Construction And Transformation Application Of Evidence-based Practice Program Of Early Mobilisation In ICU Adult Patients With Mechanical Ventilation

Objective:To summarize the best evidence for early mobilisation of ICU adult mechanically ventilated patients.On this basis,to construct an evidence-based practicing program of early mobilisation in ICU adult patients with mechanical ventilation,and to carry out clinical translational application to evaluate its effect.Methods:Systematic retrieval of high-quality research literature related to early activities of mechanically ventilated ICU patients,evaluate the quality of the literature,and summarize the best evidence.The expert meeting method was used to evaluate the clinical FAME attributes of the evidence,determine the evidence items introduced into clinical practice,and constructed the clinical review indicators.Used review indicators as an evaluation tool to investigate the current situation of evidence application in a comprehensive ICU of a tertiary hospital in Guizhou Province,analyzed the factors that promote and hinder the evidence-practice differences,and formulated action strategies.Used qualitative research methods,semi-structured interviews with mechanically ventilated patients in ICU were conducted to understand and analyze the true feelings of patients during the implementation of early activities,and to provide a basis for formulating plans.The expert meeting method was adopted,based on the best evidence,combined with the review results and qualitative research results,to construct a localized early mobilisation plan.Used a historical control study,patients who were admitted to the comprehensive ICU of a tertiary hospital in Guizhou Province from June to November 2019 and from January to June 2020 meet the inclusion criteria for mechanically ventilated patients,and set them as the observation group and the control group(n=55)).The control group was given routine intensive care,and the observation group implemented an early mobilisation plan based on the best evidence based on the control group.The differences in mechanical ventilation time,ICU hospitalization time,BI score,MRC score,ICU-AW incidence,and various review indicators before and after the application of evidence were compared between the two groups.Results:1.This study included a total of 9 articles from 2014 to 2019,included 3 guidelines,3systematic reviews,2 expert consensus,and 1 evidence summary;a total of 23 pieces of the best evidence for early mobilisation of mechanical ventilation in ICU adults were summarized,content included the timing of start-up,patient evaluation,pre-activity preparation,division of labor,activity types and methods,activity frequency and time,informed consent,safety standards,and process monitoring.2.Through the discussion of the expert meeting method,it was planned to include 22 clinical practice evidences and constructed 14 review indicators,included 5 at the system level,6 at the medical staff level,and 3 at the patient/family level.The review results showed that the implementation rate of the four review indicators at the system level was0%,the implementation rate of the review indicators at the medical staff level was0%-56.67%,and the implementation rates of the review indicators at the family and patient level were 13.33%-23.33%.Qualitative research results show that lack of relevant knowledge,disease states,pain,sleep disorders,and safety factors are hindering factors that affect the implementation of early activities.Through the discussion of expert meetings,an early mobilisation plan and process based on the best evidence was formulated.The content of the early mobilisation plan includes: start and suspension standards,activity methods,sequence,time,frequency,and safety assurance.3.There was no statistical difference in baseline data between the two groups at the time of enrollment(P>0.05).After 1 day of intervention,2 cases were dropped in the observation group,1 case in the control group,1 case in the test group and 1 case in the control group 2 days after the intervention.They were finally included in the analysis observation group(n=52)and the control group(n=53).The mechanical ventilation time,ICU hospitalization time,and the incidence of ICU-AW in the observation group were lower than those in the control group(P<0.05);the MRC score of the observation group was higher when the patients transferred out of the ICU than the control group(P<0.05);the observation group was transferred There was no statistically significant difference in BI score when out of ICU and the control group(P>0.05).After the evidence-based project was introduced into the clinic,the clinical review indicators were improved compared with the baseline review,and the difference was statistically significant(P<0.05).In the system level indicators,10,11,13,and 14 all increased from 0% to 100%.Among the medical staff review indicators,indicator 3 increased from 0% to 53.33%,and indicator 5 increased from 14.51% to 91.94%.At the patient and family level,the implementation rate of review indicator 7 increased from 20% to 63.33%,indicator 8 increased from 23.33% to 43.33%,and indicator 9 increased from 13.33% to 36.67%.Conclusion:1.The literature included in this study has a high quality score.The 23 pieces of evidence collected in this study cover the specific implementation of early activities in ICU adult mechanically ventilated patients.The evidence is richer and provides a reliable basis for the construction of the research program.2.Evidence of early mobilisation in ICU adult mechanically ventilated patients is low in clinical translation.Under the guidance of the "evidence-based continuous quality improvement model",an early mobilisation plan based on the best evidence and combined with local clinical situations can be used for clinical care.3.After the introduction of the best evidence-based early mobilisation program into clinical practice,it improves clinical outcome of mechanically ventilated patients and increases the implementation rate of early mobilisation.