Standardization of Weaning Practices for Adult Ventilator Patients

• Multidisciplinary Task Force Committee:• Critical Care Services (Anesthesiology,

Pulmonary, Trauma, Neurosurgery)• Department of Respiratory Care - clinical staff and

team leaders • Center for Clinical Effectiveness

Opportunity Statement and Desired Outcome

• There is an opportunity to improve the outcomes of the ventilator-assisted patient. In 2001, a house-wide ventilator weaning protocol was developed and implemented by a multidisciplinary task force.

• Goal: 50% reduction in weaning time

Most Likely Causes for Current Opportunity

• Suboptimal communication among physician, nurse and respiratory care team members

• Variation in weaning practices among critical care services

• Need for ongoing education regarding best practices for weaning

Solutions Implemented• Increased involvement of medical leadership in

selected ICUs• Education to all healthcare providers• Proactive assessment and response to data at

regular ICU QI meetings• Consistent and ongoing communication between

Nursing and Respiratory Care staff to ensure appropriate implementation of the protocol

Ave

rage

Wea

ning

Hou

rsNeuro Sciences Average Weaning Hours

Extubated Mechanically Ventilated Adults Patients Greater Than 2 Days

CY00 Q

1

CY00 Q

2

CY00 Q

3

CY00 Q

4

CY01 Q

1

CY01 Q

2

CY01 Q

3

CY01 Q

4

CY02 Q

1

CY02 Q

2

CY02 Q

3

CY02 Q

4

CY03 Q

1

CY03 Q

2

CY03 Q

3

CY03 Q

4

CY04 Q

1

CY04 Q

2

CY04 Q

3

CY04 Q

4

CY05 Q

1

CY05 Q

2

CY05 Q

3

CY05 Q

4

0

10

20

30

40

50

60

70

80

90

Mean = 42.3 Hours

Mean = 32.6 Hours

Data Description: Extubated Adult ICU Patients On a Ventilator Greater Than 2 Days Who Were Successfully Weaned. The average time it took (in hours) to successfully wean patients off of the ventilator.Source: PIMSCCE Analyst: Penny Bleffer-RidingConfidential Material for Quality Improvement Purposes

We

an

ing

Mo

de

Usa

ge

NeuroSciences Weaning Mode Protocol UsageExtubated Mechanically Ventilated Adult Patients Greater Than 2 Days

CY00 Q

1

CY00 Q

2

CY00 Q

3

CY00 Q

4

CY01 Q

1

CY01 Q

2

CY01 Q

3

CY01 Q

4

CY02 Q

1

CY02 Q

2

CY02 Q

3

CY02 Q

4

CY03 Q

1

CY03 Q

2

CY03 Q

3

CY03 Q

4

CY04 Q

1

CY04 Q

2

CY04 Q

3

CY04 Q

4

CY05 Q

1

CY05 Q

2

CY05 Q

3

CY05 Q

4

0%

20%

40%

60%

80%

100%

Mean = 39%

Mean = 68%

Data Description: Extubated Adult ICU Patients On a Ventilator Greater Than 2 Days Who Were Successfully Weaned. The percent of successfully weaned extubated adult population using the protocol for discontinuation of mechanical ventilation.Source: PIMSCCE Analyst: Penny Bleffer-RidingConfidential Material for Quality Improvement Purposes

4ICU Average Weaning HoursA

vera

ge

We

ani

ng

Hou

rsSurgical ICU Average Weaning Hours

Extubated Mechanically Ventilated Adult Patients Greater Than 2 Days

CY00-Q

1

CY00-Q

2

CY00-Q

3

CY00-Q

4

CY01-Q

1

CY01-Q

2

CY01-Q

3

CY01-Q

4

CY02-Q

1

CY02-Q

2

CY02-Q

3

CY02-Q

4

CY03-Q

1

CY03-Q

2

CY03-Q

3

CY03-Q

4

CY04-Q

1

CY04-Q

2

CY04-Q

3

CY04-Q

4

CY05-Q

1

CY05-Q

2

CY05-Q

3

CY05-Q

4

0

20

40

60

80

100

120

Mean = 54.5 Hours

Mean = 47.3 Hours

Data Description: Extubated Adult ICU Patients On a Ventilator Greater Than 2 Days Who Were Successfully Weaned. The average time it took (in hours) to successfully wean patients off of the ventilator..Source: PIMSCCE Analyst: Penny Bleffer-RidingConfidential Material for Quality Improvement Purposes

Wea

ning

Mod

e U

sage

Surgical ICU Weaning Mode Protocol UsageExtubated Mechanically Ventilated Adult Patients Greater Than 2 Days

CY00-Q

1

CY00-Q

2

CY00-Q

3

CY00-Q

4

CY01-Q

1

CY01-Q

2

CY01-Q

3

CY01-Q

4

CY02-Q

1

CY02-Q

2

CY02-Q

3

CY02-Q

4

CY03-Q

1

CY03-Q

2

CY03-Q

3

CY03-Q

4

CY04-Q

1

CY04-Q

2

CY04-Q

3

CY04-Q

4

CY05-Q

1

CY05-Q

2

CY05-Q

3

CY05-Q

4

0%

20%

40%

60%

80%

100%

Mean = 58%

Mean = 64%

Data Description: Extubated Adult ICU Patients On a Ventilator Greater Than 2 Days Who Were Successfully Weaned. The percent of successfully weaned extubated adult population using the protocol for discontinuation of mechanical ventilation.Source: PIMSCCE Analyst: Penny Bleffer-RidingConfidential Material for Quality Improvement Purposes

Ave

rage

Wea

ning

Hou

rs2ICU Average Weaning Hours

Extubated Mechanically Ventilated Adult Patients Greater Than 2 Days

CY00 Q

1

CY00 Q

2

CY00 Q

3

CY00 Q

4

CY01 Q

1

CY01 Q

2

CY01 Q

3

CY01 Q

4

CY02 Q

1

CY02 Q

2

CY02 Q

3

CY02 Q

4

CY03 Q

1

CY03 Q

2

CY03 Q

3

CY03 Q

4

CY04 Q

1

CY04 Q

2

CY04 Q

3

CY04 Q

4

CY05 Q

1

CY05 Q

2

CY05 Q

3

CY05 Q

4

0

10

20

30

40

50

60

70

80

90

Mean = 42.2 Hours

Data Description: Extubated Adult ICU Patients On a Ventilator Greater Than 2 Days Who Were Successfully Weaned. The average time it took (in hours) to successfully wean patients off of the ventilator..Source: PIMSCCE Analyst: Penny Bleffer-RidingConfidential Material for Quality Improvement Purposes

Wea

nin

g M

od

e U

sag

e2ICU Weaning Mode Protocol Usage

Extubated Mechanically Ventilated Adult Patients Greater Than 2 Days

CY00 Q

1

CY00 Q

2

CY00 Q

3

CY00 Q

4

CY01 Q

1

CY01 Q

2

CY01 Q

3

CY01 Q

4

CY02 Q

1

CY02 Q

2

CY02 Q

3

CY02 Q

4

CY03 Q

1

CY03 Q

2

CY03 Q

3

CY03 Q

4

CY04 Q

1

CY04 Q

2

CY04 Q

3

CY04 Q

4

CY05 Q

1

CY05 Q

2

CY05 Q

3

CY05 Q

4

0%

20%

40%

60%

80%

100%

Mean = 37%

Data Description: Extubated Adult ICU Patients On a Ventilator Greater Than 2 Days Who Were Successfully Weaned. The percent of Successfully weaned extubated adult population using the protocol for discontinuation of mechanical ventilation.Source: PIMSCCE Analyst: Penny Bleffer-RidingConfidential Material for Quality Improvement Purposes

Conclusions and Next Steps

• Utilization of the protocol has increased dramatically in the Neurosciences and Surgical Intensive Units.

• Weaning time has decreased by more than 50% in those units consistently using the protocol.

• Usage of the protocol in selected areas is inconsistent. Leadership and communication issues remain opportunities for improvement.