Beginning Restorative Activities Very Early: Implementation of an Early Mobility Initiative in a Pediatric Onco-Critical Care Unit.

Autor:	Ghafoor S; Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States., Fan K; Department of Pediatric Critical Care, University of Tennessee Health Science Center, Memphis, TN, United States., Williams S; Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States., Brown A; Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States., Bowman S; Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States., Pettit KL; Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis, TN, United States., Gorantla S; Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis, TN, United States., Quillivan R; Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis, TN, United States., Schwartzberg S; Department of Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, TN, United States., Curry A; Department of Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, TN, United States., Parkhurst L; Department of Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, TN, United States., James M; Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States., Smith J; Department of Child Life, St. Jude Children's Research Hospital, Memphis, TN, United States., Canavera K; Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, United States., Elliott A; Division of Psychiatry, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States., Frett M; Division of Anesthesiology, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States., Trone D; Department of Pharmaceutical Services, St. Jude Children's Research Hospital, Memphis, TN, United States., Butrum-Sullivan J; Department Critical Care/Pulmonary Medicine-Respiratory Therapy, St. Jude Children's Research Hospital, Memphis, TN, United States., Barger C; Department of Inpatient Units-Nursing, St. Jude Children's Research Hospital, Memphis, TN, United States., Lorino M; Department of Inpatient Units-Nursing, St. Jude Children's Research Hospital, Memphis, TN, United States., Mazur J; Department of Nursing Administration- Nursing Education, St. Jude Children's Research Hospital, Memphis, TN, United States., Dodson M; Department of Nursing Administration- Nursing Education, St. Jude Children's Research Hospital, Memphis, TN, United States., Melancon M; Department of Nursing Administration- Nursing Education, St. Jude Children's Research Hospital, Memphis, TN, United States., Hall LA; Department of Inpatient Units-Nursing, St. Jude Children's Research Hospital, Memphis, TN, United States., Rains J; Department Critical Care/Pulmonary Medicine-Respiratory Therapy, St. Jude Children's Research Hospital, Memphis, TN, United States., Avent Y; Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States., Burlison J; Department of Pharmaceutical Sciences- Patient Safety, St. Jude Children's Research Hospital, Memphis, TN, United States., Wang F; Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, United States., Pan H; Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, United States., Lenk MA; Department of Quality Improvement Education and Training, Cincinnati Children's Hospital- James M. Anderson Center for Health Systems Excellence, Cincinnati, OH, United States., Morrison RR; Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States., Kudchadkar SR; Departments of Anesthesiology and Critical Care Medicine, Pediatrics and Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Jazyk:	angličtina
Zdroj:	Frontiers in oncology [Front Oncol] 2021 Mar 08; Vol. 11, pp. 645716. Date of Electronic Publication: 2021 Mar 08 (Print Publication: 2021).
DOI:	10.3389/fonc.2021.645716
Abstrakt:	Introduction: Children with underlying oncologic and hematologic diseases who require critical care services have unique risk factors for developing functional impairments from pediatric post-intensive care syndrome (PICS-p). Early mobilization and rehabilitation programs offer a promising approach for mitigating the effects of PICS-p in oncology patients but have not yet been studied in this high-risk population. Methods: We describe the development and feasibility of implementing an early mobility quality improvement initiative in a dedicated pediatric onco-critical care unit. Our primary outcomes include the percentage of patients with consults for rehabilitation services within 72 h of admission, the percentage of patients who are mobilized within 72 h of admission, and the percentage of patients with a positive delirium screen after 48 h of admission. Results: Between January 2019 and June 2020, we significantly increased the proportion of patients with consults ordered for rehabilitation services within 72 h of admission from 25 to 56% ( p <0.001), increased the percentage of patients who were mobilized within 72 h of admission to the intensive care unit from 21 to 30% ( p =0.02), and observed a decrease in patients with positive delirium screens from 43 to 37% ( p =0.46). The early mobility initiative was not associated with an increase in unplanned extubations, unintentional removal of central venous catheters, or injury to patient or staff. Conclusions: Our experience supports the safety and feasibility of early mobility initiatives in pediatric onco-critical care. Additional evaluation is needed to determine the effects of early mobilization on patient outcomes. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2021 Ghafoor, Fan, Williams, Brown, Bowman, Pettit, Gorantla, Quillivan, Schwartzberg, Curry, Parkhurst, James, Smith, Canavera, Elliott, Frett, Trone, Butrum-Sullivan, Barger, Lorino, Mazur, Dodson, Melancon, Hall, Rains, Avent, Burlison, Wang, Pan, Lenk, Morrison and Kudchadkar.)
Databáze:	MEDLINE
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