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Recommended Citation
Mackenzie J, Saler J, Dickinson G, et al. ICU Collaborative Spontaneous Awakening Trail Improvement Project. Quality Improvement poster presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Presentation Notes
Quality Improvement poster presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Abstract
Background
The clinical practice of spontaneous awakening trials (SAT)is established as best evidence based on Society of Critical Care Medicine A-F Bundle. Specifically, SAT is in the B component to safely screen eligibility for weaning sedation in anticipation of extubation and proceeding through the remaining bundle sequence. Evidence supports that when patients have less sedation, it decreases the chances of delirium, promotes early mobility which decreases length of stay and complications.
Local Problem
Spontaneous awakening trials performed by intensive care unit (ICU) nurses deviated from practice during and subsequently after the pandemic. There was a deviation in practice due to new unconventional modalities needed to adequately sedate the COVID 19 patient population with ARDS to allow for adequate ventilation and oxygenation. Baseline audits across two ICU units in 2024 showed 24.5% documentation of SAT. Random audits on average eligible patients (n=6) across two units showed ventilation time of 6.95 hours.
Method
The Plan Do Study Act was the method utilized for this project. Baseline audits and a re-education plan was initiated by clinical nurse champions in coordination with ICU CNS in January 2024. The champions presented to peers and interdisciplinary unit leadership, to garner insights, feedback and collaboration. Pre and post education surveys were conducted and shared across units.
Results/Conclusions
The post implementation data showed on average a 38.5% compliance in SAT documentation indicating a 14.5% change across the two units. Additionally, a distal outcome was a decrease in average ventilator hours to 5.80 hours across two units. Pre-post confidence scores and other feedback was also obtained.
Implications for Practice
Continue to monitor, address unit specific barriers, and reinforce the SAT in practice and sustainment. Expand the initiative to the third ICU unit, and inclusion of population specific considerations that can impact SAT eligibility. The next area of opportunity in the A-F, ICU liberation bundle to approach is early mobility.
References
Sara Grieshop; ABCDEF Bundle. Am J Crit Care 1 March 2023; 32 (2): 100. doi: https://doi.org/10.4037/ajcc2023998
Marra, A., Ely, E. W., Pandharipande, P. P., & Patel, M. B. (2017). The ABCDEF Bundle in Critical Care. Critical care clinics, 33(2), 225–243. https://doi.org/10.1016/j.ccc.2016.12.005
Document Type
Poster
Publication Date
11-13-2024
ICU Collaborative Spontaneous Awakening Trail Improvement Project
Background
The clinical practice of spontaneous awakening trials (SAT)is established as best evidence based on Society of Critical Care Medicine A-F Bundle. Specifically, SAT is in the B component to safely screen eligibility for weaning sedation in anticipation of extubation and proceeding through the remaining bundle sequence. Evidence supports that when patients have less sedation, it decreases the chances of delirium, promotes early mobility which decreases length of stay and complications.
Local Problem
Spontaneous awakening trials performed by intensive care unit (ICU) nurses deviated from practice during and subsequently after the pandemic. There was a deviation in practice due to new unconventional modalities needed to adequately sedate the COVID 19 patient population with ARDS to allow for adequate ventilation and oxygenation. Baseline audits across two ICU units in 2024 showed 24.5% documentation of SAT. Random audits on average eligible patients (n=6) across two units showed ventilation time of 6.95 hours.
Method
The Plan Do Study Act was the method utilized for this project. Baseline audits and a re-education plan was initiated by clinical nurse champions in coordination with ICU CNS in January 2024. The champions presented to peers and interdisciplinary unit leadership, to garner insights, feedback and collaboration. Pre and post education surveys were conducted and shared across units.
Results/Conclusions
The post implementation data showed on average a 38.5% compliance in SAT documentation indicating a 14.5% change across the two units. Additionally, a distal outcome was a decrease in average ventilator hours to 5.80 hours across two units. Pre-post confidence scores and other feedback was also obtained.
Implications for Practice
Continue to monitor, address unit specific barriers, and reinforce the SAT in practice and sustainment. Expand the initiative to the third ICU unit, and inclusion of population specific considerations that can impact SAT eligibility. The next area of opportunity in the A-F, ICU liberation bundle to approach is early mobility.
References
Sara Grieshop; ABCDEF Bundle. Am J Crit Care 1 March 2023; 32 (2): 100. doi: https://doi.org/10.4037/ajcc2023998
Marra, A., Ely, E. W., Pandharipande, P. P., & Patel, M. B. (2017). The ABCDEF Bundle in Critical Care. Critical care clinics, 33(2), 225–243. https://doi.org/10.1016/j.ccc.2016.12.005
Affiliations
Aurora St. Luke's Medical Center