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Abstract

Objective: Children who survive critical illness suffer many sequelae of prolonged hospitalization. National guidelines recommend pediatric intensive care units (PICUs) employ ICU care bundles to combat acquired delirium, pain, and weakness. While use of early mobility (EM) protocols has increased in PICUs, there remain challenges with adherence. Here we describe the results of a cross-sectional survey conducted at a single center tertiary PICU. The aim of this study is to better understand perceived barriers to EM in the PICU. We hypothesized that providers would be most concerned about safety of EM. Methods: A total of 94 PICU providers were included in this study, including nurses, physicians, and therapists. Responses were collected anonymously, and participation was voluntary. The initial survey was conducted prior to enacting an EM protocol to gauge knowledge and opinions surrounding EM. Based on results, education regarding EM was performed by a multidisciplinary team. An EM protocol “Move Jr.” was initiated. Four months post initiation, a follow-up survey was sent to the same cohort of providers to determine knowledge of the protocol, changes in opinions, as well as barriers to implementation of EM. Results: While providers believed EM was beneficial for patients and were interested in implementing an EM protocol, the initial top three perceived barriers to EM were risk of inadvertent extubation, risk of inadvertent loss of central lines, and time constraints. Four months after initiation of the EM protocol, a follow up survey revealed that the top 3 perceived barriers of EM had changed to time constraints, increased workload, and level of sedation. Conclusion: After 4 months the change in perceived barriers suggests greater acceptance of the safety of EM but challenges in application. Survey responses describe a desire to perform EM exercises but difficulty finding time. Understanding of the protocol also differed among providers. Greater collaboration among providers could lead to more cohesive therapy plans. There was clear benefit in educating providers to consider EM as a priority in patient care.

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