Jones Nicole, Shivji Rozmeen
Neuroscience Intensive Care Unit, Rush University Medical Center, Chicago, Illinois (Dr Jones); Adult Gerontology Acute Care DNP Program (Dr Jones) and Adult Health and Gerontological Nursing (Dr Shivji), Rush University College of Nursing, Chicago, Illinois; and The University of Chicago, Chicago, Illinois (Dr Shivji) Dr Jones is now at University of Illinois Chicago (UIC), Chicago, Illinois.
Crit Care Nurs Q. 2023;46(2):157-164. doi: 10.1097/CNQ.0000000000000448.
Prolonged mechanical ventilation can lead to undesirable outcomes, including reduced 6-month survival, increased hospital mortality, intensive care unit (ICU) length of stay, and physiological stress. A large academic medical center currently has a Spontaneous Awakening Trials/Spontaneous Breathing Trials (SAT/SBT) protocol with an SAT/SBT compliance goal of 80%; however, the medical intensive care unit's (MICU) SAT/SBT compliance rate was only 33% for FY2020. The Define-Measure-Analyze-Improve-Control (DMAIC) framework was used to guide this quality improvement project. Current processes and root causes for noncompliance were analyzed through chart reviews, a preimplementation staff survey, and meetings with stakeholders. Compliance rates were compared before and after implementation. Interventions included education, reminder fliers, weekly chart audits, and individualized weekly emails to noncompliant RNs and RTs. To achieve project sustainability, 2 unit champions were selected to continue the weekly emails and chart audits. Data were collected from 216 patients and 1063 patient ventilator days from October 2020 to October 2021. The SAT/SBT compliance steadily increased throughout the 13-month implementation period, except for 3 months. The preimplementation monthly SAT/SBT compliance rate was 26% in September 2020. After 13 months of project implementation, the SAT/SBT compliance rate was 64% in October 2021. There was no significant change in patient ventilator days pre- and post-quality improvement project. A multi-intervention implementation strategy consisting of education in-services, weekly chart audits, weekly emails to staff with current compliance rates, and reminder fliers can successfully increase SAT/SBT compliance rates. Utilizing unit champions provides sustainability.
长时间机械通气可能导致不良后果，包括6个月生存率降低、医院死亡率增加、重症监护病房（ICU）住院时间延长以及生理应激。一家大型学术医疗中心目前有一项自主觉醒试验/自主呼吸试验（SAT/SBT）方案，SAT/SBT合规目标为80%；然而，2020财年该医疗重症监护病房（MICU）的SAT/SBT合规率仅为33%。定义-测量-分析-改进-控制（DMAIC）框架被用于指导这个质量改进项目。通过病历审查、实施前员工调查以及与利益相关者的会议，分析了当前流程和不合规的根本原因。比较了实施前后的合规率。干预措施包括教育、提醒传单、每周病历审核以及向不合规的注册护士和呼吸治疗师发送个性化的每周电子邮件。为实现项目的可持续性，挑选了2名科室负责人继续发送每周电子邮件和进行病历审核。收集了2020年10月至2021年10月期间216名患者和1063个患者呼吸机日的数据。在13个月的实施期内，除了3个月外，SAT/SBT合规率稳步上升。2020年9月实施前的月度SAT/SBT合规率为26%。经过13个月的项目实施，2021年10月的SAT/SBT合规率为64%。质量改进项目前后患者呼吸机日没有显著变化。由教育在职培训、每周病历审核、向员工发送包含当前合规率的每周电子邮件以及提醒传单组成的多干预实施策略可以成功提高SAT/SBT合规率。利用科室负责人可实现可持续性。
