DescriptionPurpose of Project: Mechanical ventilation is a life-saving intervention. However, it places the patients who require it at a higher risk of complications such as pneumonia, atelectasis, acute respiratory distress syndrome, thromboembolism, pulmonary edema, delirium, and ICU-acquired weakness. The Wake Up and Breathe protocol is one part of the evidence-based guide entitled the ABCDEF bundle from the Society of Critical Care Medicine in order to assist clinicians in reducing the number of complications critically ill patients experience. An evidence practice gap was identified at the project site regarding the method utilized to wean patients from mechanical ventilation. This quality improvement project aimed to reduce ventilator days and intensive care unit (ICU) length of stay by introducing Weaning Huddles, a Communication Board, and the Wake Up and Breathe Protocol from the ABCDEF bundle.
Methodology: A quality improvement project was implemented on a medical ICU in a large urban Level 1 academic trauma center. All mechanically ventilated patients received the project interventions which included the Wake Up and Breathe Protocol, daily Weaning Huddles, and a Communication Board. Retrospective chart reviews were completed for an eight-week period prior to implementation, four weeks after implementation, and at the completion of eight weeks of implementation.
Results: While there was no statistically significant decrease in ventilator days or ICU length of stay in aggregate, a control chart did demonstrate a downward trend in ventilator days. Documentation rates of Spontaneous Awakening Trials (SATs), Spontaneous Breathing Trials (SBTs), and paired SATs and SBTs significantly improved post intervention.
Implications for Practice: The evidence practice gap previously identified at the project site was closed after implementation, thus improving the quality of care provided. Further study could evaluate whether a significant reduction in ventilator days or ICU length of stay is observed over a longer time period and what other variables influence these outcomes. Improvements in outcomes such as length of stay, ventilator days or incidence of complications such as delirium could lead to reduced costs for the patient, the hospital, and the healthcare system as a whole.