Table 1

Early mobility and exercise programme

AssessmentPatients in the intervention group will be assessed at 7.30 hour by the RN allocated to the patient to ensure they meet minimum safety criteria. the safety screen is a checklist within the early mobility and exercise safety screen within the CIS. The completion of a screen within the CIS will ensure the patient meets safety criteria prior to mobilisation.
Safety screenM- Is the myocardium stable?
(No evidence of acute myocardial ischaemia in the previous 24 hours; no dysrhythmias requiring the administration of a new antiarrhythmic.)
O- Is oxygenation adequate?
(FiO2 ≤0.6 and PEEP ≤10 cm H2O)
V – Are vasopressors minimal?
(No increase dose of vasopressors for at least 2 hours)
E – Does the patient respond to verbal stimuli?
(RASS ≥ −2)
S – Is the patient safe to mobilise?
(Not receiving treatment that restricts mobility (ie, open abdomen), no injuries which contraindicate mobility (ie, unstable fractures))
Safety screen responseIf any questions in the safety screen are answered No—remain with Level one exercise. If all questions in the safety screen are answered Yes, and the Consultant agrees, proceed to early mobility and exercise prescription.
PrescriptionPatients who pass the safety screen will progress to the Early Mobility and Exercise tab in the CIS. The RN will prescribe the level of exercise the participant will receive. The ICU physiotherapist will provide guidance as required. Patients will progress through a four-level regime, receiving the highest level of physical activity they can manage.
CISOnce the appropriate level of exercise is chosen, the RN will create a nursing order which will act as a prescription. The prescribed exercise will appear in the CIS at the appropriate time throughout the day. The RN will be provided a 2-hour window either side of the prescribed time to allow other patient therapies to occur.
Early mobility and exercise prescription
 Level 1—participant does not pass safety screen.Passive range of motion three times a day (06.00, 13.00, 20.00 hours)
Sitting position three times a day (06.00, 13.00, 20.00 hours) in the Hill-Rom Progressa Bed—the standard bed in the site ICU.
 Level 2—participant can lift arm on requestActive resistance exercise in bed twice daily (10.00, 18.00 hours). Sitting position in bed three times a day (06.00, 13.00, 20.00 hours). Sitting on edge of bed daily.
 Level 3—participant can lift leg on requestActive resistance exercise in bed twice daily (10.00, 18.00 hours). Sitting position in bed three times a day (06.00, 13.00, 20.00 hours). Sitting on edge of bed daily. Active trial of stand once per day.
 Level 4—participant can lift leg on request and completed level three the previous day.Active resistance exercise in bed twice daily (10.00, 18.00 hours). Sitting position in bed three times a day (06.00, 13.00, 20.00 hours). Sitting on edge of bed daily. Active trial of stand once per day. Ambulation once per day (marching, taking steps, walking in corridors).
  • CIS, computerised information system; FiO2, fractional inspired oxygen; RASS, Richmond Agitation and Sedation Scale; RN, registered nurse.