Primary Author:	Margot Andison, PhD, BSN, RN, CCRN
Co-Principal Investigators/Collaborators:	Trisha Patel, PharmD, BCPS, James Johnson, MD, Diane Murphy, RRT
Organization	University of Alabama at Birmingham Hospital

Abstract

Purpose

To reduce time on mechanical ventilation with a RN/Respiratory Therapist (RT)-driven weaning protocol.

Background

Clinical outcomes are directly related to the time a patient is on mechanical ventilation, driving efforts to reduce vent time (1-5). Mechanically ventilated patients are commonly sedated; sedation management that includes daily lightening of sedation helps reduce overall time on the vent (2,3,5).

Materials & Methods

A Sedation Powerplan for ventilated patients was initiated in two phases. Phase I utilized a RN-driven Daily Awakening task scheduled for 0700. A standardized protocol for sedation was utilized and sedation was evaluated using the Richmond Agitation Sedation Scale (RASS) with a target of -2 (light sedation) on a -5 to +4 scale (unarousable to combative). RNs titrated sedatives based on daily awakening performance, per protocol. In Phase II, both a Spontaneous Awakening Trial (SAT) and Spontaneous Breathing Trial (SBT) were implemented. RN/RT tasks added to the Powerplan included, a) hold sedation and tube feedings at 0300, b) perform SAT at 0500, c) perform SBT at 0530 with RT. Screening criteria for the SAT and SBT were protocolized (5). Extubation decisions were made during morning rounds by the physician team.

Results

During Phase I, physicians frequently noted over-sedation of patients in the early morning, decreasing the probability a patient would pass the Daily Awakening at 0700 or pressure support trials. These observations prompted the implementation of Phase II. Time on the vent during Phase I (May, June, n=128) and Phase II (September-December, n=347), was significantly different, 6.7 versus 3.63 days, respectively (p<0.001). Implementation of Phase II has reduced MICU length of stay (LOS) by 1.3 days and Hospital LOS of 3.2 days for that group over baseline. The reduced LOS has increased MICU patient admissions by 17 per month, representing the equivalent of 2.85 additional MICU beds.

Conclusion

Utilization of a RN/RT-driven weaning protocol reduced time on mechanical ventilation, reduced ICU LOS and hospital LOS.

Bibliography

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© Improvement Science Research Network, 2012

The ISRN published this as received and with permission from the author(s).