2.50
Hdl Handle:
http://hdl.handle.net/10755/157017
Category:
Abstract
Type:
Presentation
Title:
High Expectations for Early Extubations
Author(s):
McEvoy, Michael T.; Suarez, Julie; Kimball, Cheryl
Author Details:
Michael T. McEvoy, RN,APRN,BN,PhD,CCRN,EMT-P, Albany Medical Center, Albany, New York, USA, email: mcevoymike@aol.com; Julie Suarez; Cheryl Kimball
Abstract:
PURPOSE: Early extubation of adult cardiac surgery patients has been demonstrated to improve outcomes. Efforts to reduce ventilator times in our cardiothoracic surgical ICU over a 5-year period were fraught with poorly defined goals, absence of benchmarks, and dearth of evidence-based practice standards. We formed a multidisciplinary team to synergistically develop protocols, measure results, and revise practices in an effort to target safe and consistently early extubation of our patients. DESCRIPTION: A multidisciplinary team including surgeons, perfusionists, cardiac anesthesiologists, respiratory therapists, CTICU bedside RNs, clinical pharmacists, intensivists, and a CNS was convened. The team reviewed 5 years of extubation data demonstrating inability to sustain decreases in ventilation times, poorly defined goals, lack of interdisciplinary collaboration, poor outcomes feedback loops, and lack of standardized vent weaning protocols. A literature review demonstrated markedly different definitions with no clear consensus on benchmarks or outliers. An internal benchmark of extubation in less than 8 hours was established. Order sets and protocols were obtained from other institutions. Separate protocols for early extubation (fast-track) and uncomplicated ventilator weaning (expected longer than 8 hour vent time) were developed. Order sets to accompany both protocols were developed. Pharmacologic agents were reviewed a trial dexmedetomidine was initiated. Education was conducted across the patient care continuum on the new order sets and protocols. Teamwork in the operating room and through the CTICU was highlighted. Feedback loops to all participants were implemented. Orders and protocols underwent multiple revisions. EVALUATION/OUTCOMES:By focusing on process rather than outcomes, we achieved ventilator times significantly less than published comparisons and below our internal benchmark of less than 8 hours. Our results have continued consistently for the past 2 years. Multiple changes were implemented to achieve these outcomes including elimination of our uncomplicated wean protocol with a new culture that all patients benefit from early weaning and could be safely trialed with our fast-track orders. Continued changes in medications and wean parameters required ongoing education and data collection in the operating room and CTICU. An ongoing feedback loop has helped us to sustain our improvements and continue to revise orders.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866
Conference Date:
2010
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
Washington, D.C., USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleHigh Expectations for Early Extubationsen_GB
dc.contributor.authorMcEvoy, Michael T.en_GB
dc.contributor.authorSuarez, Julieen_GB
dc.contributor.authorKimball, Cherylen_GB
dc.author.detailsMichael T. McEvoy, RN,APRN,BN,PhD,CCRN,EMT-P, Albany Medical Center, Albany, New York, USA, email: mcevoymike@aol.com; Julie Suarez; Cheryl Kimballen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157017-
dc.description.abstractPURPOSE: Early extubation of adult cardiac surgery patients has been demonstrated to improve outcomes. Efforts to reduce ventilator times in our cardiothoracic surgical ICU over a 5-year period were fraught with poorly defined goals, absence of benchmarks, and dearth of evidence-based practice standards. We formed a multidisciplinary team to synergistically develop protocols, measure results, and revise practices in an effort to target safe and consistently early extubation of our patients. DESCRIPTION: A multidisciplinary team including surgeons, perfusionists, cardiac anesthesiologists, respiratory therapists, CTICU bedside RNs, clinical pharmacists, intensivists, and a CNS was convened. The team reviewed 5 years of extubation data demonstrating inability to sustain decreases in ventilation times, poorly defined goals, lack of interdisciplinary collaboration, poor outcomes feedback loops, and lack of standardized vent weaning protocols. A literature review demonstrated markedly different definitions with no clear consensus on benchmarks or outliers. An internal benchmark of extubation in less than 8 hours was established. Order sets and protocols were obtained from other institutions. Separate protocols for early extubation (fast-track) and uncomplicated ventilator weaning (expected longer than 8 hour vent time) were developed. Order sets to accompany both protocols were developed. Pharmacologic agents were reviewed a trial dexmedetomidine was initiated. Education was conducted across the patient care continuum on the new order sets and protocols. Teamwork in the operating room and through the CTICU was highlighted. Feedback loops to all participants were implemented. Orders and protocols underwent multiple revisions. EVALUATION/OUTCOMES:By focusing on process rather than outcomes, we achieved ventilator times significantly less than published comparisons and below our internal benchmark of less than 8 hours. Our results have continued consistently for the past 2 years. Multiple changes were implemented to achieve these outcomes including elimination of our uncomplicated wean protocol with a new culture that all patients benefit from early weaning and could be safely trialed with our fast-track orders. Continued changes in medications and wean parameters required ongoing education and data collection in the operating room and CTICU. An ongoing feedback loop has helped us to sustain our improvements and continue to revise orders.en_GB
dc.date.available2011-10-26T19:20:51Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:20:51Z-
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.conference.date2010en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationWashington, D.C., USAen_GB
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.