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Building a Protocol to Guide Mobility in the ICU

Dammeyer, Jennifer MSN, RN, CNS, ANP, CCRN; Dickinson, Sharon MSN, RN, CNS-BC, ANP, CCRN; Packard, Donald PT, MSPT; Baldwin, Noel BSN, RN; Ricklemann, Connie BSN, RN

doi: 10.1097/CNQ.0b013e3182750acd
Original Articles

Professional experience and wisdom have taught us that immobility is a risk factor for various adverse outcomes, such as deep vein thrombosis, joint contractures, pulmonary dysfunction, and bone demineralization to name a few. Balancing bed rest and mobility may improve both short- and long-term outcomes for our patients. Moreover, early, routine mobilization of critically ill patients is safe and reduces hospital length of stay, shortens the duration of mechanical ventilation, improves muscle strength, and functional independence. At the University of Michigan, we have turned the tides by creating a structured process to get our patients moving through the use of a standardized mobility protocol. Our protocol is simple and can easily be adapted for all patient populations by simply modifying some of the inclusion and exclusion criteria. The activities are grounded in the evidence and well thought out to prevent complications and promote mobilization. The purpose of this article was to present the science behind the development of a multidisciplinary protocol for early mobilization of critically ill patients that can be adapted to any intensive care unit patient with minor modifications.

Critical Care Medicine Unit (Ms Dammeyer), Surgical Intensive Care and Rapid Response (Ms Dickinson), and Physical Therapy Department (Mr Packard), University of Michigan School of Nursing (Ms Dickinson), Critical Care Medicine Unit (Mr Baldwin), and Surgical Intensive Care (Ms Ricklemann), University of Michigan, Ann Arbor.

Correspondence: Jennifer Dammeyer, MSN, RN, CNS, ANP, CCRN, University of Michigan Critical Care Medicine Unit, 1500 East Medical Center Dr, Ann Arbor, MI 48109 ( or Sharon Dickinson MSN, RN, CNS-BC, ANP, CCRN, University of Michigan Surgical Intensive Care/Rapid Response, University of Michigan Hospital and Health Centers, Box 0076, 1500 E Medical Center Dr, Ann Arbor, MI (

Jennifer Dammeyer and Sharon Dickinson acknowledge first authorship.

The authors thank Sarah Taylor and Craig Meldrum for their help in preparation of this article. They also thank all of the staff of the SICU, TBICU, CCMU, and the PT who have made the mobility protocol initiative safe and effective for the patients.

© 2013 Lippincott Williams & Wilkins, Inc.