Evidence-based clinical improvement for mechanically ventilated patients.
Bundling or grouping together evidence-based interventions to improve care for the mechanically ventilated patient was piloted by a 10-bed medical-surgical critical care unit of a hospital. The bundled care interventions included: (a) keeping the head of bed elevated at 30 degrees, (b) instituting daily interruption of continuous sedative infusion, (c) assessing readiness to wean using a rapid-wean assessment guide, (d) initiating deep venous thrombosis prophylaxis, and (e) implementing peptic ulcer disease prophylaxis. The interventions were implemented using a plan-do-check-act quality-improvement methodology. Results indicated that the use of bundled interventions for mechanically ventilated patients could decrease average ventilator times and average length of stay with no concomitant increase in reintubations. Average mortality rates and the number of adverse events per 100 patient days also were reduced.
Hampton
Debra C
DC
Critical Care/Telemetry/Transitional & Interventional Care, Saint Joseph Healthcare, Lexington, KY, USA. DHampton@sjhlex.org
Griffith
Deborah
D
Howard
Alan
A
D016292:Procedural Sedation / Q000451:nursing / Q000592:standards; D003422:Critical Care / Q000458:organization & administration*; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D009730:Nursing Assessment / Q000379:methods / Q000592:standards; D015403:Nursing Evaluation Research; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D010347:Patient Care Planning / Q000458:organization & administration; D010437:Peptic Ulcer / Q000209:etiology / Q000517:prevention & control; D010865:Pilot Projects; D011187:Posture; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial / Q000009:adverse effects / Q000401:mortality / Q000451:nursing / Q000592:standards*; D013997:Time Factors; D017749:Total Quality Management / Q000458:organization & administration*; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control; D015300:Ventilator Weaning / Q000451:nursing / Q000592:standards