NURSE-DRIVEN EARLY PROGRESSIVE MOBILIZATION IN PEOPLE WITH ACUTE CARDIOVASCULAR DISEASE

Abstract

Early mobilization (EM) is recommended in intensive care units. However, there is little known about nurse-driven EM in patients with acute cardiovascular disease. We prospectively followed patients in a nurse-driven EM program over a six-month period in a Cardiovascular Intensive Care Unit (CICU) at an academic tertiary care hospital in Montreal, Canada. The Level of Function (LOF) scale, which ranges from 0 (bed immobile) to 5 (able to walk > 20 meters; Figure), was used to both measure functional status and to guide mobilization activities. There were 349 patients (67.1 ± 13.9 years old, 33.8% [N=118] female) included. The most common admission diagnoses were acute coronary syndrome (32.7%, N=114), congestive heart failure (18.6%, N=65) and atrial fibrillation (11.2%, N=39). Length of stay was 2.8 ± 2.6 days in the CICU and 9.4 ± 13.5 days in the hospital. The LOF was 4.7 ± 0.7 prior to hospitalization, 3.3 ± 1.4 at CICU admission and 4.2 ± 0.9 at CICU discharge (Figure). There were 3,507 mobilization activities performed out of a possible 3,978 activities (88.2%). Adverse events occurred in 0.4% (15/3,507) of mobilizations, none of which had serious clinical consequences. The most common adverse events were non-limiting dyspnea (N=6, 0.2%), transient tachyarrhythmias (N=4, 0.1%) and chest discomfort (N=2, 0.1%). There were no injuries to healthcare professionals. One-fifth of patients (N=67, 19.2%) initially had contraindications to mobilization; all of these patients were subsequently mobilized. Nurse-driven EM is safe, feasible and effective in patients with acute cardiovascular disease.