Decreasing Length of Mechanical Ventilation in Cardiothoracic Surgery Patients: A Nursing Driven Practice Change

2.50
Hdl Handle:
http://hdl.handle.net/10755/182064
Category:
Abstract
Type:
Presentation
Title:
Decreasing Length of Mechanical Ventilation in Cardiothoracic Surgery Patients: A Nursing Driven Practice Change
Author(s):
Shinn, Julie
Author Details:
Julie Shinn, RN, MA, CNS, FAAN, Clinical Nurse Specialist, Stanford Hospital and Clinics, Stanford, California, USA, email: jshinn@stanfordmed.org
Abstract:
Poster presentation, ANCC National Magnet Conference: Prolonged mechanical ventilation is considered a complication by the Society of Thoracic Surgeons (STS) and is defined as mechanical ventilation > 24 hours. In our population, the percent of patients who required mechanical ventilation for > 24 hours in 2006 was 24.9%. The acceptable STS benchmark was 10% for all STS participants. We clearly had a need for improvement so a multidisciplinary team was assembled to address the problem. Purpose The purpose of this project was to identify practices contributing to prolonged mechanical ventilation and to develop strategies to decrease mechanical ventilation hours to meet the STS benchmark. Methods: Our team consisted of nurses, respiratory therapists and a physician intensivist. Factors which contributed to prolonged intubation were identified as surgeon reluctance to allow extubation during the night, sedation practices of nurses to maintain overnight intubation and no clear goals for extubation. Changes implemented included an agreement by anesthesia to decrease narcotic dosing at the end of surgery, surgeon agreement that extubation could occur at any time, a goal of extubation within 6 hours and a visual paper clock taped over the bed which displayed the admission time. The actual extubation time was recorded on the clock and turned into the nurse manager. The team met bi-weekly to address outliers and identify further barriers. Outcomes: We have successfully changed practice and sustained results as demonstrated by 29.2% of patients extubated at 6 hours in 2007, 34% in 2008 and 38.5% in 2009. Patients on mechanical ventilation for > 24 hours decreased to 10.9% in 2009.
Repository Posting Date:
28-Oct-2011
Date of Publication:
28-Oct-2011
Conference Date:
2010
Conference Name:
ANCC National Magnet Conference
Conference Host:
American Nurses Credentialing Center
Conference Location:
Phoenix, Arizona, USA
Description:
The 14th American Nurses Credentialing Center (ANCC) National Magnet Conference, held 13-15 October, 2010 at the Phoenix Convention Center in Phoenix, Arizona, 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_US
dc.typePresentationen_GB
dc.titleDecreasing Length of Mechanical Ventilation in Cardiothoracic Surgery Patients: A Nursing Driven Practice Changeen_GB
dc.contributor.authorShinn, Julieen_US
dc.author.detailsJulie Shinn, RN, MA, CNS, FAAN, Clinical Nurse Specialist, Stanford Hospital and Clinics, Stanford, California, USA, email: jshinn@stanfordmed.orgen_US
dc.identifier.urihttp://hdl.handle.net/10755/182064-
dc.description.abstractPoster presentation, ANCC National Magnet Conference: Prolonged mechanical ventilation is considered a complication by the Society of Thoracic Surgeons (STS) and is defined as mechanical ventilation > 24 hours. In our population, the percent of patients who required mechanical ventilation for > 24 hours in 2006 was 24.9%. The acceptable STS benchmark was 10% for all STS participants. We clearly had a need for improvement so a multidisciplinary team was assembled to address the problem. Purpose The purpose of this project was to identify practices contributing to prolonged mechanical ventilation and to develop strategies to decrease mechanical ventilation hours to meet the STS benchmark. Methods: Our team consisted of nurses, respiratory therapists and a physician intensivist. Factors which contributed to prolonged intubation were identified as surgeon reluctance to allow extubation during the night, sedation practices of nurses to maintain overnight intubation and no clear goals for extubation. Changes implemented included an agreement by anesthesia to decrease narcotic dosing at the end of surgery, surgeon agreement that extubation could occur at any time, a goal of extubation within 6 hours and a visual paper clock taped over the bed which displayed the admission time. The actual extubation time was recorded on the clock and turned into the nurse manager. The team met bi-weekly to address outliers and identify further barriers. Outcomes: We have successfully changed practice and sustained results as demonstrated by 29.2% of patients extubated at 6 hours in 2007, 34% in 2008 and 38.5% in 2009. Patients on mechanical ventilation for > 24 hours decreased to 10.9% in 2009.en_GB
dc.date.available2011-10-28T15:07:30Z-
dc.date.issued2011-10-28en_GB
dc.date.accessioned2011-10-28T15:07:30Z-
dc.conference.date2010en_US
dc.conference.nameANCC National Magnet Conferenceen_US
dc.conference.hostAmerican Nurses Credentialing Centeren_US
dc.conference.locationPhoenix, Arizona, USAen_US
dc.descriptionThe 14th American Nurses Credentialing Center (ANCC) National Magnet Conference, held 13-15 October, 2010 at the Phoenix Convention Center in Phoenix, Arizona, USA.en_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.-
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