Program promoting early patient mobilization recognized by Quebec Order of Nurses
A team from CIUSSS West-Central Montreal has won a prize from the Quebec Order of Nurses for an innovative program at the Jewish General Hospital that promotes early physical activity for patients with acute cardiovascular conditions.
The Innovation award from the order’s Montreal/Laval section recognizes a multidisciplinary team at the Azrieli Heart Centre that developed the Early Progressive Mobilization Program.
The idea for the project came in 2018. Diana Dima was a Senior Nurse Advisor at the Heart Centre when she observed that patients with acute cardiovascular conditions tended to remain in bed all day, much the way they had for decades.
“It was an antiquated idea that came from the 1950s,” Ms. Dima says. “The culture had been to let patients rest, in order to rest their heart and avoid further damage.”
Ms. Dima thought there had to be a better way. Working with a multidisciplinary team in the Cardiovascular Intensive Care Unit, she and her colleagues set out to transform the approach to treating critically ill heart patients. Rather than favour bed rest, they developed and implemented a program to get these patients up and moving as soon as possible.
The Early Progressive Mobilization Program, led by nurses, was so successful that is has now been adopted in the cardiac care units at St-Mary’s and the MUHC, and endorsed by the Canadian Council of Cardiovascular Nurses.
The prize from the Quebec Order of Nurses recognizes Ms. Dima along with Assistant Nursing Director Diane Brault; Julie Valiquette, Senior Advisor in Professional Practice for Rehabilitation and Multidisciplinary Services; and Dr. Michael Goldfarb, Director of Quality of Care and the Safety Division of Cardiology at the JGH.
“It feels wonderful to be recognized,” says Ms. Dima, who is now Chief of Specialized Nurse Practitioners at CIUSSS West-Central Montreal. “This highlights what nurses can do as professionals in their own right to improve patient care at the bedside. And it shows what they can accomplish when they have the support of the Nursing Directorate.”
It took a full year of study and research to set up the program with the multidisciplinary team. Ms. Dima and Dr. Goldfarb researched the existing literature and found mobility programs for general Intensive Care Units but not specifically for cardiovascular patients, “which is why we saw the need to develop one for this clientele,” Ms. Dima explains.
A key component of the program is a grid that evaluates patients’ functional abilities from zero to five; this “Level of Function Scale” helps healthcare providers then prescribe appropriate activities, whether it’s sitting in a chair, doing exercises in bed or walking around the cardiac unit.
The notion of early mobilization marks a departure from the long-held practice of keeping patients with acute heart disease such as arrhythmia or heart failure in bed all day, based on the notion that movement endangers their recovery.
“There’s no reason for these patients to stay in bed if they’re medically stable,” Ms. Dima says. “They should get moving as soon as possible, according to their capacity.”
Our CIUSSS’s program also involves patients and their families, who have responded enthusiastically: In a survey of more than 100 participants, 94 per cent said they believed early mobilization helped the patient’s recovery.
And the program has shown demonstrable results. Compared to non-participants, patients who undergo early mobilization are more likely to return home than go to a rehabilitation centre.
“Patients are getting up and moving faster than before,” Ms. Dima says. “By the time they leave the cardiovascular intensive care unit, their functional mobility has measurably improved.”