At three months post-implementation of the early mobility
program, the Neuro ICU had an 11 percent increase in the number
of eligible patients mobilized. A 35 percent reduction in falls and
a 33 percent reduction in readmission to the ICU also occurred.
A culture of early mobility has been established and is now
addressed each day for each patient in the neuro ICU.
Another area of study in the neuro ICU came out of a need
expressed by a neuro ICU nurse and respiratory therapist dyad
following an emotionally laden transition to comfort care. A
survey was developed by multiple disciplines including nursing,
neurocritical care and neurology and distributed to neurocritical
care attending physicians, residents, nurse practitioners, respiratory
therapists and nurses. The survey revealed that only 9.5 percent
of the nurses and respiratory therapists felt included as part of the
comfort care decision-making process and 78 percent felt that they
had experienced at least one transition to comfort care that was
less than ideal.
A checklist was developed to encourage communication among
all interdisciplinary team members prior to initiating comfort
care. Education is ongoing as house staff and new team members
from the various disciplines become part of the interdisciplinary
team. This checklist provides an opportunity to ensure that each
member of the interdisciplinary team, including the nurse and
the respiratory therapist, is in agreement with the plan of care.
This initiative has been viewed as successful in the neuro ICU
and discussion is currently under way to embrace this initiative
throughout the hospital.
The nurses in the neuro ICU at Harborview have an active and
essential role in the work of neurocritical care. From direct patient
care to continuous quality improvement and research, the nurses
are integral members of the neurocritical care team.
The author would like to thank Kellie Hurley, Cory Kelly, Rebekah Marsh
and Pat Tanzi for their contributions to the development of this article.