Dissertation
Early Progressive Mobility (EPM) in the ICU
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2025
Abstract
Background: Prolonged immobility in the Intensive Care Unit (ICU) is associated with post-intensive care syndrome (PICS), healthcare-associated pressure injuries (HAPIs), and extended ICU length of stay (LOS). Despite evidence supporting Early Progressive Mobility (EPM) protocols, these interventions remain underutilized (Needham et al., 2012; Bach & Hetland, 2022). Purpose: This quality improvement project aimed to implement and evaluate a nurse-led EPM protocol in a large urban medical center to improve ICU-specific outcomes, including HAPI incidence, LOS, and discharge disposition. Methods: The multifaceted intervention included staff education, interdisciplinary collaboration, patient and family engagement, and implementation of a standardized EPM protocol. Chi-square analyses were used to examine differences in HAPI occurrence, ICU LOS, and discharge disposition pre- and post-EPM implementation (Schallom et al., 2020). Findings: Among 2,527 ICU patients, 84.25% were in the post-implementation group. A statistically significant increase in HAPIs was observed post-implementation (? (1) = 10.88, p < .001), suggesting the need for enhanced skin protection strategies during mobilization. A statistically significant increase in the number of patients with an ICU LOS of less than 5 days was found post-implementation (? (1) = 4.36, p = .037), indicating a shift toward shorter stays. Although not statistically significant, there was a favorable trend toward more home discharges among patients discharged alive (? (1) = 1.70, p = .192). Discussion: Implementation of a nurse-driven EPM protocol was associated with improved ICU throughput as evidenced by a greater number of shorter stays and suggested a trend toward improved functional outcomes upon discharge. However, the increase in HAPIs underscores the need for concurrent emphasis on skin integrity. EPM protocols offer a scalable and replicable model for improving ICU care delivery and warrant integration with safety bundles to optimize patient outcomes (Roberts et al., 2016; Schweickert & Kress, 2018).
Details
- Title: Subtitle
- Early Progressive Mobility (EPM) in the ICU
- Creators
- Wade Johnson - University of Iowa
- Contributors
- Julie Stanik-Hutt (Chair) - University of Iowa
- Resource Type
- Dissertation
- Project Type
- Poster
- Degree Awarded
- Doctor of Nursing Practice (DNP), University of Iowa
- Degree in
- Adult/Gerontology Nurse Practitioner (Acute Care)
- Date degree season
- Spring 2025
- Publisher
- University of Iowa
- Number of pages
- 1 page
- Copyright
- Copyright 2025 Wade Johnson
- Language
- English
- Academic Unit
- College of Nursing; Doctor of Nursing Practice Projects
- Record Identifier
- 9984841527002771
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