Early mobilisation practices of patients in intensive care units in Zimbabwean government hospitals - a cross-sectional study.

Abstract

Background: Recent evidence shows that early mobilisation of patients in an intensive care unit (ICU) is feasible, safe and associated with improvement in patients' clinical outcomes. However, its successful implementation is dependent on several factors, which include ICU structure and organisational practices.

Objectives: To evaluate the structure and organisational practices of Zimbabwean government hospital ICUs and to describe early mobilisation practices of adult patients in these units.

Methods: A cross-sectional survey was conducted in all government hospitals in Zimbabwe. Data collected included hospital and ICU structure, adult patient demographic data and mobilisation activities performed in the ICU during the 24 hours prior to the day of the survey.

Results: A total of five quaternary level hospitals were surveyed, with each hospital having one adult ICU. Four of the units were open-type ICUs. The majority of the units (n=3; 60%) reported that they had a permanent physiotherapist who covered their unit, but none of the physiotherapists worked solely in the ICU. The nurse-to-patient ratio across all units was 1:1. None of the units utilised a standardised sedation scoring system or a standardised outcome measure to assess patient mobility status. Only one ICU (20%) had a patient eligibility guideline for early mobilisation in place. Across the ICUs, 40 patients were surveyed. The median (interquartile range) age was 33 (23.3 - 38) years and 24 (60%) were mechanically ventilated. Indications for admission into the ICU included acute respiratory failure (n=12; 30%) and postoperative care (n=10; 25%). Mobilisation activities performed in the previous 24 hours included turning the patient in bed (n=39; 97.5%), sitting over the edge of the bed (n=10; 25%) and walking away from the bedside (n=2; 5%). The main reason listed for treatment performed in bed was patients being sedated and unresponsive (n=13; 32.5%).

Conclusion: Out-of-bed mobilisation activities were low and influenced by patient unresponsiveness and sedation, staffing levels and lack of rehabilitation equipment in ICU.