ICU. Studies have shown that implementation of the bundle, including a ventilator weaning protocol and maintaining light levels of sedation, improve patient outcomes. However, "real-world" application of the A-F Bundle had been unsuccessful at the study site prior to the multidisciplinary quality improvement project.
METHOD:This quality improvement project was conducted in a 31-bed adult ICU beginning in February 2021. First, the electronic medical record, documentation, and policies/ procedures were redesigned to follow the A-F Bundle elements. Then, the multidisciplinary leadership team, including nursing, respiratory therapy, pharmacy, and administration, created a spontaneous awakening trial (SAT) and spontaneous breathing trial (SBT) protocol. Lastly, extensive multidisciplinary education was provided to nursing (6 hours), respiratory therapy (1.5 hours), and prescribers (1 hour) to review the evidenced-based recommendations, A-F Bundle, and SAT/SBT protocol. This quality improvement project then compared the amount of propofol used per patient, ventilator days, ICU length of stay (LOS), hospital LOS, and mortality pre (January 2021) and post (June 2021) completion of the project.
RESULTS:Twenty-five adults were included in the pre-group and 29 in the post. Median amount of propofol used per ventilator day decreased from 11 mcg/kg/min to 9 mcg/kg/ min when comparing the pre to the post-group. This decrease was also seen in median amount of propofol used per patient (600 mL to 400 mL) and per ventilator day (150 mL vs. 83 mL). Ventilator days were the same between the two groups (5 days). However, median ICU LOS and hospital LOS were lower in the post-group (ICU LOS: 14 vs. 9 days, hospital LOS 20 vs. 14 days). Morality rate in the pre-group was 64% vs. 31% in the post-group.
CONCLUSIONS:The studied quality improvement project, which included A-F bundle implementation and multidisciplinary education, decreased sedative use and LOS.
