CONTEXT: Despite evidence that the use of specific interventions can decrease morbidity and mortality for patients receiving mechanical ventilation, a gap exists between best evidence and practice. A prospective cohort study was conducted in a surgical intensive care unit (ICU) that included all patients who were mechanically ventilated. The study was designed to ensure that for 90% of ventilator days, patients receive processes associated with improved outcomes, including semirecumbent positioning, daily interruption of sedative-drug infusions, peptic ulcer disease prophylaxis, and deep venous thrombosis prophylaxis. INTERVENTION: The improvement model included three interventions: (1) administering a questionnaire to identify barriers to compliance with the four care processes, (2) implementing an educational intervention, and (3) implementing a checklist to be completed daily during ICU rounds to ask providers whether patients were receiving these therapies. RESULTS: Overall, 80% of nurses did not know there was evidence to support at least one of the four therapies. During the study period (March 4-April 29, 2002), the percentage of ventilator days on which patients received all four care processes increased from 30% to 96% (p < .001). DISCUSSION: Evidence-based therapies for mechanically ventilated patients can reduce morbidity, mortality, and costs of care.
CONTEXT: Despite evidence that the use of specific interventions can decrease morbidity and mortality for patients receiving mechanical ventilation, a gap exists between best evidence and practice. A prospective cohort study was conducted in a surgical intensive care unit (ICU) that included all patients who were mechanically ventilated. The study was designed to ensure that for 90% of ventilator days, patients receive processes associated with improved outcomes, including semirecumbent positioning, daily interruption of sedative-drug infusions, peptic ulcer disease prophylaxis, and deep venous thrombosis prophylaxis. INTERVENTION: The improvement model included three interventions: (1) administering a questionnaire to identify barriers to compliance with the four care processes, (2) implementing an educational intervention, and (3) implementing a checklist to be completed daily during ICU rounds to ask providers whether patients were receiving these therapies. RESULTS: Overall, 80% of nurses did not know there was evidence to support at least one of the four therapies. During the study period (March 4-April 29, 2002), the percentage of ventilator days on which patients received all four care processes increased from 30% to 96% (p < .001). DISCUSSION: Evidence-based therapies for mechanically ventilated patients can reduce morbidity, mortality, and costs of care.
Authors: Joan D Penrod; Peter J Pronovost; Elayne E Livote; Kathleen A Puntillo; Amy S Walker; Sylvan Wallenstein; Alice F Mercado; Sandra M Swoboda; Debra Ilaoa; David A Thompson; Judith E Nelson Journal: Crit Care Med Date: 2012-04 Impact factor: 7.598
Authors: Patricia C Dykes; Ronen Rozenblum; Anuj Dalal; Anthony Massaro; Frank Chang; Marsha Clements; Sarah Collins; Jacques Donze; Maureen Fagan; Priscilla Gazarian; John Hanna; Lisa Lehmann; Kathleen Leone; Stuart Lipsitz; Kelly McNally; Conny Morrison; Lipika Samal; Eli Mlaver; Kumiko Schnock; Diana Stade; Deborah Williams; Catherine Yoon; David W Bates Journal: Crit Care Med Date: 2017-08 Impact factor: 9.296
Authors: Maité Garrouste-Orgeas; François Philippart; Cédric Bruel; Adeline Max; Nicolas Lau; B Misset Journal: Ann Intensive Care Date: 2012-02-16 Impact factor: 6.925