completely immobile and 10 being able to walk independently without a gait aid. Patients who are able to walk with a gait aid, such as a walker or cane, are typically given a score of 9.
0. Nothing (lying in bed) – Passively rolled or passively exercised by staff, but not actively moving
1. Sitting in bed, exercises in bed – Any activity in bed, including rolling, bridging, active exercises; not moving out of bed or over the edge of the bed 2. Passively moved to the chair (no standing)- Hoist, passive lift, or slide transfer to the chair, with no standing or sitting on the edge of the bed
3. Sitting over the edge of the bed – May be assisted by staff but involves actively sitting over the side of the bed with some trunk control
4. Standing – Weight bearing through the feet in the standing position, with or without assistance. This may include the use of a standing lifter device or tilt table.
5. Transferring bed to chair – Able to step or shuffle from standing to the chair. This involves actively transferring weight from one leg to another to move to the chair. If the patient has been stood with the assistance of a medical device, they must step to the chair (not included if the patient is wheeled in a standing lifter device).
6. Marching on the spot (at bedside) – Able to walk on the spot by lifting alternate feet (must be able to step at least 4 times, twice on each foot), with or without assistance
7. Walking with the assistance of 2 or more people – Walking away from the bed/chair by at least 5 m (5 yds) assisted by 2 or more people
8. Walking with the assistance of 1 person – Walking away from the bed/chair by at least 5 m (5 yds) assisted by 1 person
9. Walking independently with a gait aid – Walking away from the bed/chair by at least 5 m (5 yds) with a gait aid, but no assistance from another person. In a wheelchair-bound person, this activity level includes wheeling the chair independently 5 m (5 yds) away from the bed/chair
10. Walking independently without a gait aid – Walking away from the bed/chair by at least 5 m (5 yds) without a gait aid or assistance from another person
How can nurses and other caregivers help patients move around safely and effectively?
There are several techniques that nurses and other caregivers can use to help patients move around safely and effectively. Some of these techniques include:
- Use of body support: This involves using a device, such as a pillow or a sheet, to support the patient’s body while they are being moved. This can help to prevent the patient from being injured during the moving process.
- Use of proper lifting techniques: This involves using the correct body mechanics when lifting a patient. This can help to prevent injuries to both the patient and the caregiver.
- Use of transfer devices: This involves using a device, such as a slide sheet or a transfer board, to help move the patient from one surface to another.
- Use of mobility devices: This involves using a device, such as a walker or Sara Stedy, to help the patient move around.
- Working together with colleagues: This involves working with colleagues to help move the patient who may be difficult to move with the assistance of one person.
General Considerations Prior to Performing Mobility Techniques
The patient’s safety is always the priority when performing any type of mobility technique. All patients should be screened for any contraindications to movement. Some general considerations that should be taken into account before performing any type of mobility technique include:
- The patient’s weight and the mode of transportation
- The patient’s current medical condition
- The patient’s current physical and mental condition
- What are your limitations – if you are unable to move the patient safely yourself then ask for help
- What is the action plan – have a gameplan ready for what you need to move the patient, what steps need to be taken, and if Plan A doesn’t work what is next
Proper Techniques for Performing Mobility Techniques
There are proper techniques that should be followed when performing any type of mobility technique. These proper techniques include:
- Consider the alignment of your spine: keep your head and neck aligned to minimize the risk of injury
- Bend and lift with your legs, not with your waist: bending at your waist places stress on your lower spine
- Avoid twisting the body, especially when bending
- Hold the patient close to your body when lifting and transferring: this will help to prevent the patient from falling by maintaining a center of gravity and will also minimize the risk of injury to both the patient and caregiver
Repositioning a Patient in Bed
One of the most common mobility techniques that nurses and other caregivers perform is repositioning a patient in bed. This technique is used to prevent pressure ulcers, improve comfort, and increase circulation. There are several steps to consider when repositioning a patient in bed, which include:
- Lock the bed rails to prevent accidental falls
- Raise the bed to waist height for better alignment of you and your colleague
- Roll the patient from their back to their side by having one person grab the edge of the draw sheet while the other person gently holds the patient. While one person pulls the sheet rolling the patient, the other person assists the roll until the patient is lying comfortably on their side.
- The patient has the opportunity to grab the side rail and pull themselves as the team pulls the sheet behind them
Moving the Patient Up in Bed
This technique is used to help the patient sit up in bed. This can be done with the assistance of two people. The steps to this technique are as follows:
- The patient should be laying supine position with their head centered on the mattress
- Each person grabs the draw sheet at the level of the shoulder and below the buttock
- Each person should be positioned at the head of the bed to allow them to pull the patient toward them instead of pushing and bending at the knee
Moving the Patient from the Bed to Wheelchair/Chair
This technique is used to move the patient from the bed to a wheelchair or chair. This can be done with the assistance of one to two people. The steps to this technique are as follows:
- Identify the strongest side for the patient and bring the chair or wheelchair to that side
- Lock the wheelchair or chair’s wheels to secure the position
- Rise the bed until it is slightly higher than the chair or wheelchair
- Never pull the patient into a steaded position! If the patient is not seated at the head of the bed, you can move the patient into this position and use the bed controls to lift the head of the bed up. You can also use the “log roll” technique by having the patient face the wheelchair on their side and having the patient push themselves up by first using their elbow, then their hand, until they are in the seated position. The person assisting with this technique can help support the patient’s back and swing their legs over the side of the bed.
- The person helping with lifting should keep their legs shoulder-width apart, back straight, and bend with the knees. You can place your knee between the patient’s leg or for more stability place both of your knees together Lift the patient until they are standing.
- Pivot the patient until their back is facing the wheelchair. Slowly and consciously, guide the patient down to the chair. Never push or pull the patient. You can use the same knee technique as before. Keep your back and neck aligned.
What are some of the challenges involved in moving ICU patients?
When moving ICU patients, it really is a team effort among multiple disciplines to get the patient moved. There are several challenges involved in moving ICU patients, which include:
- The patient may be very weak and unable to assist with the mobility technique
- The patient may be in a lot of pain and unable to tolerate being moved
- The patient may have IV lines, monitors, or other equipment attached that limit their movement
- The patient may be at risk of falling or injuring themselves if not moved correctly
- The patient may have had a procedure that inhibits their ability to move (e.g., surgery, intubation)
When beginning the moving attempt, it is important to coordinate with your colleagues, plan the move, and have all the necessary equipment readily available.
It is also important to make sure you are following orders from the physician and respecting the patient’s wishes. The goal is to make the move as safe and comfortable as possible for the patient while also ensuring that the integrity of the IV lines, monitors, and other equipment is maintained.