2010 OPEN FORUM Abstracts
A MULTI-PROFESSIONAL APPROACH REDUCES PROLONGED VENTILATION OF CORONARY ARTERY BYPASS PATIENTS.
Michael Bocci1, Faisal Masud2, Ken Hargett1, Jose Rodriguez1, Romar Reyes1, Margaret Berger1, Kathy Knaack2, Dana Samways2; 1Respiratory Care Services, The Methodist Hospital, Houston, TX; 2DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, TX
Background: The Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database report is an important benchmark program for large volume cardiovascular centers. A key indicator is the percentage of prolonged ventilation (defined as >24 hours) for Coronary Artery Bypass (CAB). Our institution had experienced an increase in the percent of prolonged ventilation to 20.7 in 2009. A performance improvement process was implemented to reduce prolonged ventilation to < 10%. Method: A Multi-Professional team with representatives from CV Surgery, Nursing, Intensivist, Respiratory Care, and Performance Improvement was formed. Initial problems identified included:1) lack of awareness of the 24 hour window from all caregivers, 2) inconsistent application of existing weaning protocols, and 3) inconsistent coordination of sedation. A plan was developed to1) increase awareness of 24 hour window, 2) improve communications between caregivers and 3) increase interventions before 24 hours. Specific interventions established included education of the 24 hour window to all caregivers especially consulting physicians. A highly visible green card was posted on the ventilator that indicated time zero (admission to unit). The green card also identified specific time intervals of 6, 12, 18, 20 and 22 hours for performance of sedation reduction and spontaneous breathing trials. Utilization of a sedation protocol was enhanced by revision of the electronic version of the protocol followed by education to nursing, physicians and respiratory care. Daily rounds were established to address every patient approaching 18-20 hours of ventilation. A weekly meeting was established to review all patients and discuss reasons for patients that exceeded 24 hours. Additional interventions including follow-up from leadership to physicians that had contributed to prolonged ventilation cases. Results: Immediate results were obtained within the first month with a reduction to 16.1 % of the CAB patients experiencing prolonged ventilation. Further refinement resulted in 8.5% by the end of the second month. In a 6 month period in excess of 252 patients were included with < 9% prolonged ventilation. Conclusion: A Multi-Professional approach utilizing increased awareness, incorporation of visual aids, effective communication, and coordination of sedation management and spontaneous breathing trials, can reduce the percentage of prolonged ventilation in CAB patients. Sponsored Research - None