Publication Date
Spring 2026
Degree Type
Doctoral Project
Degree Name
Doctor of Nursing Practice (DNP)
Department
Nursing
First Advisor
Elaine Ware
Keywords
Early mobilization, Nurse-driven mobility algorithm, Nurse-driven early mobility safety screen
Abstract
Background: Early mobilization of critically ill patients is recommended in clinical practice guidelines to mitigate ICU-acquired weakness, delirium, and improve recovery. This intervention is inconsistently implemented in many health systems due to a variety of barriers. One frequent barrier is uncertainty regarding whether patients meet safety criteria for mobilization. Purpose: The purpose of this quality improvement project was to implement a nurse-driven early-mobility algorithm with a clinical safety screen in an adult medical-surgical ICU and evaluate its impact on patient mobility scores, delirium rates, and ICU length of stay. Methods: The intervention was evaluated using a quasi-experimental before and after approach. A total of 129 patients were included in the study. The pre-implementation patient cohort comprised patients admitted from August through October 2025 (n = 64). The nurse-driven algorithm was implemented in November 2025. Patients in the post-implementation cohort were admitted from December 2025 through February 2026 (n = 65). Results: The post-intervention cohort included more medical patients (49% vs 32%) and had longer ICU length of stay (5.7 vs 5.4 days) and higher delirium prevalence. Mobility rates were high in the pre-intervention cohort (~68%), which may represent a ceiling effect. In regression analyses, each additional day with a passed safety screen was associated with a 1.74-point increase in mean mobility score and a higher proportion of screened days was associated with a decrease in ICU length of stay. Conclusions: Implementation of a nurse-driven early mobility safety screen may facilitate mobilization of critically ill patients; however, outcomes were confounded by high baseline mobility, differences in pre- and post- intervention groups, and a short assessment period.
Recommended Citation
Saito, Andrea, "Implementation of a Nurse-Driven Early Mobility Algorithm in Critically Ill Adults" (2026). Doctoral Projects. 218.
DOI: https://doi.org/10.31979/etd.uwcd-hbk7
https://scholarworks.sjsu.edu/etd_doctoral/218
