2012 OPEN FORUM Abstracts
COMPLIANCE OF PAIRED SEDATION AWAKENING TRIALS AND SPONTANEOUS BREATHING TRIALS: THE EFFECTS ON MEASURABLE OUTCOMES.
Dawn M. Turner1, Campbell Greg4, Shaw Henderson4, Cora Small2, Laurie Morgan1, Jill Jones2, Sharon Wilson2, Martha Shetley2, Jim Humble2, Derek Hudson3, Paula Blankenship2, Patricia Fricks2, Frank Frederico5, Michael Westley5; 1Respiratory Care, Mission Health System, Asheville, NC; 2Adult Medicine and Critical Care, Mission Health System, Asheville, NC; 3Performance Improvement, Mission Health System, Asheville, NC; 4Asheville Pulmonary and Critical Care Associates, Mission Health System, Asheville, NC; 5Institute Healthcare Improvement, Institute Healthcare Improvement, Boston, MA
Background: The Institute of Healthcare Improvement (IHI) ventilator bundle recognized that sedation awakening trials (SAT) paired with spontaneous breathing trials (SBT) are crucial to reduce mortality rates and improve patient outcomes. Evidence supports daily interruptions of sedation in conjunction with a SBT will decrease the length of time on the ventilator, incidence of ventilator acquired pneumonia, and the patients overall length of stay. Methods: An interdisciplinary team was formed in partnership with coaches from IHI. The Medical Surgical Intensive Care Unit (MSICU) interdisciplinary core team committed to quality improvement developed a plan to improve transitions of care among the Respiratory Care Practitioners (RCP) and Registered Nurse (RN) at the bedside with a focus on compliance of the SBT process. Results: The Mission Hospital MSICU baseline data for March 2011 yielded a 31% adoption rate for SBT. Further investigation displayed variations in practice among the Respiratory Care Practitioners (RCP) executing the SBT and coordination with the RNs for SAT was nonexistent. The sedation holiday performed by the RN and SBT performed by the RCP were not in concert as recommended in the literature for successful liberation from the mechanical ventilator. Compliance was measured based on whether all eligible patients were identified and if the procedure was then carried out as specified in the protocol. 90 days after implementation, 100% of eligible patients were identified correctly and 100% had the SBT completed correctly. The number of ventilator days per patient was reduced from 2.79 to 2.58. Overall length of stay for ventilated patients was reduced from 5.1 to 4.33 days. VAP rates continue to remain at zero with this intervention. Conclusions: Patient outcomes have been improved and costs of care reduced through active implementation of this program. Feedback from staff suggests that communication in care improved after implementing RCP bedside rounds and providing a visual cue as a reminder to all staff of the plan to conduct the SBT that day. SBT compliance and coordination of care improved with implementation of this IHI ventilator bundle in the MSICU. The recommendation is to discuss, diffuse, and implement this model in all ICUs meanwhile sustaining gains, quality control in the MSICU. Sponsored Research - None MSICU Data Elements, Average Ventilator Days and Average Length of Stay