1995 OPEN FORUM Abstracts
COLLABORATIVE TEACHING LAB REDUCES INCIDENCE OF AUTO-PEEP:
Ken Hargett, BS, RRT; Jon Nilsestuen, PhD, RRT, University of Texas Medical Branch, Galveston TX.
Over the past year the Hospital Department and the Program in Respiratory Care have jointly developed a computerized lung station for teaching ventilator graphics. The lab has been utilized for simulating patient clinical scenarios and to develop training materials for both students and staff. As one method of evaluating the lab we initiated a CPI process to identify the incidence of unrecognized Auto-PEEP , both before and after staff training. A data collection form was created which identified the patient and ventilator characteristics and determined whether auto-PEEP was present based on the ventilator graphics, and whether auto-PEEP was recognized as evidenced by (a) the ventilator flow sheet, (b) the physician progress note or (c) the respiratory therapist progress note. The data was collected by a single investigator who evaluated all patients admitted to the medical/ surgical services over a two week period. The survey was then repeated following staff development training using the graphics analysis lab. The training highlighted recognition of auto-PEEP.
Results: the overall incidence of auto-PEEP was 50%. [47% (15 of 32 pts) in the Surgical units and 55% (12 of 22 pts) in the Medical units]. None of the charting for the 27 pts with auto-PEEP had any previous indication of its existence (100% unrecognized auto-PEEP). Auto-PEEP was most frequently found to be due to ventilator settings. i.e. too low a set inspiratory flowrate, decelerating flow pattern causing prolonged inspiratory time, or autocycling of the ventilator causing too short an expiratory time. Post training, the overall incidence of auto-PEEP was reduced to 18% (9/50 pts). All of the patients had known asthma or COPD. The incidence of ventilator induced auto-PEEP was reduced to 4% (2/50). All incidences of auto-PEEP were recognized and documented in the chart. Experience: Prior to the study the only feedback we had regarding the teaching effectiveness of the lab was the standard course/lab evaluation administered by the school. The high incidence of unrecognized auto-PEEP is one indicator that inservices using standard printed materials had not been very effective in teaching wave-form analysis. Interpretation and experience: The ventilator lab has at least in the short term greatly improved the identification of auto-PEEP by the staff. The incidence of ventilator setting/therapist induced auto-PEEP was drastically decreased. Our experience has had several other positive implications: staff have taken a much more active role in recognizing, reporting and resolving inappropriate waveforms; the frequent use of the decelerating flow patterns has been reduced, students and staff enjoy a new sense of collegiality; and physicians have started to recognize the importance of routinely evaluating the wave forms.