Early Mobility for Post-Cardiac Surgery Patients on Vasoactive Medication: A Nurse-Led Quality Improvement Project

Early mobilisation (EM) is critical for faster recovery in critically ill patients; it leads to improved outcomes, such as reduced length of stay (LOS), decreased muscle atrophy and minimal functional decline. However, implementing EM in the cardiovascular intensive care unit (CVICU), particularly for patients on vasopressors, poses challenges due to concerns regarding haemodynamic instability and adverse events. Success depends on nurses' knowledge and confidence; however, barriers exist in high-acuity settings.

This study aimed to enhance the knowledge and perspectives of CVICU nurses regarding EM among patients receiving vasopressors and to assess its impact on patient outcomes.

A quality improvement initiative was conducted in the adult CVICU of a tertiary hospital in Riyadh, Saudi Arabia. An educational programme was delivered to CVICU nurses to improve their understanding and use of the Banner Mobility Assessment Tool in daily practice, forming the basis for implementing EM protocols.

A total of 40 nurses received education, of which 25 (62.5%) responded to the questionnaire before implementation and 30 (75%) responded afterwards. The intervention significantly improved the nurses' knowledge of ICU-acquired weakness in patients receiving vasopressors (p = 0.005). Confidence in initiating EM (p = 0.002), starting without a physician's request (p = 0.006) and staying updated on mobility practices (p = 0.001) also increased. The pre-implementation group had 27 patients, while the post-implementation group had 45 patients; 24 in the EM group and 21 in the late mobilisation group. ICU mobility scores significantly increased between pre- and post-implementation groups (p < 0.001). The mean ICU mobility score at CVICU discharge was higher in the EM group (8.9 ± 0.9) than in the pre-implementation group (7.8 ± 0.6) (p < 0.001).

Nurse-driven early mobility for post-cardiac surgery patients taking vasoactive medication is safe and feasible and facilitates improved patient mobility before discharge while reducing the LOS.

This study highlights the potential of early mobilisation to enhance patient outcomes in critical care settings, emphasising the importance of nurse-led interventions.