2010 OPEN FORUM Abstracts
NON-COMPLICANCE OF LIBERATION FROM MECHANICAL VENTILATION FOLLOWING A STANDARDIZED WEANING PROTOCOL: A RT/RN INTERVENTION.
Lisa Cracchiolo; Barnes Jewish Hospital, St. Louis, MO, MO Authors: Lisa Cracchiolo, RRT, AE-C; Adam Sampson, MA, RRT; Carrie Sona, RN, MSN, CCRN, CCNS; Elizabeth Dykeman RN; Jessica Bowles RN, BSN. Barnes-Jewish Hospital, St. Louis, MO
Background: Clinician driven, evidence based weaning protocols have been in place at Barnes-Jewish Hospital Surgical Intensive Care Unit(SICU) since 2002. Previously published data displayed a high success rate with clinician directed weaning. Sustaining that success over time has proven challenging. A growing number of patients in our SICU, experience delays in extubation. The expectation is a patient be extubated within one hour post a successful spontaneous breathing trial (SBT). Method: A multidisciplinary team of MD, RT and RN staff developed an audit tool to evaluate weaning protocol compliance. Audit tool criteria include, number of daily SBT performed, success or failure of trial, extubation rates, time to extubation, self-extubation, reintubation, MD staff involved in care decisions and reasons given by medical staff for failure to extubate. Chart audits were done 3-4 times weekly rotating between RN and RT staff from January to April 2010. Results: 45 days were audited. 130 SBTs were performed in 87 patients. 102 of the 130 SBT have resulted in a pass, of those 102 passing trials 35 extubations occurred. Time of passing SBT to time of extubation ranged from 0 to 1072 minutes. The average time to extubation after passing a trial was 144.9 minutes. The reasons given by the medical staff for not extubating patients after a successful trial were: mental status 21, procedure 16, clinically worse 11, team to evaluate prior to extubation 9, wet 6, airway concern 4, sedation 4, family issue 3, unknown 3, secretions 3 and febrile 1. Many times more than 1 reason was listed per patient. Two (2) of the patients with delays in extubation longer than 100 minutes had rationale for the delay listed as sedation and clinically worse. No reasons were listed for the other delays in extubation. Non-clinical delays such as; ICU team rounds and ICU team waiting to see patient during rounds or to see the patient while actively performing SBT prior to extubation occur. Conclusion: This highlights an area for process improvement in our ICU. This intervention by RT/RNs identified the need for better communication between the bedside clinician and physicians. Three process changes have been instituted and daily audits are ongoing. Sponsored Research - None