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Confronting Barriers and Producing Outcomes. Don Packard, PT, MSPT University of Michigan Hospital. Objectives. Illustrate use of the EBP Process using Early Mobility in the ICU, sharing the benefits and barriers to working with the multidisciplinary team.

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confronting barriers and producing outcomes

Confronting Barriers and Producing Outcomes

Don Packard, PT, MSPT

University of Michigan Hospital

  • Illustrate use of the EBP Process using Early Mobility in the ICU, sharing the benefits and barriers to working with the multidisciplinary team.
  • Compare and contrast patient outcome data from pre-intervention to intervention
  • Understand process change for global culture change and implementation.

Culture of Immobility

  • Management of the patient – MD and RN
  • Changes in medications and technology
  • Apathy and training level of therapy staff




Needham, D.; Perme, C. “Early Mobility in the Critically Ill: Getting Started in Your ICU.” Webinar 10/13/11 SCCM


The actual therapy in the ICU is not different, but the process by which we deliver it needs to evolve.


PROCESS of Evidenced Based Practice

  • Literature
  • Identify need
    • Recognized Literature
    • Unit Data
  • Gather Team Members
  • Literature Synthesis
  • Identify Outcomes
  • Site Visit
  • Choose Intervention
    • Specify Intervention
    • Criteria for Inclusion
  • Core Group
  • Change Champions
  • Survey: Mobility Routine
  • Education: Facts
  • Language
  • Immersion
  • Observable Outcomes
  • Time
  • Iowa Model: EBP Change
  • Implementation Model

LEAN Process - Therapy

  • Current State
  • Future State
  • Therapy would wait for physician decision for consult.
  • Need to have stable staffing.
  • Low volume
  • Need to be involved more quickly.
  • Need to shift our staffing coverage.
  • Potential for increased volume.
change champions
Change Champions
  • Identify Benefits
  • Promote the Cause
  • Identify Barriers
  • Participation
    • Unit Survey
    • Invest in Criteria
    • Educate Staff
identify goals
Identify goals
  • Therapy
  • Nursing

Assistive Staff – Rehab Tech

  • Rehab Tech as an important part of the multidisciplinary team.
  • Increased Safety
  • Improved Teamwork w Nursing
  • Increased Activity/Progression
  • Increased Awareness

Access to PT

  • Adding PT consult to order set.
    • Full PT team buy in and support
  • Realignment of PT coverage.
    • Cross coverage and training
  • Rehab Tech to help with efficiency

1 pt per PT

(20 extra pts daily)

3 units per PT

(60 extra units daily)


Standard Approach - Language

  • Actually wrote out our ‘typical’ steps we take when progressing a patient through the phases of mobility.
  • Educated Nursing staff on FIM documentation language to ensure common understanding of assistance level.
  • Posted Mobility Recommendations in each room.

July 2009

July 2010

July 2011


July 2009

July 2010

July 2011


Early Mobility Being Achieved

  • April 4 – July 30 2011
  • Nursing and PT data collection.
  • Visual system for team to follow progress
  • Moving Patients Forward!

Mobility Barriers

  • April 4 – July 30 2001
  • Further inspection on barriers outside of exclusion criteria

Multidisciplinary Secrets to Success

  • Add Physical Therapy Consult to the Admission Order Set
  • Change Champions to provide education/role modeling
  • Improve stable staffing from Physical Therapy
  • Re-education of Spontaneous Awakening Trial/Change time
  • Build Multidisciplinary relationships throughout
  • PT to provide on the spot education/dialogue with staff
  • Increased respect and understanding of our roles, and how we work together

Secrets to Success

  • Therapy and Nursing onboard and working together. Need to have an understanding to support each other.
  • More than just talking about it. DO IT – and have others see it. Invite senior management – and make sure to follow up yourself!
  • Keep data and information visible for all to see.
  • ULTIMATELY, keeping the patient’s best interests in the spotlight.