Barriers to Adherence of Early Mobilization Protocols in the Pediatric Intensive Care Units

Abstract 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 the use of early mobility (EM) protocols has increased in PICUs, there remain challenges with adherence. The aim of this study is to better understand perceived barriers to EM in the PICU before and after introducing an EM protocol. We hypothesized that providers would be most concerned about the safety of EM. This pre–post-survey study was conducted at a single-center tertiary PICU. A total of 94 PICU providers were included in this study, including nurses, physicians, and therapists. Responses were collected anonymously. Survey respondents consented to participation. The initial survey was conducted prior to enacting an EM protocol to gauge knowledge and opinions surrounding EM. Based on the results, education regarding EM was performed by a multidisciplinary team. An EM protocol “Move Jr.” was initiated. Four months postinitiation, 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 the implementation of EM. While providers believed that 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 the initiation of the EM protocol, a follow-up survey revealed that the top three perceived barriers of EM had changed to time constraints, increased workload, and level of sedation. 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 a clear benefit in educating providers to consider EM as a priority in patient care.