Implementing the comprehensive unit-based safety program model to improve the management of mechanically ventilated patients in Saudi Arabia - 04/01/19
, Maha Al-Juaid, RN, BSN, MSN b, Hanan Al-Mutairi, MSc c, George Bibin, RN c, John Alchin, RN d, Amal Matroud, RN e, Victoria Burrows, RN f, Ismael Tan, RN d, Salha Zayer, RN g, Brintha Naidv, RN g, Basim Kalantan, MPT h, Yaseen M. Arabi, MD, FCCP, FCCM iHighlights |
• | A multidisciplinary team using the Comprehensive Unit-based Safety Program Model can reduce the complications associated with mechanical ventilation. |
• | Daily delirium assessment and early mobility are important strategies for reducing ventilator-associated events. |
• | Active feedback on bundle compliance and rates of ventilator-associated events is probably beneficial. |
• | Benchmarking your institutions with others allows you to better achieve your target goals. |
• | Sustained improvement in quality of care and patient safety requires a behavioral change in health care providers. |
Résumé |
Background |
Ventilator-associated events are common in mechanically ventilated patients. They are associated with more days on mechanical ventilation, longer intensive care unit (ICU) stay, and increased risk of mortality. Theoretically, interventions that prevent ventilator-associated events should also reduce associated morbidity. We evaluated the Comprehensive Unit-based Safety Program approach to improve the care of mechanically ventilated patients.
Methods |
All mechanically ventilated patients admitted to the ICU between October 1, 2015, and October 31, 2016, were prospectively monitored for the development of ventilator-associated events according to the National Healthcare Safety Network criteria. A process care bundle (endotracheal intubation with subglottic suctioning, head-of-bed elevation ≥30°, target sedation scores, daily spontaneous awakening trials, spontaneous breathing trials), daily delirium assessment, and an early mobility protocol were instituted. The bundle compliance, ventilator-associated events rates, ICU length of stay, and mortality rate were noted. The database allowed viewing of current rates, trends, and averages of all participating sites.
Results |
In the study period, 2,321 patients were admitted to the ICU, and 1,231 required mechanical ventilation (10,342 ventilator days). There were 115 ventilator-associated events: 82 ventilator-associated conditions, 15 infection-related ventilator-associated conditions, and 18 possible cases of ventilator-associated pneumonia. The ICU mortality rate was 13.3%, compared with 28.7% for those mechanically ventilated patients with ventilator-associated events (P = .0001). There was increased compliance for spontaneous awakening trials (51.5%-76.9%, P = .0008) and spontaneous breathing trials (54.2%-72.2%, P = .02) and a decrease in infection-related ventilator-associated conditions (4.2-3.5 per 1,000 days), possible cases of ventilator-associated pneumonia (2.1-1.7 per 1,000 days), ICU mortality (45.3%-19.1%, P = .045), and ventilator-associated events associated mortality rates (33.3%-8.3%, P < .37). Physical therapy participation and mobility were 60.8% and 26.4%, respectively.
Conclusion |
The implementation of a multipronged program like the Comprehensive Unit-based Safety Program could improve the care processes and outcomes of mechanically ventilated patients.
Le texte complet de cet article est disponible en PDF.Key words : Ventilator-associated events, Comprehensive Unit-based Safety Program, Safety and quality improvement, Intensive care unit
Plan
| Conflicts of interest: None declared. |
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| Author contributions: RK was head of the project and oversaw the analytical plan. M.A. oversaw validation of CAM-ICU score in Arabic. G.B. performed data entry. A.M., V.B., I.T., S.Z., and B.N. oversaw the implementation of the CUSP project in their ICU unit. B.K. oversaw implementation and supervision of the mobility protocol. J.A. oversaw supervision of nursing staff. A.M., V.B., I.T., S.Z., and B.N. monitored bundle compliance. H.A., G.B., J.A., A.M., V.B., I.T., S.Z., and B.N. participated in staff education. R.K., M.A., H.A., and G.B. participated in data collection.R.K., M.A., and Y.A. participated in drafting of the manuscript. All authors participated in critical revision of the manuscript for important intellectual content. All authors participated in approval of the final version to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the article are appropriately investigated and resolved. |
Vol 47 - N° 1
P. 51-58 - janvier 2019 Retour au numéro
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