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Tadyanemhandu C.1,2, van Aswegen H.1, Ntsiea V.1
1University of the Witwatersrand, Physiotherapy, Johannesburg, South Africa, 2University of Zimbabwe, Rehabilitation, Harare, Zimbabwe
Background: Early mobilisation of patients in the intensive care unit (ICU) is advocated for as an intervention that may attenuate the consequences of critical illness. Recent evidence shows that early mobilisation of patients in ICU is feasible and safe and is associated with improvement in patients' clinical outcomes. However, its successful implementation is dependent on a number of factors which include ICU structure and organisational practices.
Purpose: To evaluate the structure and organisational practices of Zimbabwean government hospital ICUs and to describe early mobilisation practices in these units.
Methods: A single day point prevalence survey was done in all five government hospitals in Zimbabwe. Data collected included hospital and ICU structure, patient demographic data and mobilisation activities done in ICU over the previous 24 hours prior to the day of the survey.
Results: All hospitals (n=5) were quaternary level hospitals, with each hospital having one adult ICU. All ICUs were mixed medical-surgical units, and only one was a closed type unit. Average number of nurses working in ICU (n=5) at the time of the survey was 28.6 (±7.6) with 1:1 nurse-patient ratio. Median number of physiotherapists working in ICU was 1 (IQR: 1-2). All ICUs reported that physiotherapists did not work solely in ICU but covered high care units, wards and outpatient departments. All units reported that nurses and physiotherapists were responsible for patient mobilisation. None of the units had early mobilisation protocols in place but 1 (20%) had a patient eligibility early mobilisation guideline. None of the ICUs had walking frames, transfer boards, hoists, tilt tables, standing frames or cycle ergometers. Across the ICUs 40 patients were surveyed. Mean age was 33.9 (±14.9) years, 17 were males (42.5%) and 24 (60%) were mechanically ventilated. Primary reasons for admission to ICU included postoperative care following emergency surgery (n=10; 25%), injury related to trauma (n=9; 22.5%) and prenatal complications (n=8; 20%). Mean duration of ICU stay was 6.7 (±5.1) days. Mobilisation activities performed in the previous 24 hours included turning the patient in bed (n=39/40; 97.5%), passive range of motion (ROM) (n=23/40; 57.5%), active-assisted ROM (n=25/40; 62.5%), active ROM (n=17/40; 42.5%), sat over edge of bed (n=10/40; 25%), sat out in chair (n=2/40; 5%), standing beside the bed (n=4/40; 10%), marching on the spot (n=3/40; 7.5%) and walking away from the bedside (n=2/40; 5%). Reasons listed for treatment performed in bed included sedation (n=15/40; 37.5%), unresponsiveness (n=16/40; 40%) and haemodynamic instability (n=10/40; 25%).
Conclusion(s): Out of bed mobilisation activities were low and mostly influenced by patient unresponsiveness and sedation. The open type ICU settings may influence the lack of existing patient care protocols or guidelines. Suggestions for future work include a longitudinal study to better identify factors that influence early mobilisation activities in these units.
Implications: Findings suggest that mobilisation activities in ICU are not evidence-based. Levels of patient cooperation and lack of therapy staff and equipment may influence current practice.
Funding acknowledgements: Fogarty HIV Implementation Science Research Training Program (UZ) and Medical Faculty Research Endowment Fund (WITS)
Topic: Critical care
Ethics approval: WITS Human Research Ethics Committee (Medical), Medical Research Council of Zimbabwe and Joint Research Ethics Committee
All authors, affiliations and abstracts have been published as submitted.
