McLean Suzanne E, Jensen Louise A, Schroeder Dallas G, Gibney Noel R T, Skjodt Neil M
University of Alberta Hospital, University of Alberta, Edmonton, Alberta, CA.
Am J Crit Care. 2006 May;15(3):299-309.
Despite multiple reminders, education sessions, and multidisciplinary team involvement, adherence to an evidence-based mechanical ventilation weaning protocol had been less than 1% in a general systems intensive care unit since implementation.
To assess the effectiveness of using an implementation program, the Model for Accelerating Improvement, to improve adherence and clinical outcomes after restarting a mechanical ventilation weaning protocol in an adult general systems intensive care unit.
A prospective comparative design, before and after implementation of the Model for Accelerating Improvement, was used with a consecutive sample of 129 patients and 112 multidisciplinary team members. Clinical outcomes were rate of unsuccessful extubations, rate of ventilator-associated pneumonia, and duration of mechanical ventilation; practice outcomes were staff's understanding of the mechanical ventilation weaning protocol, perceptions of the practice safety climate, and adherence to the weaning protocol.
After the intervention, the rate of unsuccessful extubations decreased, and staff's understanding of and adherence to the weaning protocol increased significantly. The rate of ventilator-associated pneumonia, duration of mechanical ventilation, and staff's perceptions of the practice safety climate did not change significantly.
Implementing the Model for Accelerating Improvement improved understanding of and adherence to protocol-directed weaning and reduced the rate of unsuccessful extubations.
尽管多次提醒、开展教育课程并让多学科团队参与，但自实施以来，在一家综合系统重症监护病房中，遵循循证机械通气撤机方案的比例一直低于1%。
评估在成人综合系统重症监护病房重新启动机械通气撤机方案后，使用加速改进模型实施计划来提高遵循率和临床结局的有效性。
采用加速改进模型实施前后的前瞻性对比设计，连续纳入129例患者和112名多学科团队成员。临床结局指标为拔管失败率、呼吸机相关性肺炎发生率和机械通气持续时间；实践结局指标为工作人员对机械通气撤机方案的理解、对实践安全氛围的认知以及对撤机方案的遵循情况。
干预后，拔管失败率降低，工作人员对撤机方案的理解和遵循情况显著提高。呼吸机相关性肺炎发生率、机械通气持续时间以及工作人员对实践安全氛围的认知没有显著变化。
实施加速改进模型可提高对方案指导撤机的理解和遵循情况，并降低拔管失败率。
