title: Pharmacist leadership in ICU quality improvement: coordinating spontaneous awakening and breathing trials.
abstract: BACKGROUND
  Coordinating efforts across disciplines in the intensive care unit is a key component of quality improvement (QI) efforts. Spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs) are considered key components of guidelines, yet unfortunately are often not done or coordinated properly.
  
  
  OBJECTIVE
  To determine if a pharmacist-driven awakening and breathing coordination (ABC) QI program would improve compliance (ie, process measures) as compared with the previous protocol, which did not involve pharmacists.
  
  
  METHODS
  The QI program included pharmacist-led education, daily discussion on rounds, and weekly performance reports to staff. Using a pre-QI versus during-QI versus post-QI intervention design, we compared data from 500 control ventilator-days (pre-QI period) versus 580 prospective ventilator-days (during-QI period). We then evaluated the sustainability of the QI program in 216 ventilator-days in the post-QI period.
  
  
  RESULTS
  SAT safety screens were performed on only 20% pre-QI patient-days versus 97% of during-QI patient-days (P < 0.001) and 100% of post-QI patient-days (P = 0.25). The rates of passing the SAT safety screen in pre-QI and during-QI periods were 63% versus 78% (P = 0.03) and 81% in the post-QI period (P = 0.86). The rates of SATs among eligible patients on continuous infusions were only 53% in the pre-QI versus 85% in the during-QI (P = 0.0001) and 87% in the post-QI (P = 1) periods.
  
  
  CONCLUSIONS
  In this QI initiative, a pharmacist-driven, interdisciplinary ABC protocol significantly improved process measures compliance, comparing the pre-QI versus during-QI rates of screening, performing, and coordinating SAT and SBTs, and these results were sustained in the 8-month follow-up period post-QI program.
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN, USA joanna.stollings@vanderbilt.edu.
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Stollings
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Julie J
authors.initials: JJ
authors.lastname: Foss
authors.affiliation: Vanderbilt University School of Medicine Nashville, TN, USA VA Tennessee Valley Geriatric Research Education and Clinical Center (GRECC) Nashville, TN, USA.
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Ambrose
authors.affiliation: Vanderbilt University School of Medicine Nashville, TN, USA.
authors.forename: Todd W
authors.initials: TW
authors.lastname: Rice
authors.affiliation: Vanderbilt University School of Medicine Nashville, TN, USA VA Tennessee Valley Geriatric Research Education and Clinical Center (GRECC) Nashville, TN, USA.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Girard
authors.affiliation: Vanderbilt University School of Medicine Nashville, TN, USA.
authors.forename: Arthur P
authors.initials: AP
authors.lastname: Wheeler
mesh_terms: D003422:Critical Care / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D007857:Leadership; D010595:Pharmacists; D010607:Pharmacy Service, Hospital; D011446:Prospective Studies; D058996:Quality Improvement; D012121:Respiration, Artificial / Q000379:methods; D015300:Ventilator Weaning
keywords: pain; sedation; spontaneous awakening trial; spontaneous breathing trial