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Increasing Nurse-Led Mobilization of Critically Ill Children Through In Situ Simulation: A Quality Improvement
Jessica M LaRosa1, Hallie Lenker2, Colleen Mennie1
1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Objective:
Critically ill children are at risk for preventable morbidities due to immobility. Early mobility, a key component of the ICU Liberation Bundle, improves outcomes and reduces mortality. Internationally, adherence to early-mobility protocols is low and nurses are pivotal for success. This quality improvement (QI) initiative aimed to assess whether an in situ early-mobility simulation for PICU nurses increased nurse-led mobilization of critically ill children.
Design:
QI initiative with an observational, pre-post design.
Setting:
PICU in a tertiary academic hospital in the United States.
Patients:
Critically ill pediatric patients admitted to the PICU.
Intervention:
An in situ early-mobility simulation session for PICU nurses.
Measurements And Main Results:
Data were collected and analyzed from February to October 2024 on randomly selected shifts in the pre-intervention (n = 22 day shifts) and post-intervention (n = 26 day shifts) phases. One hundred and one children 1-17 years old who were admitted to the PICU and had length of stay greater than or equal to 72 hours were included. Eighty percent of all critical care nurses (80/100) participated in the simulation session. Post-intervention, the median number of nurse-led mobilizations per patient in a 12-hour shift increased from 5 to 6 (p = 0.02). Participation in the simulation was associated with an increase of 1.9 mobilizations per patient in a 12-hour shift after adjusting for age, illness severity, functional status and mobility level. (p = 0.004). Nursing knowledge of patients' mobility levels improved (p = 0.004), and self-efficacy in mobilizing critically ill children increased from 67% to 93% (p < 0.001). No significant increase in safety events was observed.
Conclusions:
In situ early-mobility simulations for PICU nurses increased nurse-led mobilizations of critically ill children without compromising safety. Further research is needed to explore the long-term impact and generalizability of this curriculum.
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