Clinical quality improvement: eliminating unplanned extubation in the CCU.
Int J Health Care Qual Assur
; 26(7): 642-52, 2013.
Article
en En
| MEDLINE
| ID: mdl-24167922
ABSTRACT
PURPOSE:
This article aims to explore coronary care unit (CCU) extubation structures, processes and outcomes. There were 13 unplanned-extubation cases (UE) among 251 intubated patients (5.2 per cent) in a cardiologist-led CCU in 2008. Seven did not require re-intubation, implying possible earlier extubation. A quality improvement project was undertaken with a goal to eliminate CCU UE within 12 months. DESIGN/METHODOLOGY/APPROACH:
Using the clinical practice improvement (CPI) method, the most significant root causes were missing sedation/analgesia protocol, no ventilator weaning protocol and absent respiratory therapist during the CCU morning rounds. Non-physician directed sedation/analgesia and ventilation weaning protocols were created and put on trial in Plan-Do-Study-Act cycles before formal implementation. Arrangements were made to allocate a respiratory therapist to the CCU daily for morning rounds.FINDINGS:
For 12 months after fully implementing the interventions, UE incidence dropped from 5.2 per cent to 0.9 per cent (p = 0.006). There were no adverse outcomes, re-intubation and/or readmission to CCU within 48 hours. PRACTICAL IMPLICATIONS Through a multi-disciplinary CPI approach, adopting non-physician directed protocols has successfully streamlined and improved airway management in mechanically ventilated patients in a cardiologist-led CCU. ORIGINALITY/VALUE There is little published data on improving intubated patient care in cardiologist-led CCUs. Previous studies centered on intensive care units managed by critical care specialists.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Desconexión del Ventilador
/
Unidades de Cuidados Coronarios
/
Mejoramiento de la Calidad
/
Extubación Traqueal
/
Intubación Intratraqueal
Tipo de estudio:
Guideline
Límite:
Humans
Idioma:
En
Revista:
Int J Health Care Qual Assur
Asunto de la revista:
PESQUISA EM SERVICOS DE SAUDE
Año:
2013
Tipo del documento:
Article
País de afiliación:
Singapur