Implementation of Two-Nurse-Driven Protocols to Improve Respiratory Status of Cardiovascular Surgery Patient

2.50
Hdl Handle:
http://hdl.handle.net/10755/164291
Category:
Abstract
Type:
Presentation
Title:
Implementation of Two-Nurse-Driven Protocols to Improve Respiratory Status of Cardiovascular Surgery Patient
Author(s):
Keuth, Jacqueline
Author Details:
Jacqueline Keuth MS, RN, MS, RN, CCNS, CCRN, Banner Good Samaritan Hospital, Phoenix, Arizona, USA, email: nacnsorg@nacns.org
Abstract:
Purpose: Pulmonary complications in the cardiovascular population increase morbidity and mortality. The nurse is the first line staff to address pulmonary problems. It is essential that they have control of interventions that improve respiratory outcomes. Nurse-driven protocols for rapid extubation and lung expansion can lead to improved outcomes and reduced length of stay. Significance: Recent clinical practice guideline recommendations cite that shortening extubation times reduces risks, complications, and hospital length of stay (LOS) for cardiac surgery patients. These practice guidelines included ventilator weaning protocols designed and implemented by non physicians (MacIntyre NR et al., 2001; Ely EW et al., 2001). Alignment with national benchmarks could be achieved by implementation and adherence to a nurse-driven extubation protocol. A clinical nurse specialist's (CNS) review of outcomes at an urban teaching hospital showing intubation times and length of stay (LOS) from surgery to discharge did not meet the national average for the percentage of patient extubation or LOS, placing our patients at risk for pulmonary complications which increases patient risk and hospital cost. Design: In a review of outcome data by Cardiothoracic CNS, it was determined that national standards for LOS and extubation times were not being met. Thus in 2006, a clinical nurse specialist lead the Cardiovascular LOS committee in the design of a nurse driven protocol from evidence based literature findings and a survey of best practices. Implementation was achieved through collaboration and extensive education of nursing and multidisciplinary staff. Part one of this project implemented a nurse-driven rapid extubation protocol but the data identified that patients continue to have respiratory issues delaying their discharge from the hospital. The LOS committee led by the CNS reconvened and investigated areas to improve the pulmonary management. Thus part two implemented a nurse-driven lung expansion protocol to address these continued concerns. Methods: The multidisciplinary LOS committee developed the nurse-driven extubation protocol. Part one of implementation was the extensive education of the rapid extubation protocol to all key stake holders: physician, respiratory therapists and nursing. Concurrent data was collected by the bedside registered nurses (RN) and analyzed bi-weekly for barriers to achieving extubation in less than 6 hours. This data was shared with nursing staff and key stake holders throughout the implementation to allow them to help with troubleshoot barriers identified by the data. When compliance was met with this protocol, the results were not as positive as initially expected on LOS. Lung expansion/incentive spirometry was identified as a possible area for improvement. We are currently in the final stages of development and implementation of a nurse-driven lung expansion protocol. This 2nd protocol will use the same strategies for collecting bi-weekly data and barrier identification on incentive spirometer results following EZPAP implementation. Findings: The 2006 analysis of 210 patients resulted in a 121% increase in patients extubated under 6 hours, average ventilator hours reduced by 19.5%; and ICU-LOS reduced by 12.2 hours. Our reintubation rates were reduced but not statistically significant. By December of 2007, we will have our results of the nurse driven lung expansion protocol. Conclusions: Nurse-driven protocols can have great impact on patient outcomes of the cardiovascular surgical populations by reducing intubation times, complications, risk and LOS. Further conclusions will be developed based on outcome of second intervention. Implications for Practice: CNS leading an evidence based project is essential in effecting changes of bedside nurse's behavior when instituting a nurse-driven protocol. More research needs to be done in the area of nurse driven protocol.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2008
Conference Name:
Clinical Nurse Specialists: Leaders in Clinical Excellence
Conference Host:
NACNS - National Association of Clinical Nurse Specialists
Conference Location:
Atlanta, Georgia, USA
Description:
Conference theme: Clinical Nurse Specialists: Leaders in Clinical Excellence, held March 5 - 8 at the Westin Peachtree Plaza in Atlanta, Georgia
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_US
dc.typePresentationen_GB
dc.titleImplementation of Two-Nurse-Driven Protocols to Improve Respiratory Status of Cardiovascular Surgery Patienten_GB
dc.contributor.authorKeuth, Jacquelineen_US
dc.author.detailsJacqueline Keuth MS, RN, MS, RN, CCNS, CCRN, Banner Good Samaritan Hospital, Phoenix, Arizona, USA, email: nacnsorg@nacns.orgen_US
dc.identifier.urihttp://hdl.handle.net/10755/164291-
dc.description.abstractPurpose: Pulmonary complications in the cardiovascular population increase morbidity and mortality. The nurse is the first line staff to address pulmonary problems. It is essential that they have control of interventions that improve respiratory outcomes. Nurse-driven protocols for rapid extubation and lung expansion can lead to improved outcomes and reduced length of stay. Significance: Recent clinical practice guideline recommendations cite that shortening extubation times reduces risks, complications, and hospital length of stay (LOS) for cardiac surgery patients. These practice guidelines included ventilator weaning protocols designed and implemented by non physicians (MacIntyre NR et al., 2001; Ely EW et al., 2001). Alignment with national benchmarks could be achieved by implementation and adherence to a nurse-driven extubation protocol. A clinical nurse specialist's (CNS) review of outcomes at an urban teaching hospital showing intubation times and length of stay (LOS) from surgery to discharge did not meet the national average for the percentage of patient extubation or LOS, placing our patients at risk for pulmonary complications which increases patient risk and hospital cost. Design: In a review of outcome data by Cardiothoracic CNS, it was determined that national standards for LOS and extubation times were not being met. Thus in 2006, a clinical nurse specialist lead the Cardiovascular LOS committee in the design of a nurse driven protocol from evidence based literature findings and a survey of best practices. Implementation was achieved through collaboration and extensive education of nursing and multidisciplinary staff. Part one of this project implemented a nurse-driven rapid extubation protocol but the data identified that patients continue to have respiratory issues delaying their discharge from the hospital. The LOS committee led by the CNS reconvened and investigated areas to improve the pulmonary management. Thus part two implemented a nurse-driven lung expansion protocol to address these continued concerns. Methods: The multidisciplinary LOS committee developed the nurse-driven extubation protocol. Part one of implementation was the extensive education of the rapid extubation protocol to all key stake holders: physician, respiratory therapists and nursing. Concurrent data was collected by the bedside registered nurses (RN) and analyzed bi-weekly for barriers to achieving extubation in less than 6 hours. This data was shared with nursing staff and key stake holders throughout the implementation to allow them to help with troubleshoot barriers identified by the data. When compliance was met with this protocol, the results were not as positive as initially expected on LOS. Lung expansion/incentive spirometry was identified as a possible area for improvement. We are currently in the final stages of development and implementation of a nurse-driven lung expansion protocol. This 2nd protocol will use the same strategies for collecting bi-weekly data and barrier identification on incentive spirometer results following EZPAP implementation. Findings: The 2006 analysis of 210 patients resulted in a 121% increase in patients extubated under 6 hours, average ventilator hours reduced by 19.5%; and ICU-LOS reduced by 12.2 hours. Our reintubation rates were reduced but not statistically significant. By December of 2007, we will have our results of the nurse driven lung expansion protocol. Conclusions: Nurse-driven protocols can have great impact on patient outcomes of the cardiovascular surgical populations by reducing intubation times, complications, risk and LOS. Further conclusions will be developed based on outcome of second intervention. Implications for Practice: CNS leading an evidence based project is essential in effecting changes of bedside nurse's behavior when instituting a nurse-driven protocol. More research needs to be done in the area of nurse driven protocol.en_GB
dc.date.available2011-10-27T11:45:38Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:45:38Z-
dc.conference.date2008en_US
dc.conference.nameClinical Nurse Specialists: Leaders in Clinical Excellenceen_US
dc.conference.hostNACNS - National Association of Clinical Nurse Specialistsen_US
dc.conference.locationAtlanta, Georgia, USAen_US
dc.descriptionConference theme: Clinical Nurse Specialists: Leaders in Clinical Excellence, held March 5 - 8 at the Westin Peachtree Plaza in Atlanta, Georgiaen_US
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.en_US
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