Since the inception of Intensive Care Units (ICUs), there have been dramatic improvements in the care of the critically ill. Mortality rates have declined; however, there is significant associated morbidity including cognitive impairment, mental health, and changes in physical function; this is collectively known as post-intensive care syndrome (PICS). PICS is strongly associated with delirium, sedation and immobility. To counteract PICS, the Society of Critical Care Medicine promote an ‘ABCDEF Bundle’ approach to care. In essence, this is a ‘less is more’ approach - less drugs, less ventilation, less sedation, less bedrest. If we can reduce the mental health disturbances, cognitive decline, and physical impairment of critical illness, we can anticipate a post-ICU population with an improved falls risk profile.
Historically, there was little risk of falls in ICU patients, as they were sedated on bed rest. Now, as our culture shifts to waking and moving, we must be attentive to doing this safely. Integrating early mobility in ICU is a strategy to tie together a multitude of best-practices. But how do you shift an ICU culture of protectionism, of ‘too sick to get out of bed’, to ‘too sick to stay in bed’?
In 2015 Fraser Health (FH) began a quality initiative known as "Mobilize Me" to engage staff and address common misconceptions associated with mobilization. The project was a success and initiated a shift in culture in the way staff viewed mobilization. Building on this project, in 2017 the FH team began creating a process for mobilizing patients on continuous renal replacement therapy, and those previously deemed too unstable to move. On the East Coast, the healthcare team in the ICUs in Halifax knew they needed to improve how they moved their sickest of patients. As they embarked on this initiative, they learned of the work of Fraser Health.
In this webinar, we’ll outline the evolution of critical care medicine, to provide the context of it’s state today.