P99: Progressive Mobilization Protocol for Patients Supported on ECMO Via Multidisciplinary Culture Change

Abstract

Our project was aimed at changing the culture surrounding mobilization of the patient supported on ECMO. Due to the critical nature of patients supported on ECMO a multidisciplinary approach of ECMO trained staff members is essential. It is known that critically ill patients benefit from early mobilization. Culture around mobilizing patients supported on ECMO at our facility has been historically conservative and progressive mobility was met with resistance. Our goal was to initiate culture change to one in which progressive mobility is an expectation for the critically ill while designing and implementing a standardized formal protocol for mobilization of patients supported on VA/VV ECMO. This initiative required a multidisciplinary team of stakeholders and influencers to promote acceptance and willingness from nursing, perfusion, pulmonary critical care team and ICU lead physicians. Our team created a protocol with the following goals: 1) increase early and progressive mobilization of patients supported on ECMO 2) decrease time of eligibility to transplant listing of patients supported on ECMO 3) improve outcomes of patients supported on ECMO to include; earlier decannulation, decreased hospital length of stay and discharge to home or rehab vs skilled nursing facility or LTACH 4) change nursing culture to one where early and progressive mobilization is the expectation for patients supported on ECMO 5) increase confidence among healthcare staff regarding early and progressive mobility of the critically ill patient. For every ECMO patient on our unit, bedside nursing staff completes a daily checklist. The purpose of this list was to create ownership from nursing to allow them stake in the process. Checklist was created and vetted by all teams to allow input and to cultivate a multidisciplinary approach. The bedside nurse and physical therapist reviewed the patients’ case daily. Once the patient passes the suggested guidelines for mobility the multidisciplinary team, led by the physical therapist and consisting of the bedside nurse, perfusionist and respiratory therapist, initiates mobility per physical therapy protocol. If patients do not pass the safety checklist by nursing, a multidisciplinary conversation occurs to determine the appropriateness (risk/benefit) of mobilizing the patient, and session is either initiated or deferred. A specialized team and protocol are imperative to successful mobility for this patient population. This initiative created influencers who consisted of team leads targeted to implement change. Culture change has occurred and patients receiving ECMO support are mobilized daily without hesitation. Our future plans include modification of nursing checklists and physical therapy protocol, creation of post mobilization procedures to collect and analyze data, and the development and implementation of an ECMO competency for our PT/OT rehabilitation staff to ensure a high level of training and clinical competence.