116 Differences in nurse documented versus reported early mobility for critically ill children

Abstract

OBJECTIVES/GOALS: In 2014, Johns Hopkins Pediatric ICU (PICU) implemented the PICU Up! early mobilization program. Subsequent studies have shown that these protocols increase mobility of PICU patients. Process improvement requires accurate documentation. Our aim is to evaluate differences in nurse documented and actual reported mobility of PICU patients. METHODS/STUDY POPULATION: A quality improvement project evaluating the impact of a simulation-based early mobility training program is being conducted, with initial analysis of pre-intervention data. Inclusion criteria includes children age 1 day to 17 years old admitted to the PICU for ≥ 3 days during a day shift and exclusion criteria includes specific mobility contraindications. Data on the number of daily mobilizations, highest level of mobility achieved during each mobilization, and occurrence of safety events is captured via direct query of the bedside nurse at the end of a 12-hour shift by a research team member using a standard data collection tool. We also recorded documented events in the electronic medical record (EMR). Paired t-tests were performed for continuous data and McNemar’s test for categorical data. RESULTS/ANTICIPATED RESULTS: In total, 50 patients were enrolled between February and April 2023. The nurses reported that patients participated in a median of 5 mobilizations (Interquartile range [IQR] 4-6) in a 12-hour shift, whereas nurses documented in the EMR that patients participated in a median of 1 mobilization (IQR 0-3; P <0.001). On direct query, the nurses stated that a total of 8 individual safety events occurred during mobility, representing a 3% (8/259) safety event rate. In the EMR, the nurses documented 1 individual safety event during mobility, representing a 1% (1/84) safety event rate (P = 0.008). Nurses reported that they mobilized 50% (25/50) of the patients out of bed; however, they documented that they mobilized only 32% (16/50) of the patients out of bed (P = 0.007). DISCUSSION/SIGNIFICANCE: Compared to EMR documentation, nurses report more mobilization of critically ill children during the day, including more out of bed mobilization and safety events. Future nurse education should focus on mobility documentation to ensure that it reflects mobility at the bedside to facilitate process improvement and optimize care for PICU patients.