The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

MEASURING THE IMPACT OF INTENSIVE STAFF EDUCATION AND ELECTRONC ALERTS TO ACHIEVE LOWER INITIAL SET TIDAL VOLUMES IN A PICU POPULATION

Tim Macknight1



Background: Respiratory Therapists often find themselves as the gatekeepers of ventilator management. Primary Children's Medical Center in Salt Lake City, Utah is a freestanding 252-bed hospital with a 32-bed Pediatric Intensive Care Unit (PICU). The PICU treats a wide variety of diseases such as operative repair of congenital heart malformations, ARDS, neurotrauma, surgical, and respiratory. Internal quality data from Jan. 2007 found average tidal volumes (Vt), after exclusion of cardiac and trach/vent patients, to be significantly higher than evidence-based guidelines suggest using. We sought to correct this trend with intensive staff education and the addition of alerts in our computerized charting system.

Methodology:
A retrospective analysis of charts from newly admitted, intubated patients to the PICU from the fourth quarter of 2006. Excluded were any patient with a cardiac diagnosis, any trach/vent patient, or any patient on a pressure-limited or high frequency mode of ventilation. 64 patients were included in the analysis and compared to 64 patients from the fourth quarter of 2007, selected using identical criteria from 2006.

Interventions:
Beginning in Feb. 2007, department education was prioritized to focus on low Vt strategies in certain PICU populations. The department Medical Director presented a lecture at the bi-monthly staff meeting describing the potential detrimental effects of high tidal volumes. The meeting was attended by 75% of full-time staff. Throughout the year, an electronic educational database was created that included scholarly articles on successful low Vt strategies and ventilator protocols used in other PICU's in the USA. An alert was added to the electronic charting system asking the bedside RRT to give a reason set VT exceeded 8 ML's/KG. Finally, comprehension and application of low Vt strategy was made a part of the annual clinical competencies during the summer 2007.

Results:
Average initial set Vt was reduced from 7.30 ML's/KG for the 4th quarter 2006 to 6.74 ML's/KG for the 4th quarter 2007. Key findings included 43/64 (67%) patients with initial set Vt less than or equal to 7 ML's/KG in 2007 compared to 26/64 (41%) in 2006. 7/64 (11%) had set Vt greater than 8 ML's/KG compared to 16/64 (25%) in 2006.

Conclusions:
Lower initial Vt can be affected by intensive staff education and the addition of alerts in electronic charting.