Implementing a Weaning Protocol for Cardiac Surgery Patients Using Simulation: A Quality Improvement Project.

Journal Article

Background

Mechanical ventilation is the standard of care after cardiac surgery, but it imposes physiologic and psychological stress on patients. The Society of Thoracic Surgery recommends 6 hours as the goal for extubation, but 60% of our patients were not meeting this metric.

Objectives

The objectives of this project were to decrease cardiac surgery patients' ventilation hours and intensive care unit length of stay using a ventilator weaning protocol.

Methods

An evidence-based ventilator weaning protocol was developed, and nurses were prepared for its implementation using a simulation education program.

Results

Ventilator hours were reduced from 7.74 to 6.27 (t = 2.5, P = .012). The percentage of patients extubated in 6 hours increased from 40% to 63.5% (χ = 7.757, P = .005). There was no statistically significant decrease in cardiovascular intensive care unit length of stay (17.15 to 15.99, t = 0.619, P = .537). Nurses' scores on a knowledge test increased significantly from pre (6.11) to post (7.79) (t = -5.04, P < .001). Their perception of confidence increased in weaning from pre (median, 4; IQR, 4,4) to post (median, 4; interquartile range [IQR], 4,5), z = -2.71, P = .007, and also in using the protocol from pre (median, 4; IQR, 3,4) to post (median, 4; IQR, 4,5) (z = -3.17, P = .002).

Discussion

Using a nurse-led ventilator weaning protocol resulted in decreased ventilator hours for patients and increased knowledge and confidence for nurses.

Full Text

Duke Authors

Cited Authors

  • Tierney, CC; Oermann, MH; Molloy, MA; Brien, L; Neisler, C

Published Date

  • September 2019

Published In

Volume / Issue

  • 38 / 5

Start / End Page

  • 248 - 255

PubMed ID

  • 31369444

Pubmed Central ID

  • 31369444

Electronic International Standard Serial Number (EISSN)

  • 1538-8646

International Standard Serial Number (ISSN)

  • 0730-4625

Digital Object Identifier (DOI)

  • 10.1097/dcc.0000000000000373

Language

  • eng