Quality Improvement Methodology to Optimize Safe Early Mobility in a Pediatric Intensive Care Unit

Area of Science:

• Pediatric Intensive Care
• Quality Improvement Science
• Patient Safety

Background:

• Early Mobility Programs (EMP) are crucial for critically ill children in the Pediatric Intensive Care Unit (PICU).
• Enhancing EMP requires robust quality improvement (QI) methodologies alongside traditional interventions.
• Optimizing patient outcomes necessitates addressing safety concerns during mobilization.

Purpose of the Study:

• To enhance an Early Mobility Program (EMP) in a tertiary PICU using QI methodology.
• To identify and mitigate potential safety events associated with early mobility in critically ill children.
• To develop simulation-based training to improve the safety and efficacy of EMP.

Main Methods:

• Implemented an EMP in the PICU and assessed physical and occupational therapist consult appropriateness.
• Evaluated patient activity levels against recommended protocols.
• Utilized Failure Modes and Effects Analysis (FMEA) to identify potential mobilization complications.
• Developed and conducted in-situ simulations based on prioritized FMEA risks.

Main Results:

• Appropriate therapist consults significantly increased post-EMP implementation (P < 0.0001).
• Most patients did not achieve optimal activity levels due to safety concerns.
• FMEA identified vital sign changes, staff injury, and pain/anxiety as key safety risks.
• Simulations demonstrated 100% participant agreement on improved performance and led to a safety checklist and clinical pathway.

Conclusions:

• Failure Modes and Effects Analysis (FMEA) is a novel technique for developing safety simulations in PICU Early Mobility.
• Simulation-based training effectively addresses safety concerns and optimizes early mobility.
• An Early Mobility checklist and pathway are valuable tools for implementing safe and effective EMPs in the PICU.