The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

QUALITY IMPROVEMENT IN MECHANICAL VENTILATION ASSESSMENT

P. F. Nuccio1, M. E. Nash1, M. Duggan1


Background:
Documentation of ventilated patient assessments is essential to patient care and quality outcomes. In a 755 bed academic medical center the average ventilator load is 40-50 per day. Computer generated documentation has established improved communication between therapists, however standardized written documentation is still required. Variability in ventilator patient documentation prompted the need for a quality improvement review.
Hypothesis:
Reliable and standardized documentation practices ensure that pertinent patient information is communicated, resulting in improved patient care.

Method:

We conducted weekly data collection over a nineteen-week period assessing the daily documentation of breath sounds, cuff pressure, patient assessment, ventilator plan, RSBI, compliance, resistance and diagnosis/surgery. 204 ventilator flow sheets were randomly selected. Following 8 weeks of data collection an intervention was developed which included presentation of data to individual therapists. The need for resistance and compliance measurements was redefined and patient indications for these measurements were also addressed. Therapists were instructed to standardize documentation on the ventilator flow sheet, which is ultimately placed in the patient’s medical record.

Results:

204 assessments were performed. The first 90 were reviewed without intervention. Results demonstrated 36% of breath sounds, 42% cuff pressure, 66% daily assessment, 67% daily plan, 34% RSBI, 21% compliance, 10% resistance, and 85% diagnosis were documented. Following intervention, 114 records were reviewed. Results showed 75% of breath sounds, 74% cuff pressure, 72% daily assessment, 48% daily plan, 65% RSBI, 62% compliance, 61% resistance and 98% diagnosis. With one exception, an overall improvement was found. (Graph)

Conclusion:

Reviewing ventilator documentation demonstrated a need for improvement. Specifications regarding daily plans were standardized as a result of the review. The necessity and usefulness of daily resistance and compliance were reviewed resulting in increased implementation and documentation. The results of this study indicated a need for continuing revision, review and education of staff to improve patient care. Significant improvement in quality is demonstrated when a formal review of patient-ventilator documentation is implemented targeting specific parameters. (Graph)

Data collection before and after intervention.

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