1 Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY, USA.
2 Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY, USA.
J Intensive Care Med. 2019 Sep;34(9):707-713. doi: 10.1177/0885066618769015. Epub 2018 Apr 22.
Evidence-based medicine often has many barriers to overcome prior to implementation in practice, hence the importance of continuous quality improvement. We report on a brief (≤10 minutes) multidisciplinary meeting prior to rounds to establish a dashboard for continuous quality improvement and studied the success of this meeting on a particular area of focus: continuous infusion benzodiazepine minimization.
This was a prospective observational study of patients admitted to the medical intensive care unit (MICU) of a large academic medical center over a 4-month period. A morning multidisciplinary prerounding meeting was implemented to report on metrics required to establish a dashboard for MICU care for the previous 24 hours. Fellows and nurse practitioners on respective teams reported on key quality metrics and other important data related to patient census. Continuous benzodiazepines were tracked daily as the number of patients per team who had orders for a continuous benzodiazepine infusion. The aim of this report is to describe the development of the morning multidisciplinary prerounding meeting and its impact on continuous benzodiazepine use, along with associated clinical outcomes.
The median number of patients prescribed a continuous benzodiazepine daily decreased over this time period and demonstrated a sustained reduction at 1 year. Furthermore, sedation scores improved, corresponding to a reduction in median duration of mechanical ventilation. The effectiveness of this intervention was mapped post hoc to conceptual models used in implementation science.
A brief multidisciplinary meeting to review select data points prior to morning rounds establishes mechanisms for continuous quality improvement and may serve as a mediating factor for successful implementation when initiating and monitoring practice change in the ICU.
循证医学在实践中常常需要克服许多障碍，因此持续质量改进至关重要。我们报告了在查房前进行的一次简短（≤10 分钟）多学科会议，该会议旨在建立一个持续质量改进的仪表盘，并研究了该会议在一个特定关注领域（连续输注苯二氮䓬类药物最小化）的成功情况。
这是一项在大型学术医疗中心的内科重症监护病房（MICU）住院患者中进行的前瞻性观察性研究。实施了一次早晨多学科预查房会议，以报告建立 MICU 护理仪表盘所需的前 24 小时的指标。各自团队的研究员和护士从业者报告了关键质量指标和与患者人数相关的其他重要数据。每天跟踪连续苯二氮䓬类药物，以了解每个团队中下达连续苯二氮䓬类药物输注医嘱的患者人数。本报告旨在描述早晨多学科预查房会议的发展及其对连续苯二氮䓬类药物使用的影响，以及相关的临床结果。
在此期间，每日开具连续苯二氮䓬类药物的患者中位数减少，并在 1 年内持续减少。此外，镇静评分得到改善，相应地减少了机械通气的中位数持续时间。该干预措施的有效性被映射到实施科学中使用的概念模型上。
在查房前进行一次简短的多学科会议，审查选定的数据点，为持续质量改进建立了机制，并在 ICU 中启动和监测实践变革时，可能作为成功实施的中介因素。
