title: Extending the benefits of early mobility to critically ill patients undergoing continuous renal replacement therapy: the Michigan experience.
abstract: 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.
authors.affiliation: Department of Nursing, University of Michigan Health System, Ann Arbor, Michigan, USA. ctal@med.umich.edu
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Talley
authors.forename: Robert O
authors.initials: RO
authors.lastname: Wonnacott
authors.forename: Janice K
authors.initials: JK
authors.lastname: Schuette
authors.forename: Jill
authors.initials: J
authors.lastname: Jamieson
authors.forename: Michael
authors.initials: M
authors.lastname: Heung
mesh_terms: D000046:Academic Medical Centers; D058186:Acute Kidney Injury / Q000628:therapy*; D002985:Clinical Protocols; D064648:Critical Care Nursing / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D004434:Early Ambulation / Q000379:methods* / Q000451:nursing; D006440:Hemofiltration / Q000009:adverse effects*; D006801:Humans; D008824:Michigan; D018579:Patient Selection; D017582:Renal Replacement Therapy / Q000379:methods*