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