From the Department of Pediatrics, Yale University School of Medicine.
Yale School of Public Health.
J Patient Saf. 2022 Jan 1;18(1):e26-e32. doi: 10.1097/PTS.0000000000000683.
Capnography has established benefit during intubation and cardiopulmonary resuscitation (CPR). Implementation within emergency departments (EDs) has lagged. We sought to address barriers to improve documented capnography use for patients requiring intubation or CPR.
A controlled before- and after-implementation study was performed in 2 urban EDs. The control site had an existing policy for capnography use. Interventions for the experimental site included a 5-minute informational video, placement of capnography monitors with a shortened warm-up period in all resuscitation rooms, laminated reminder cards, and feedback during staff meetings. Staff members were surveyed about knowledge before and after the intervention. Records were reviewed for documented capnography use for 3 months before and 6 months after the intervention. Change in documented use at the experimental site was compared with the control site.
At the experimental site, 118 providers participated and 190 records were reviewed; 544 records were reviewed from the control site. There was a significant increase in the proportion of documented capnography use at the experimental site (8% versus 19%, P = 0.04) compared with the control site (64% versus 71%, P = 0.10). However, there was no significant trend over time at the experimental site after the intervention (P = 0.86). Despite high baseline knowledge about capnography, providers had improvements in survey responses regarding indications for intubation and CPR, normal values, and minimum effective values during CPR.
Documented capnography use increased with simple interventions but with no positive trend. Additional work is needed to improve use, including further evaluation of capnography's implementation in the ED.
在插管和心肺复苏术 (CPR) 期间，二氧化碳描记法的应用已得到证实。但它在急诊科 (ED) 的实施却滞后了。我们试图解决阻碍问题，以提高对需要插管或 CPR 的患者进行二氧化碳描记法记录的使用。
在 2 家城市 ED 中进行了一项对照前后实施的研究。对照点有二氧化碳描记法使用的现有政策。实验组的干预措施包括 5 分钟的信息视频，在所有复苏室中放置预热时间较短的二氧化碳描记法监测器，使用带胶卡片提醒，并在员工会议期间提供反馈。在干预前后对员工进行了有关知识的调查。在干预前和干预后 3 个月记录了二氧化碳描记法的使用情况。比较实验组和对照组记录使用情况的变化。
在实验组，有 118 名医护人员参与，共审查了 190 份记录；对照组审查了 544 份记录。与对照组（64%比 71%，P = 0.10）相比，实验组（8%比 19%，P = 0.04）记录中二氧化碳描记法使用的比例显著增加。然而，干预后实验组的时间趋势没有显著变化（P = 0.86）。尽管在二氧化碳描记法方面有很高的基线知识，但在插管和 CPR 的适应证、正常值和 CPR 期间的最小有效值方面，医护人员在调查中的回答有所改善。
通过简单的干预措施，记录中二氧化碳描记法的使用有所增加，但没有积极的趋势。需要进一步努力来提高使用率，包括进一步评估二氧化碳描记法在急诊科的实施情况。
