Implementation of a Progressive Mobilization Program in a Medical-Surgical Intensive Care Unit

2015 ◽  
Vol 35 (5) ◽  
pp. 28-42 ◽  
Author(s):  
April Messer ◽  
Linda Comer ◽  
Steve Forst
Keyword(s):  
Intensive Care ◽  
Educational Intervention ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Intensive Care Nurses ◽  
Positive Effects ◽  
Implementing Change ◽  
Before And After ◽  
Mobility Protocols ◽  
And Performance

BackgroundCurrent literature supports implementation of progressive mobility protocols in intensive care units. Education can help nurses overcome barriers to mobility and increase knowledge about the positive effects of mobility.ObjectiveTo evaluate the effect of education for a progressive mobilization program for intensive care nurses on knowledge and performance.MethodsA pretest-posttest evaluation was conducted for 41 nurses, and a chart review was performed before and after implementation of the educational intervention to evaluate changes in knowledge and mobilization.ResultsScores after the educational intervention were significantly higher than scores before the intervention (t = 2.02; P < .001). Overall mobilization (P = .04) and dangling (P = .01) increased significantly after the education. No significant increases occurred in ambulating or getting patients up to a chair.ConclusionsMobilization education was effective and increased nurses’ knowledge about the benefits of mobility for critically ill patients. The educational program also affected how nurses performed mobility interventions. Although provision of education had positive effects on patients’ mobility, leadership and coaching are still important components in implementing change.

scholarly journals A Diagnostic Stewardship Intervention To Improve Blood Culture Use among Adult Nonneutropenic Inpatients: the DISTRIBUTE Study

2020 ◽  
Vol 58 (10) ◽  
Author(s):  
Valeria Fabre ◽  
Eili Klein ◽  
Alejandra B. Salinas ◽  
George Jones ◽  
Karen C. Carroll ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Control Units ◽  
Stewardship Program ◽  
Academic Center ◽  
Before And After ◽  
The Impact

ABSTRACT Interventions to optimize blood culture (BCx) practices in adult inpatients are limited. We conducted a before-after study evaluating the impact of a diagnostic stewardship program that aimed to optimize BCx use in a medical intensive care unit (MICU) and five medicine units at a large academic center. The program included implementation of an evidence-based algorithm detailing indications for BCx use and education and feedback to providers about BCx rates and indication inappropriateness. Neutropenic patients were excluded. BCx rates from contemporary control units were obtained for comparison. The primary outcome was the change in BCxs ordered with the intervention. Secondary outcomes included proportion of inappropriate BCx, solitary BCx, and positive BCx. Balancing metrics included compliance with the Centers for Medicare and Medicaid Services (CMS) SEP-1 BCx component, 30-day readmission, and all-cause in-hospital and 30-day mortality. After the intervention, BCx rates decreased from 27.7 to 22.8 BCx/100 patient-days (PDs) in the MICU (P = 0.001) and from 10.9 to 7.7 BCx/100 PD for the 5 medicine units combined (P < 0.001). BCx rates in the control units did not decrease significantly (surgical intensive care unit [ICU], P = 0.06; surgical units, P = 0.15). The proportion of inappropriate BCxs did not significantly change with the intervention (30% in the MICU and 50% in medicine units). BCx positivity increased in the MICU (from 8% to 11%, P < 0.001). Solitary BCxs decreased by 21% in the medicine units (P < 0.001). Balancing metrics were similar before and after the intervention. BCx use can be optimized with clinician education and practice guidance without affecting sepsis quality metrics or mortality.

Redesigning Orientation in an Intensive Care Unit Using 2 Theoretical Models

2015 ◽  
Vol 26 (3) ◽  
pp. 204-214 ◽  
Author(s):  
Elizabeth Kozub ◽  
Maribel Hibanada-Laserna ◽  
Gwen Harget ◽  
Laurie Ecoff
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Theoretical Models ◽  
Surgical Intensive Care Unit ◽  
Turnover Rates ◽  
Theoretical Frameworks ◽  
Surgical Intensive Care ◽  
Orientation Program ◽  
Before And After

Background: To accommodate a higher demand for critical care nurses, an orientation program in a surgical intensive care unit was revised and streamlined. Two theoretical models served as a foundation for the revision and resulted in clear clinical benchmarks for orientation progress evaluation. Purpose: The purpose of the project was to integrate theoretical frameworks into practice to improve the unit orientation program. Methods: Performance improvement methods served as a framework for the revision, and outcomes were measured before and after implementation. Results: The revised orientation program increased 1- and 2-year nurse retention and decreased turnover. Critical care knowledge increased after orientation for both the preintervention and postintervention groups. Conclusion: Incorporating a theoretical basis for orientation has been shown to be successful in increasing the number of nurses completing orientation and improving retention, turnover rates, and knowledge gained.

STANDARDIZATION AND PERFORMANCE IMPROVEMENT IN AN OPEN SURGICAL INTENSIVE CARE UNIT: THE PHARMACY RENAL DOSING PROTOCOL

2004 ◽  
Vol 32 (Supplement) ◽  
pp. A26 ◽  
Author(s):  
Carla C Braxton ◽  
Julie Kennedy ◽  
Shelly Gunderson ◽  
Brian McAfee ◽  
Nyla O’Neal ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Performance Improvement ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
And Performance
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