The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

IMPACT OF A NEONATAL VENTILATOR QUALITY ASSURANCE PROGRAM ON VENTILATOR CARE

Raymond Malloy BS RRT, John Emberger BS RRT, Alan Spitzer MD. Herbert Patrick MD, Departments of Respiratory Care and Pediatries, Thomas Jefferson University Hospital Inc, Philadelphia PA

Background: The Respiratory Care Ventilator Management Evaluation Program added a neonatal ventilator QA&I program to the existing adult program which gathers daily comprehensive data on ventilator patients. Our Intensive Care Nursery (ICN) Neonatologists were consulted for QA&I data ranges. Hypothesis: We wanted to determine if neonatal ventilator QA&I and education about ventilator management would impact the ventilator care given to prematures. Methods: Data including: ventilator settings, ABG's, oxygenation and ventilation weaning, and tube characteristics were gathered. Data was analyzed quarterly by respiratory care personnel and reported to ICN group meetings for physician and nursing feedback . The data for the initial three quarters ventilator weaning of prematures were examined. Indicators 1 and 2, shown below, assess the aggressiveness of weaning oxygenation and ventilation parameters. Indicators 3 and 4, shown below, assess if weaning is too aggressive and a rebound effect is occurring. There was an emphasis placed on these weaning parameters after first quarter was gathered. Results: The total number of prematures (N) was 51, with a total of 482 daily encounters (n).

QA & I Indicators Apr-Jun, 95 Jul-Sep, 95 Oct-Dec,95

(Before Education) N = 24 N = 20

N = 12, n = 135 n = 198 n = 149

1. F_{1}O_{2}

or PEEP weaned if

P_{1}O_{2} >80 torr 54% 67% 74%

2. PIP or IMV Rate

weaned if last

P_{1}CO_{2} < 38 torr 58% 71% 70%

3. F_{1}O_{2} or PEEP

not increased after

being weaned 100% 91% 100%

4. PIP or IMV Rate not

increased after

being weaned 100% 92% 100%

Conclusion: A neonatal ventilator QA&I program increased awareness of appropriate parameters for weaning ventilators in the ICN. The increase in indicators 1 and 2 show that weaning has become more aggressive with increased awareness of appropriate parameters, and indicators 3 and 4 show that we have not become over aggressive though there was a slight lapse in indicators 3 and 4 during Jul-Sep, 95. Other factors need to be analyzed in the future such as rotating house staff, and severity of the prematures.

Reference: OF-96-148

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