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Extending the Benefits of Early Mobility to Critically Ill Patients Undergoing Continuous Renal Replacement Therapy: The Michigan Experience

Talley, Cheryl L. RN; Wonnacott, Robert O. ADN; Schuette, Janice K. BSN, RN, CCRN; Jamieson, Jill RN; Heung, Michael MD

doi: 10.1097/CNQ.0b013e3182753387
Original Articles

Evidence to support improved outcomes with early ambulation is strong in medical literature. Yet, critically ill continuous renal replacement therapy (CRRT) patients remain tethered to their beds by devices delivering supportive therapy. The University of Michigan Adult CRRT Committee identified this deficiency and sought to change it. There was no guidance in the literature to support mobilizing this population; therefore, we reviewed literature from devices with similar technological profiles. Revision of our institutional mobility protocol for the CRRT population included a simple safety acronym, ASK. The acronym addresses appropriate candidacy; secured, appropriate access; and potential device and patient complications as a memorable aid to help nursing staff determine whether their CRRT patients are candidates for early mobility. After implementing our CRRT mobility standard, a preliminary study of 109 CRRT patients and a review of incident reports related to CRRT demonstrated no significant adverse patient events or falls and no access complications related to mobility. This deliberate intervention allows CRRT patients to safely engage in mobility activities to improve this population's outcomes. A simple mobility protocol and safety acronym partnered with strong clinical leadership has permitted the University of Michigan to add CRRT patients to the body of early mobility literature.

Departments of Nursing (Messrs Talley, Schuette, and Jamieson and Mr Wonnacott) and Medicine (Dr Heung), University of Michigan Health System, Ann Arbor, Michigan.

Correspondence: Cheryl L. Talley, RN, Department of Nursing, 1500 E. Medical Center Dr, C-127 MIB, SPC 5804, Ann Arbor, MI 48109 (

The authors thank Sharon Dickinson for her guidance and thoughtful review of the manuscript. They also thank the other members of the University of Michigan Health System CRRT Committee, in particular, Theresa Mottes, for her efforts in data collection and quality monitoring.

None of the authors has any relevant financial or funding disclosures to report.

© 2013 Lippincott Williams & Wilkins, Inc.