Impact of Empowerment of Nursing Unit Council in a Medical Critical Care Unit on Ventilator-Associated Events and Ventilator Days.

Abstract

Background: Mechanical ventilation increases patients' risk for ventilator-associated events. Nursing unit councils can help mitigate these events through shared governance.

Local problem: The medical critical care unit at the project site faced challenges in outperforming benchmarks, increasing ventilator days, and consistently adhering the ICU Liberation Bundle. This project aimed to reintroduce effective practices and enhance nurse empowerment to reduce ventilator-associated events and improve patient outcomes.

Methods: Led by a clinical nurse specialist and the medical critical care nursing unit council, the quality improvement project focused on the spontaneous awakening and breathing trials element of the ICU Liberation Bundle. Multifaceted interventions included education, data literacy training, compliance monitoring, and root cause analysis of ventilator-associated events. The Council Health Survey was distributed before and after the intervention to evaluate the nursing unit council's feelings of empowerment.

Results: In the preintervention period, 23 patient charts were audited and in the intervention period, 34 patient charts were audited. Before the intervention, 15 nurses completed the Council Health Survey, and after the intervention, 9 nurses completed it. The intervention took place during 8 weeks. Ventilator-associated events decreased by 33.3% and the ventilator-associated event rate per 1000 ventilator days decreased by 29.9%; however, these changes were not significant (P = .70). Spontaneous awakening trial compliance increased from 75.7% to 83.0% (P = .39) and spontaneous breathing trial compliance decreased from 88.4% to 70.4% (P = .10); neither change was significant. Council Health Survey overall scores dropped 9.8%; subscale scores did not significantly change (P values ranged from .10 to .81).

Conclusion: The ICU Liberation Bundle has been shown to improve patient outcomes. Future initiatives should focus on sustaining a comprehensive approach to reducing ventilator-associated events.