Practice Variation in Respiratory Therapy Documentation During Mechanical Ventilation

Akhtar, Saadia; Weaver, John J; Pierson, David J.; Rubenfeld, Gordon D.

doi:10.1378/chest.124.6.2275

Cited by 20 publications

(8 citation statements)

References 12 publications

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“…There were a number of shared barriers reported across all types of MICU clinicians including staffing and time. Finding the time and personnel necessary to mobilize can be a deterrent to implementation of mobility programs and an often reported concern in quality improvement studies targeting broader acceptance of mobility [ 12 , 13 , 19 , 22 , 25 ]. Our study findings suggest that clinicians think staffing is inadequate and nursing time insufficient.…”

Section: Discussionmentioning

confidence: 99%

Medical intensive care unit clinician attitudes and perceived barriers towards early mobilization of critically ill patients: a cross-sectional survey study

et al. 2014

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BackgroundEarly mobilization (EM) of patients on mechanical ventilation (MV) is shown to improve outcomes after critical illness. Little is known regarding clinician knowledge of EM or multi-disciplinary barriers to use of EM in the intensive care unit (ICU). The goal of this study was to assess clinician knowledge regarding EM and identify barriers to its provision.MethodsSimultaneous cross-sectional surveys of medical ICU (MICU) nurses (RN)/physical therapists (PT) respondents and physician (MD) respondents in a single MICU at an academic hospital in Seattle, WA in 2010–2011. Responses were indicated on a 5 point Likert scale and reported as proportion of respondents agreeing or disagreeing. Chi-square testing and Fisher’s exact testing was performed to determine whether responses differed by duration of employment or prior EM experience.ResultsA total of 120 clinicians responded to the survey (91 MDs (response rate 82% (91/111)), 17 RNs (response rate 22%, (17/78)), and 12 PTs (response rate 86%, (12/14)), overall response rate 86%). Most clinicians indicated knowledge regarding benefits of EM. More attending physicians reported knowledge of EM benefits, but also that risks of EM outweigh the benefits compared to trainees (p = 0.02 and 0.01). Clinicians across disciplines reported near universal agreement to use of EM for patients on MV, while the minority reported agreement to EM for patients on vasoactive agents. The most frequently reported cross-disciplinary barriers to EM were staffing and time. Risk of self-injury and excess work stress were indicated as barriers by RN and PT respondents.ConclusionsMICU clinicians, at our institution, reported knowledge of EM in the ICU. Staffing and clinician time were frequently identified cross-disciplinary barriers. Risk of self-injury and excess work stress were frequently reported RN and PT barriers.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2253-14-84) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Medical intensive care unit clinician attitudes and perceived barriers towards early mobilization of critically ill patients: a cross-sectional survey study

et al. 2014

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“…For example, collection of laboratory data was constrained by the frequency and timing of tests ordered by the ICU clinicians. Similarly, as in other observational research, certain ventilator-related parameters, such as plateau pressure, were not consistently measured or documented in the medical record [15]. In these situations, related data were recorded when available.…”

Section: Development Of Methodology For Exposure Measurementsmentioning

confidence: 99%

Intensive care unit exposures for long-term outcomes research: Development and description of exposures for 150 patients with acute lung injury

Needham

Wang

Desai

et al. 2007

Journal of Critical Care

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“…Fourth, the survey can only evaluate stated practice and cannot evaluate adherence to or use of the protocols. Our data likely overestimate the actual availability and use of protocols 24. The mere existence of a protocol may not influence practice or education in any way if the protocol is not actually employed.…”

Section: Discussionmentioning

confidence: 70%

The availability of clinical protocols in US teaching intensive care units

Prasad

Christie

Bellamy

et al. 2010

Journal of Critical Care

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PURPOSE Clinical protocols to standardize care may improve patient outcomes but worsen trainee education. Our objective was to determine the availability of clinical protocols in teaching medical ICUs. MATERIALS AND METHODS We administered an electronic questionnaire regarding protocol availability in five specific clinical areas. All directors of adult medical ICUs in US teaching hospitals were eligible to participate. RESULTS The response rate was 70%. 86% of ICU directors reported availability of protocols for ventilation liberation, 73% for sedation, 62% for sepsis resuscitation, 60% for lung-protective ventilation, and 48% for life support withdrawal. Ventilation liberation protocols are most often started and driven by respiratory therapists (40% and 90%); sedation started by residents (41%) and driven by nurses (95%); sepsis resuscitation started and driven by residents (49% and 46%); lung-protective ventilation started by attending physicians (39%) and driven by respiratory therapists (67%); and life support withdrawal started by attending physicians (93%) and driven by nurses (47%). CONCLUSIONS There is wide variation in clinical protocol availability among teaching hospitals. Further study of the effect of protocols on education is needed.

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Practice Variation in Respiratory Therapy Documentation During Mechanical Ventilation

Cited by 20 publications

References 12 publications

Medical intensive care unit clinician attitudes and perceived barriers towards early mobilization of critically ill patients: a cross-sectional survey study

Medical intensive care unit clinician attitudes and perceived barriers towards early mobilization of critically ill patients: a cross-sectional survey study

Intensive care unit exposures for long-term outcomes research: Development and description of exposures for 150 patients with acute lung injury

The availability of clinical protocols in US teaching intensive care units

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