Wake Me Up! It’s Time to Breathe With the ABCs

Lehigh Valley Hospital (Allentown, Pennsylvania)

CSI Summary

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CSI Presentation

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CSI Toolkit

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Project Topic:

Spontaneous awakening and breathing trials

Hospital Unit:

2K South Medical Surgical Intensive Care Unit (ICU)

CSI Participants:

  • Katie Didyoung, MSN, RN, CCRN
  • Laurel Lovelace, MSN, RN, ACNS
  • Alyssa Minnich, MSN, RN, AGCNS-BC, CEN, TCRN

Video Presentation:

View this CSI team's project presentation video to earn CERPs.

Project Goals/Objectives:

  1. Standardize nursing practice to perform spontaneous awakening trial (SAT) daily when ordered
  2. Include SAT and spontaneous breathing trial (SBT) information when communicating with healthcare providers
  3. Re-educate staff on correct use of Richmond Agitation Sedation Scale (RASS)
  4. Decrease total ventilator days 10%
  5. Decrease ventilator-associated pneumonia (VAP)/ventilator-associated events (VAE) 16%

Project Outcomes:

  1. Decreased total ventilator days 39%
  2. Decreased pneumonia and VAE 85%
  3. These outcomes resulted in an estimated annual fiscal impact of $2.2 million.

Project Overview:

A lack of standardized practice for SAT and SBT in our health network often resulted in nurses discontinuing sedation only when requested by a provider, despite a daily SAT order. A review of current unit practice revealed that, due to rounds occurring about 12-1:00 p.m., SATs were performed later in the day, leaving patients intubated until later in the afternoon. In addition, chart audits revealed escalation of sedation medications with improper RASS scoring. These factors directly impact total ventilator days, ICU and hospital length of stay, and risk of VAP/VAE.

During project kickoff, our CSI team educated staff about RASS and the benefits of performing daily SATs/SBTs. At daily huddles, we identified patients eligible for SAT/SBT.

The project was received positively by our peers, providers and interdisciplinary team members. We achieved a 39% decrease in total ventilator days and an 85% decrease in VAP and VAE. We also experienced two unintended positive outcomes: anecdotal decreases in time on sedation and number of days from intubation to use of Precedex.

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The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.