Improving Care for the Ventilated Patient

Abstract

Context

Despite evidence that the use of specific interventions can decrease morbidity and mortality for patients receiving mechanical ventilation, a gap exists between best evidence and practice. A prospective cohort study was conducted in a surgical intensive care unit (ICU) that included all patients who were mechanically ventilated. The study was designed to ensure that for 90% of ventilator days, patients receive processes associated with improved outcomes, including semirecumbent positioning, daily interruption of sedative-drug infusions, peptic ulcer disease prophylaxis, and deep venous thrombosis prophylaxis.

Intervention

The improvement model included three interventions: (1) administering a questionnaire to identify barriers to compliance with the four care processes,(2) implementing an educational intervention, and (3) implementing a checklist to be completed daily during ICU rounds to ask providers whether patients were receiving these therapies.

Results

Overall, 80% of nurses did not know there was evidence to support at least one of the four therapies. During the study period (March 4–April 29, 2002), the percentage of ventilator days on which patients received all four care processes increased from 30% to 96% (p < .001).

Discussion

Evidence-based therapies for mechanically ventilated patients can reduce morbidity, mortality, and costs of care.