P0471 / #837: EARLY REHABILITATION IN PAEDIATRIC CRITICAL CARE: A TWO PART STUDY INVESTIGATING REAL AND PERCEIVED BARRIERS AND BENEFITS TO EARLY REHABILITATION

Abstract

Aims & Objectives: To evaluate real and perceived barriers to early rehabilitation (ER) in a pediatric critical care unit, and to assess the nursing team’s perceptions about risk and benefits of ER. Methods: We performed a retrospective evaluation of missed or delayed opportunities for ER, and a prospective staff survey to assess perceived patient specific barriers, risks and benefits of ER. Results: From November 2018 to October 2019 we identified 410 delayed or missed opportunities for ER for patients meeting departmental guideline criteria. Physiotherapy staffing (17%), delayed orders (17%) and nursing staff declining based on clinical condition (16%) were the most frequent barriers observed to rehabilitation (Fig 1). On the staff survey, clinical condition (50%), patient comfort (35%) and patient safety (30%) were the most common perceived barriers to ER. Staffing levels and lack of physician order were significantly under reported. Our patient level analysis showed that nursing staff perceived their patient to be of a greater risk from ER compared to our guidelines in 42% of the cases. Among patients perceived to be at high risk, most were classified as medium (62%) or low (18%) risk according to the unit guidelines. The greatest perceived potential benefits of early rehabilitation were reduced ventilator dependent days, improvement in musculoskeletal condition, and improved quality of life on discharge. Conclusions: There are significant discrepancies between real and perceived barriers to ER in our PICU. Nurses perceptions of the risk associated with ER is significantly higher than our guideline definition, this discrepancy has a significant impact on ER implementation.