2007 OPEN FORUM Abstracts
IMPACT OF VENTILATOR PROTOCOL ORDERS ON DECREASING VENTILATOR LENGTH OF STAY
T. J. Jackson1
Background: The desire to provide safe mechanical ventilation led to the purchase of the Puritan Bennett 840 ventilator. It provided weaning adjuncts not previously available; rapid vent weaning was able to be safely performed and incorporated into our weaning protocols for post-surgical patients. Differences in practice continued to exist with medical ventilator weaning. Physician confidence in rapid vent weaning led to inclusion of vent weaning orders for all ventilated patients.
Method: Strategies developed to implement registered nurse (RN)/respiratory therapist (RT) daily patient goal-setting, creating standardized ventilator orders, and aggressive ventilator weaning protocols. Physician champions supported standardization of orders. Educational training developed by respiratory therapist/clinical nurse specialist for critical care nursing on rapid vent weaning. Trialed implementation of ventilator setting and patient goals for one week to assess success of process design. Posted educational flyers. Implemented RN/RT rounds by shift. Revised ventilator protocols to include rapid weaning for all patients in Medical/Surgical ICU. Revised ICU orders for ventilated patients to include RT to begin weaning the patient immediately based on RT-driven protocol and daily evaluation of readiness-to-extubate. Monitoring included periodic surveillance by respiratory care manager to verify readiness-to-extubate parameters and presence of ventilator weaning orders.
Results: At Bloomington Hospital we have reduced the median ventilator length of stay (LOS) to 1.5 days from 3.0 days by increasing the utilization of early vent wean orders from 22% to 87% of all patients on mechanical ventilation. Hospital-wide reintubation percentage has not been impacted since implementation of rapid vent weaning.
Conclusions: Use of the safe weaning adjuncts is effective when combined with education, teamwork, and physician acceptance. Physician championed trial with a select patient population demonstrated that the rapid vent wean process was safe and effective paving the way for hospital-wide roll out.
IMPACT OF A VENTILATOR PROTOCOL ON DECREASING VENTILATOR LENGTH OF STAY