2007 OPEN FORUM Abstracts
INTRODUCTION OF RESPIRATORY CARE PRACTIONER DRIVEN WEANING PROTOCOLS IN THE NEONATAL INTENSIVE CARE UNIT
D. A. Igo1, F. Henry1
Comparing Ventilator Days versus Bubble CPAP Days
Background: Respiratory Care Practioner (RCP) driven ventilator weaning protocols were developed for the Neonatal Intensive Care Unit (NICU) to reduce total ventilator days for low birth weight infants (1500 gram) and improve respiratory care practioners’ job satisfaction when working in the NICU. Concurrently we hoped to see an increase in Bubble CPAP use as non invasive ventilation will hopefully decrease the risks associated with intubation and ventilation.
Methods: We built and delivered a survey for the RCP’s that work in NICU. The survey consisted of questions about job satisfaction, autonomy, respect, scope of care and desire to expand the role of the RCP in the NICU.
Weaning protocols were developed following literature review (including Vermont Oxford Quality Improvement NIC/Q Collaborative, AARC [American Association of Respiratory Care], and Cochrane Collaborative), and “best practice” discussions. Following development, review and consent of the neonatology physicians, a protocol was put into place for NICU admissions <1500 gram birth weight, without life threatening birth defects who were not participating in competing ongoing respiratory trials. Education was provided to all staff members. The implementation date was March 13 2006.
Results: Monthly feedback of ventilator days was made available to the entire NICU staff. We were able to decrease ventilator days from an average of 18 days/patient pre-implementation to a post-implementation 4.8 days/patient average.
Summary: Job satisfaction has increased for the RCPs and we are working on more RCP protocols for the NICU. As a result of our success with the weaning protocol, we were able to introduce and implement a surfactant administration protocol.
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Comparing data pre-implementation to post implementation of March 13 2006. Total number of ventilator/CPAP days divided by number of patients on ventilators/CPAP.