Duke Raleigh Hospital

By Rick Gannotta, NP, DHA, FACHE, Duke Raleigh Hospital President

The secret to getting out of intensive care quickly turns out to be something pretty elementary: Walking.

While that may sound obvious, it wasn’t always. Not so long ago, prevailing wisdom held that patients in the ICU should be heavily sedated. Now we know the best way to get a patient well and on his or her way home is minimal sedation. When we help patients become ambulatory as soon as safely possible, we can pave the way for better patient outcomes, shorter hospital stays and fewer days on a ventilator.

A multidisciplinary team led by Kristin Merritt, nurse manager in the ICU and Mimi Matthys, ICU Clinical Team Lead have done inspirational work on early progressive mobility (EPM). The team has created a protocol that gets ICU patients who are on a ventilator up and walking much earlier than ever before. They’ve also created an entire education campaign to promote the effort.

The EPM project started in October 2012 with a $10,000 grant from the American Association of Critical Care Nurses (AACN) Clinical Scene Investigator (CSI) Academy. This grant awarded four nurses – Katherine Geyer, BSN, RN, CCRN; Craig Sibbach, BSN, RN, CCRN; Kerrie Klepfer, BSN, BSN; Jennifer LeBlanc, BSN, RN, CCRN along with CSI Coaches Connie Clark, RN and Brittain Wood, RN – a 16-month long nursing excellence and leadership training program to improve outcomes for ICU patients. This idea wasn’t dictated by CSI; the staff identified early ambulation as an important area of focus and one they wanted to investigate.

The concept for EPM begins with the once-radical idea that rehab starts from day one. The ICU staff is never going to push a patient to do something he or she isn’t ready for, but the staff now has the mindset that early ambulation is the ultimate goal. As Kristin Merritt has said, “Early ambulation saves lives.”

The CSI team conducted an ICU staff pre-survey to assess staff perceptions regarding ambulating patients. Then, a nurse-driven EPM protocol was created and vetted. In March, the CSI team launched the “Walk This Way” EPM campaign with two full days of education for staff.

Getting ambulatory starts small. A patient may dangle his feet off the side of the bed one day, and that may be enough. Then the next day, he may move from his bed to a chair. The next day, he may be ready for a walk down the hall. All of this is happening under the careful supervision of our ICU staff.

And the staff is helping patients celebrate every milestone. They’ve made it fun by using an Olympic theme in the ICU. Patients get medals for each step they take in their recovery.

In addition to the nurses who developed the EPM project, our gratitude goes to the critical care team, surgeons, rehab staff, CSI coaches from Infection Prevention, ICU nursing leadership, the respiratory therapy team, who fully embraced the concept and have made it standard practice in the ICU.

The EPM work is so significant that it’s even going beyond Duke Raleigh Hospital. Other hospitals have asked to review our protocol, and the team has been chosen to present at AACN National Teaching Institute Critical Care conference in Denver this May. So, the team’s work is influencing healthcare outside our own walls.

The faster ICU patients can get up and get moving, the sooner they can get home. Nothing is more gratifying than seeing an ICU patient get up and walk out on us.