Progressive Mobility Program at St. Joseph’s: Taking one step at time towards better health

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Progressive mobility in critical care is a growing trend in health care worldwide, which aims to keeps patients moving through exercise during their Intensive Care Unit (ICU) stay.

St.   Joseph’s Health Centre’s ICU team has developed its own Progressive Mobility program to improve the overall function of their patients, to give them the best chance for optimal quality of life once they are discharged.

“Through the program we are helping patients to keep their muscles moving, so that when they are ready to go to the ward, they are in a much better physical and mental state because they’ve had some activity,” says Julie Ninnis, Patient Care Manager of the ICU at St. Joe’s.

“When I was training as a critical care nurse, the methodology in caring for ICU patients was to keep them sedated, asleep, with the lights off, in a very quiet atmosphere. Yes, these patients do need to rest, but a growing number of studies now are finding that progressive mobility will not harm patients – and will actually help them in the long run,” she says.

Keeping patients sedated and inactive increases their risk of delirium and disorientation and can ultimately lengthen a patient’s stay in the ICU, Ninnis explains. The ICU team, including nurses, a physiotherapist, respiratory therapists, ICU assistants, physicians and a pharmacist; collaboratively determine how patients can safely start a mobility program.

“Mobility starts with passive movements when the patient is in bed,” says Pat Glover, the physiotherapist in St. Joe’s ICU. “It’s all about maintaining that range of motion and joint movement – and when the patients cannot do it themselves we can do it for them,” she says.

Rosie Goulart, an ICU registered nurse, says the team helps patients do a variety of activities like stretches, sitting up in bed or dangling their feet at the bedside – all great starting points that lead patients to gain the strength they need. Eventually patients can walk around the unit if they are able to.

ICU staff also work with families, to get them involved in their loved one’s exercise program – helping them do their stretches or walking with them around the unit. “These

exercises help patients get better faster and it adds so much value when families are involved,” says Glover.

“(The program) helps families as well because they see their loved one sitting in a chair or their feet dangling at the bedside. To them that is a sign of a step forward to improvement,” says Goulart. “I think that the program is great and it has helped the team as well as patients and families understand how important mobilization is,” she adds.

Glover explains that ICUs are being outfitted to promote mobility. “We have lower beds now, so that it’s safer for patients to get in and out of bed. There is a lot of equipment coming onto the market to enhance mobility for patients in an acute care setting who may be at a weaker level,” she says.

The team is also trialing a passive-to-active arm and leg exerciser to see how our patients can benefit from this type of equipment, Glover adds. ICU patient Bill McDow has used this equipment during his recovery. “This machine is easy to use and I feel great,” he says.

The path to developing the program began a few years ago, when the ICU team saw an article in Critical Care Nurse. From there, ICU staff members joined a five-session webinar series to understand more about progressive mobility for ICU patients.

Glover, along with a nursing colleague attended the Critical Care Rehab Conference at the JohnsHopkinsHospital in Baltimore last September. The ICU team took their learnings from the webinar and conference, as well as gathered input from local hospital colleagues, and pulled together a Working Group. That group focused on developing the program, which launched earlier this year.

For patients, it is just as important to support them physically and mentally. “Many patients feel intimidated and feel that they can’t be mobile – so it takes a lot of reassurance and praise, reminding them that it’s just about taking baby steps that will help them over time,” says Ninnis.  She adds that the support of the health care team allows patients to initiate movement despite the equipment they need such as tubing, pumps, IV poles and ventilators.

This program is important for our patients overall well-being beyond their care in the ICU, explains Ninnis. “It truly is a way we can work to Put Patients First – not just with what we are doing for them today, but to give them the biggest gain in their recovery after their acute illness,” she says. “We are engaging our patients in this process and it shows them that we are all a part of a team working with them. There is a great sense of pride among our staff because they are able to help patients this way.”

“Our program is promoting best practice in our ICU and it’s encouraging to see that we are continuing on practices that have started at world-renowned facilities,” adds Glover. “I think this should make our community feel good about what we do here at St. Joe’s.”