Standardization of Weaning Practices for Adult Ventilator Patients

1
Standardization of Weaning Practices for Adult
Ventilator Patients

• Multidisciplinary Task Force Committee
• Critical Care Services (Anesthesiology,
  Pulmonary, Trauma, Neurosurgery)
• Department of Respiratory Care - clinical staff
  and team leaders
• Center for Clinical Effectiveness

2
Opportunity Statement and Desired Outcome

• There is an opportunity to improve the outcomes
  of the ventilator-assisted patient. In 2001, a
  house-wide ventilator weaning protocol was
  developed and implemented by a multidisciplinary
  task force.
• Goal 50 reduction in weaning time

3
Most Likely Causes for Current Opportunity

• Suboptimal communication among physician, nurse
  and respiratory care team members
• Variation in weaning practices among critical
  care services
• Need for ongoing education regarding best
  practices for weaning

4
Solutions Implemented

• Increased involvement of medical leadership in
  selected ICUs
• Education to all healthcare providers
• Proactive assessment and response to data at
  regular ICU QI meetings
• Consistent and ongoing communication between
  Nursing and Respiratory Care staff to ensure
  appropriate implementation of the protocol

5
Neuro Sciences Average Weaning Hours
Extubated Mechanically Ventilated Adults Patients
Greater Than 2 Days
90
80
70
Mean 42.3 Hours
60
50
Average Weaning Hours
40
30
Mean 32.6 Hours
20
10
0
CY00 Q1
CY00 Q2
CY00 Q3
CY00 Q4
CY01 Q1
CY01 Q2
CY01 Q3
CY01 Q4
CY02 Q1
CY02 Q2
CY02 Q3
CY02 Q4
CY03 Q1
CY03 Q2
CY03 Q3
CY03 Q4
CY04 Q1
CY04 Q2
CY04 Q3
CY04 Q4
CY05 Q1
CY05 Q2
CY05 Q3
CY05 Q4
Data Description Extubated Adult ICU Patients
On a Ventilator Greater Than 2 Days Who Were
Successfully Weaned. The average time it took
(in hours) to successfully wean patients off of
the ventilator. Source PIMS CCE Analyst Penny
Bleffer-Riding Confidential Material for Quality
Improvement Purposes
6
NeuroSciences Weaning Mode Protocol Usage
Extubated Mechanically Ventilated Adult Patients
Greater Than 2 Days
100
80
Mean 68
60
Mean 39
Weaning Mode Usage
40
20
0
CY00 Q1
CY00 Q2
CY00 Q3
CY00 Q4
CY01 Q1
CY01 Q2
CY01 Q3
CY01 Q4
CY02 Q1
CY02 Q2
CY02 Q3
CY02 Q4
CY03 Q1
CY03 Q2
CY03 Q3
CY03 Q4
CY04 Q1
CY04 Q2
CY04 Q3
CY04 Q4
CY05 Q1
CY05 Q2
CY05 Q3
CY05 Q4
Data Description Extubated Adult ICU Patients
On a Ventilator Greater Than 2 Days Who Were
Successfully Weaned. The percent of successfully
weaned extubated adult population using the
protocol for discontinuation of mechanical
ventilation. Source PIMS CCE Analyst Penny
Bleffer-Riding Confidential Material for Quality
Improvement Purposes
7

4ICU Average Weaning Hours
Surgical ICU Average Weaning Hours
Extubated Mechanically Ventilated Adult Patients
Greater Than 2 Days
120
100
Mean 54.5 Hours
80
Average Weaning Hours
60
Mean 47.3 Hours
40
20
0
CY00-Q1
CY00-Q2
CY00-Q3
CY00-Q4
CY01-Q1
CY01-Q2
CY01-Q3
CY01-Q4
CY02-Q1
CY02-Q2
CY02-Q3
CY02-Q4
CY03-Q1
CY03-Q2
CY03-Q3
CY03-Q4
CY04-Q1
CY04-Q2
CY04-Q3
CY04-Q4
CY05-Q1
CY05-Q2
CY05-Q3
CY05-Q4
Data Description Extubated Adult ICU Patients
On a Ventilator Greater Than 2 Days Who Were
Successfully Weaned. The average time it took
(in hours) to successfully wean patients off of
the ventilator.. Source PIMS CCE Analyst
Penny Bleffer-Riding Confidential Material for
Quality Improvement Purposes
8
Surgical ICU Weaning Mode Protocol Usage
Extubated Mechanically Ventilated Adult Patients
Greater Than 2 Days
100
Mean 64
80
60
Weaning Mode Usage
Mean 58
40
20
0
CY00-Q1
CY00-Q2
CY00-Q3
CY00-Q4
CY01-Q1
CY01-Q2
CY01-Q3
CY01-Q4
CY02-Q1
CY02-Q2
CY02-Q3
CY02-Q4
CY03-Q1
CY03-Q2
CY03-Q3
CY03-Q4
CY04-Q1
CY04-Q2
CY04-Q3
CY04-Q4
CY05-Q1
CY05-Q2
CY05-Q3
CY05-Q4
Data Description Extubated Adult ICU Patients
On a Ventilator Greater Than 2 Days Who Were
Successfully Weaned. The percent of successfully
weaned extubated adult population using the
protocol for discontinuation of mechanical
ventilation. Source PIMS CCE Analyst Penny
Bleffer-Riding Confidential Material for Quality
Improvement Purposes
9
2ICU Average Weaning Hours
Extubated Mechanically Ventilated Adult Patients
Greater Than 2 Days
90
80
70
Mean 42.2 Hours
60
50
Average Weaning Hours
40
30
20
10
0
CY00 Q1
CY00 Q2
CY00 Q3
CY00 Q4
CY01 Q1
CY01 Q2
CY01 Q3
CY01 Q4
CY02 Q1
CY02 Q2
CY02 Q3
CY02 Q4
CY03 Q1
CY03 Q2
CY03 Q3
CY03 Q4
CY04 Q1
CY04 Q2
CY04 Q3
CY04 Q4
CY05 Q1
CY05 Q2
CY05 Q3
CY05 Q4
Data Description Extubated Adult ICU Patients
On a Ventilator Greater Than 2 Days Who Were
Successfully Weaned. The average time it took
(in hours) to successfully wean patients off of
the ventilator.. Source PIMS CCE Analyst
Penny Bleffer-Riding Confidential Material for
Quality Improvement Purposes
10
2ICU Weaning Mode Protocol Usage
Extubated Mechanically Ventilated Adult Patients
Greater Than 2 Days
100
80
60
Weaning Mode Usage
Mean 37
40
20
0
CY00 Q1
CY00 Q2
CY00 Q3
CY00 Q4
CY01 Q1
CY01 Q2
CY01 Q3
CY01 Q4
CY02 Q1
CY02 Q2
CY02 Q3
CY02 Q4
CY03 Q1
CY03 Q2
CY03 Q3
CY03 Q4
CY04 Q1
CY04 Q2
CY04 Q3
CY04 Q4
CY05 Q1
CY05 Q2
CY05 Q3
CY05 Q4
Data Description Extubated Adult ICU Patients
On a Ventilator Greater Than 2 Days Who Were
Successfully Weaned. The percent of Successfully
weaned extubated adult population using the
protocol for discontinuation of mechanical
ventilation. Source PIMS CCE Analyst Penny
Bleffer-Riding Confidential Material for Quality
Improvement Purposes
11
Conclusions and Next Steps

• Utilization of the protocol has increased
  dramatically in the Neurosciences and Surgical
  Intensive Units.
• Weaning time has decreased by more than 50 in
  those units consistently using the protocol.
• Usage of the protocol in selected areas is
  inconsistent. Leadership and communication issues
  remain opportunities for improvement.