Problem: Up to 80% of patients admitted to an Intensive Care Unit (ICU) experience delirium. This can have a significant impact on patient, system and quality of care outcomes. Once thought to be harmless, delirium is associated with: increased mortality, prolonged duration in mechanical ventilation, prolonged hospital stay, acquired weakness, institutional placement and cognitive impairment that may persist post-discharge.

The objective of this strategy was to safely improve patient outcomes through a cross site, evidence informed, coordinated, patient centered, integrated and interdisciplinary approach.

The goals of project were the following: 1) to increase the number of mobility events as defined by standardized criteria; 2) to increase the accuracy of the assessments of pain, sedation and delirium; 3) to increase staff awareness of available tools; and 4) to understand the impact of mobilization/delirium on interdisciplinary collaboration.

New tools were developed to facilitate patient mobilization and decrease the incidence of delirium. These included a mobility protocol, delirium, sleep and sedation educational materials for both staff and families. The mobility protocol provides a step approach, with standardized definitions and with criteria to progress mobility to the next step. The pictorial drawings associated with each step were developed by a frontline staff member, increasing staff engagement. The utilization of late career nurse funds provided additional support to physiotherapy, respiratory therapy and nursing, enabling safe mobilization of ventilated patients. This also allowed for peer education regarding the benefits of early mobilization and the impact on the development of delirium. Knowledge translation strategies were used to engage front line staff in peer presentations, including the patient experience and peer champions.

The ability to engage and empower members of the frontline interdisciplinary team in meeting the project objectives was the true success of the early mobilization project.

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Title: Clinical Nurse Specialist

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