Achieving quality health outcomes through the implementation of a spontaneous awakening and spontaneous breathing trial protocol.
BACKGROUND
Continuous sedation infusions can lead to prolonged treatment with mechanical ventilation (MV), resulting in serious complications. Spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs) are strategies that limit the amount of sedative agents a patient receives and promote extubation.


OBJECTIVE
The objective of this performance improvement project was to evaluate the outcomes of an evidence-based practice protocol that included SATs and SBTs on the duration of treatment with MV, ventilator utilization ratio (VUR), intensive care unit (ICU) length of stay (LOS), and incidence of self-extubations and reintubations.


METHODS
A convenience sample of 112 discharged patients' medical records was used for this descriptive, comparative secondary data analysis. An evidence-based SAT/SBT practice protocol was designed by a multidisciplinary team and implemented. Three months after the implementation, a retrospective medical record review was conducted to evaluate patient outcomes.


RESULTS
The median duration of treatment with MV was significantly lower in the postprotocol group (3.8 days vs 2.7 days, U = 1222, Z = -2.013, P = .04, r = 0.19). A significant decrease was found in the VUR (0.68 vs 0.52, U = 2.5, Z = -2.293, P = .02, r = 0.69). No difference was found in the ICU LOS and frequency of self-extubation or reintubation after a self-extubation between the preprotocol and postprotocol groups. Ten of 45 SAT opportunities (22%) and 67 of 130 SBT opportunities (52%) were missed by the nurse or the respiratory therapist.


CONCLUSIONS
The duration of treatment with MV and the VUR were reduced in patients who received the SAT/SBT protocol. The incidence of self-extubation was not different when an SAT was implemented. The ICU LOS was not reduced in patients who received SATs and SBTs.
Kimmith Jones is Clinical Nurse Specialist, Sinai Hospital of Baltimore, 2401 W Belvedere Ave, Baltimore, MD 21215 (kimmithjones@gmail.com). Robin Newhouse is Chair and Professor, Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore. Karen Johnson is Research Director, Nursing, Banner Healthcare System, Phoenix, Arizona. Kristin Seidl is Director of Nursing and Patient Care Outcomes, University of Maryland Medical Center, Baltimore.
Kimmith
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Jones
Robin
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Newhouse
Karen
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Johnson
Kristin
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Seidl
D000368:Aged; D000369:Aged, 80 and over; D060666:Airway Extubation; D002985:Clinical Protocols; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D007362:Intensive Care Units; D007902:Length of Stay; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D015300:Ventilator Weaning
D006993:Hypnotics and Sedatives