2012 OPEN FORUM Abstracts
VENTILATION LIBERATION IN A ONCOLOGICAL CANCER CENTER; A QUALITY IMPROVEMENT INITIATIVE.
Clarence Finch, Mary L. Warren, Quan Nguyen, Laura Withers, Nisha Rathi; Respiratory Care, MD Anderson Cancer Center, Houston, TX
BACKGROUND Prolonged mechanical ventilation is a known cause of increased morbidity and mortality for patients admitted to the intensive care unit. Within our 26-bed Medical Intensive Care Unit (MICU) at The University of Texas MD Anderson Cancer Center patients spend an average of 6.62 days on the ventilator. The MICU incorporates evidence-based protocols such as a daily spontaneous breathing trial (SBT) and a daily sedation/analgesia holiday (temporary cessation of sedating infusions) to efficiently wean patients. Protocol adherence, in either of these can prolong liberation, thereby increasing the probability of infections and increasing cost. Our goal was to reduce the average ventilator days per patient by ten (10) percent in six (6) months. METHOD/INTERVENTION With Quality Institutional Review Board (QIRB) approval we organized a multidisciplinary ICU team involving intensivists, mid-level providers (MLPs), respiratory therapists (RTs), bedside nurses, clinical pharmacists, information technologists (IT), and research specialists for a weaning project. Following a Six Sigma DMAIC model we identified existing barriers that played a role in prolonging the ventilator-patient relationship. A fishbone diagram and Pareto-chart highlighted the noncompliance with sedation/analgesia holidays and spontaneous breathing trial protocols as a major focus area. Baseline data thirteen (13) consecutive months was collected. RESULTS After our intervention, our average ventilator days per MICU patient decreased by 12% following our interventions from 6.62 days to 5.84 (a decrease of 0.78 days). ICU length of stay also decreased by 13% from 9.46 days to 8.22 days per ventilated MICU patient (a decrease of 1.24 days). Nursing compliance for the analgesia holiday protocol increased from the baseline average of 30% increased to 54% four months post-intervention. Compliance for the sedation holiday protocol increased from 36% baseline to 74% post intervention. Cost reduction associated with this intervention was $398,329.62 during the period. CONCLUSION The reduction of ventilator hours and ICU days is significantly enhanced when all members of the multidisciplinary team are committed to reducing the cost of operation and applying evidence base care strategies. Sponsored Research - None