Joanna L Stollings1, Julie J Foss2, E Wesley Ely3, Anna M Ambrose2, Todd W Rice4, Timothy D Girard3, Arthur P Wheeler4. 1. Vanderbilt University Medical Center, Nashville, TN, USA joanna.stollings@vanderbilt.edu. 2. Vanderbilt University Medical Center, Nashville, TN, USA. 3. Vanderbilt University School of Medicine Nashville, TN, USA VA Tennessee Valley Geriatric Research Education and Clinical Center (GRECC) Nashville, TN, USA. 4. Vanderbilt University School of Medicine Nashville, TN, USA.
Abstract
BACKGROUND: Coordinating efforts across disciplines in the intensive care unit is a key component of quality improvement (QI) efforts. Spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs) are considered key components of guidelines, yet unfortunately are often not done or coordinated properly. OBJECTIVE: To determine if a pharmacist-driven awakening and breathing coordination (ABC) QI program would improve compliance (ie, process measures) as compared with the previous protocol, which did not involve pharmacists. METHODS: The QI program included pharmacist-led education, daily discussion on rounds, and weekly performance reports to staff. Using a pre-QI versus during-QI versus post-QI intervention design, we compared data from 500 control ventilator-days (pre-QI period) versus 580 prospective ventilator-days (during-QI period). We then evaluated the sustainability of the QI program in 216 ventilator-days in the post-QI period. RESULTS: SAT safety screens were performed on only 20% pre-QI patient-days versus 97% of during-QI patient-days (P < 0.001) and 100% of post-QI patient-days (P = 0.25). The rates of passing the SAT safety screen in pre-QI and during-QI periods were 63% versus 78% (P = 0.03) and 81% in the post-QI period (P = 0.86). The rates of SATs among eligible patients on continuous infusions were only 53% in the pre-QI versus 85% in the during-QI (P = 0.0001) and 87% in the post-QI (P = 1) periods. CONCLUSIONS: In this QI initiative, a pharmacist-driven, interdisciplinary ABC protocol significantly improved process measures compliance, comparing the pre-QI versus during-QI rates of screening, performing, and coordinating SAT and SBTs, and these results were sustained in the 8-month follow-up period post-QI program.
BACKGROUND: Coordinating efforts across disciplines in the intensive care unit is a key component of quality improvement (QI) efforts. Spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs) are considered key components of guidelines, yet unfortunately are often not done or coordinated properly. OBJECTIVE: To determine if a pharmacist-driven awakening and breathing coordination (ABC) QI program would improve compliance (ie, process measures) as compared with the previous protocol, which did not involve pharmacists. METHODS: The QI program included pharmacist-led education, daily discussion on rounds, and weekly performance reports to staff. Using a pre-QI versus during-QI versus post-QI intervention design, we compared data from 500 control ventilator-days (pre-QI period) versus 580 prospective ventilator-days (during-QI period). We then evaluated the sustainability of the QI program in 216 ventilator-days in the post-QI period. RESULTS: SAT safety screens were performed on only 20% pre-QI patient-days versus 97% of during-QI patient-days (P < 0.001) and 100% of post-QI patient-days (P = 0.25). The rates of passing the SAT safety screen in pre-QI and during-QI periods were 63% versus 78% (P = 0.03) and 81% in the post-QI period (P = 0.86). The rates of SATs among eligible patients on continuous infusions were only 53% in the pre-QI versus 85% in the during-QI (P = 0.0001) and 87% in the post-QI (P = 1) periods. CONCLUSIONS: In this QI initiative, a pharmacist-driven, interdisciplinary ABC protocol significantly improved process measures compliance, comparing the pre-QI versus during-QI rates of screening, performing, and coordinating SAT and SBTs, and these results were sustained in the 8-month follow-up period post-QI program.
Authors: Michael T Kenes; Joanna L Stollings; Li Wang; Timothy D Girard; E Wesley Ely; Pratik P Pandharipande Journal: Pharmacotherapy Date: 2017-10-17 Impact factor: 4.705
Authors: Joanna L Stollings; Jennifer L Thompson; Benjamin A Ferrell; Mika Scheinin; Grant R Wilkinson; Christopher G Hughes; Ayumi K Shintani; E Wesley Ely; Timothy D Girard; Pratik P Pandharipande; Mayur B Patel Journal: Ann Pharmacother Date: 2018-01-24 Impact factor: 3.154
Authors: Joanna L Stollings; Sarah L Bloom; Li Wang; E Wesley Ely; James C Jackson; Carla M Sevin Journal: Ann Pharmacother Date: 2018-02-18 Impact factor: 3.154
Authors: Leanne M Boehm; Brenda T Pun; Joanna L Stollings; Timothy D Girard; Peter Rock; Catherine L Hough; S Jean Hsieh; Babar A Khan; Robert L Owens; Gregory A Schmidt; Susan Smith; E Wesley Ely Journal: Intensive Crit Care Nurs Date: 2020-05-08 Impact factor: 3.072