Implementing a weaning assessment tool in critically ill intubated adults
Creators: name: Galati, Nicole
Publisher: name: No Publisher Supplied
Year: 2024

description: Purpose of Project: This doctorate project, which also served as a quality improvement project, aimed to implement the Wake Up and Breathe Protocol by the Society of Critical Care Medicine into daily practice on critically ill adults on mechanical ventilation on a medical-surgical intensive care unit. In utilizing the Wake Up and Breathe Protocol as a weaning assessment tool, the primary desired outcomes for this initiative included decreasing total ventilator days and increasing both daily sedation awakening trials and spontaneous breathing trials performed. Methodology: The Wake Up and Breathe Protocol was translated into a SmartText nursing note in the electronic medical record system. All elements of the Wake Up and Breathe Protocol were included in the nursing assessment note and a hyperlink was attached to the electronic note for nurses to reference while completing their assessment. Implementing the Wake Up and Breathe Protocol took place over three phases. Phase one consisted of educating staff on the site's weaning policy, the Wake Up and Breathe Protocol, and how to utilize the SmartText nursing note created. During this phase data was collected on 20 critically ill intubated adults regarding their total ventilator days, sedation interruptions, and spontaneous breathing trials performed. Phase two consisted of implementing the SmartText nursing note with Wake Up and Breathe elements into practice. After a month of staff utilizing the created SmartText nursing note in daily practice, phase three commenced with an anonymous staff survey in which feedback was obtained regarding ideas for future translation and challenges staff faced with implementing the Protocol into practice. Retrospective data collection was also performed during this time; data was collected on 20 critically ill intubated adults regarding ventilator days, sedation interruptions, and spontaneous breathing trials.Results: Ventilator days were found to increase during implementation of the weaning assessment nursing note with the Wake Up and Breathe Protocol elements from an average of 7.5 days to 7.9 days. However, compliance with spontaneous awakening trials and spontaneous breathing trials increased with the implementation of the Wake Up and Breathe Protocol. There were a total of 164 spontaneous awakening trials recorded and 35 spontaneous breathing trials performed during the implementation phase compared to 83 and 22 trials recorded pre-implementation, respectively. Implications for Practice: Potential implications for future translation include editing the SmartText nursing note to include a task icon on the "Brain" in the electronic medical record to remind staff to perform this assessment on their intubated patients every shift. Further, this weaning assessment has the potential to be adopted in all critical care settings to improve patient outcomes in all mechanically ventilated critically ill adults. While the outcomes measured were not statistically significant, it is anticipated that if the Wake Up and Breathe Protocol were implemented in a wider population of mechanically ventilated adult patients, ventilator days and adverse ventilator outcomes would decrease, as evidenced by previous similar studies in literature.