The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

SUSTAINABILITY OF A QUALITY IMPROVEMENT PROGRAM IN MECHANICAL VENTILATION ASSESSMENT

Mary E. Nash1, Marie Duggan1, Paul F. Nuccio1



Background: The documentation of ventilated patient assessments is essential to patient care and quality outcomes. In a 780 bed academic medical center the average ventilator load is approximately 40 to 50 per day. Computer generated documentation has established better communication between respiratory therapists; however, standardized written methods of documentation are still required. A quality improvement program was found to be an effective way to improve documentation, but the ability to sustain quality improvement was unclear.

Hypothesis:: Reliable and standardized documenting practices can be sustained by frequent staff education and reinforcement, resulting in continuously improved patient care.

Methods: A follow-up observational assessment was performed to compare previous results following an intervention, to current status following a 1-year period of quarterly staff education and weekly reinforcement. Over a 28 week period, ventilator documentation was evaluated from 364 flow sheets. Similar to the previous study, parameters assessed included the daily documentation of auscultation of breath sounds, cuff pressures, patient assessment, ventilator plan, RSBI, compliance, resistance and diagnosis/surgery.

Results: Following the previous intervention 1 year ago, 114 patient ventilator flow sheets 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. Reassessment performed 1 year later demonstrates an overall improvement in documentation with 90% of breath sounds, 91% cuff pressure, 90% daily assessment, 70% daily plan, 83% RSBI, 62% compliance, 61% resistance, and 99% diagnosis reported. (Graph) With the exception of the compliance and resistance documentation, an overall improvement was found. Efforts are now focused on developing methods to improve these parameters.

Conclusion: Significant improvement in the quality of care is demonstrated when a formal review of patient ventilator documentation is implemented with specific parameters targeted. This study demonstrates that a continued and sustained improvement is possible with regular staff education and reinforcement. Further education is required to address consistency with compliance and resistance measurements.