Impact of Guided Interventions on Terminal Extubation: A Pilot Project

Activity Summary

Required reading for all learners: Implicit Bias impacts patient outcomes

More than 40% of deaths in critical care units occur after withdrawal of life-sustaining interventions. Evidence is lacking regarding the superiority of immediate extubation versus terminal weaning at the end of life. Immediate extubation is faster, but research is associated with a higher risk of patient distress due to dependence on anticipatory medications. Families and registered nurses may experience higher levels of trauma with increased patient distress. Terminal weaning offers a better opportunity to manage symptoms over time during gradual reduction of ventilator support, but this lengthier process may also increase nurse and family distress. At a 368-bed acute care hospital, nurses reported a lack of training on managing end-of-life symptoms associated with terminal extubation and the need for a standardized protocol to guide assessment and interventions. This study examines how the use of an evidence-based terminal extubation protocol affects bedside nursing practice.

Objectives

Describe a protocol to standardize terminal extubation.
Recognize the primary concern for dyspnea and suffering in patients undergoing terminal extubation.
Identify a validated tool called the Respiratory Distress Observation (RDOS) tool to evaluate dyspnea in terminal extubation patients.

Continuing Education Disclosure Statement

Successful Completion

Learners must complete the entire activity and the associated evaluation to be awarded contact hours AND read Implicit Bias impacts patient outcomes. No partial credit will be awarded.

Accreditation

The American Association of Critical-Care Nurses is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.
Provider approved by the California Board of Registered Nursing, Provider number CEP 1036, for {contactHours} contact hours.

Disclosures

Any relevant relationship between an ineligible company and an individual with the ability to influence clinical content will be identified by the Nurse Planner within the activity. Any relevant relationship between an ineligible company and an individual with the ability to influence clinical content has been mitigated.

Accreditation refers to recognition of continuing education only and does not imply AACN, ANCC, or CBRN approval or endorsement of any commercial products discussed or displayed in conjunction with this educational activity. Activities with pharmacology hours are to assist the APRN in fulfilling the pharmacotherapeutic education requirements for licensure and certification renewals.

Activities meet the standards for most states that require mandatory continuing education for license and/or certification renewal. AACN recommends consulting with your own state board of nursing or credentialing organization before submitting your certificate of completion.

Refund Policy

Continuing Education Activities are nonrefundable.