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

Published

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