Achieving quality health outcomes through the implementation of a spontaneous awakening and spontaneous breathing trial protocol

Kimmith Jones, Robin Newhouse, Karen Johnson, Kristin Seidl

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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 patientsÊ 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. CONCLUSION:: 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.

Original languageEnglish (US)
Pages (from-to)33-42
Number of pages10
JournalAACN Advanced Critical Care
Volume25
Issue number1
DOIs
StatePublished - Jan 2014
Externally publishedYes

Fingerprint

Clinical Protocols
Respiration
Artificial Respiration
Health
Mechanical Ventilators
Intensive Care Units
Length of Stay
Medical Records
Evidence-Based Practice
Incidence
Proxy
Therapeutics
Hypnotics and Sedatives
Nurses

Keywords

  • evidence-based practice
  • outcome evaluation
  • spontaneous awakening trial
  • spontaneous breathing trial

ASJC Scopus subject areas

  • Critical Care
  • Emergency Medicine
  • Medicine(all)

Cite this

Achieving quality health outcomes through the implementation of a spontaneous awakening and spontaneous breathing trial protocol. / Jones, Kimmith; Newhouse, Robin; Johnson, Karen; Seidl, Kristin.

In: AACN Advanced Critical Care, Vol. 25, No. 1, 01.2014, p. 33-42.

Research output: Contribution to journalArticle

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abstract = "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{\^E} 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. CONCLUSION:: 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.",
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