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Education and team leadership can improve care for ICU patients on mechanical ventilation

Intensive care unit (ICU) patients on mechanical ventilation are at increased risk for death and complications such as gastrointestinal bleeding and ventilator-associated pneumonia (VAP). Evidence confirms that four interventions can reduce complications and deaths in the ventilated patient: semirecumbent positioning of the patient (head of the bed is elevated 30 or more degrees to prevent VAP), daily interruption of sedative-drug infusions, peptic ulcer disease prophylaxis, and deep venous thrombosis prophylaxis.

A quality improvement (QI) team led by ICU intensivists can improve the care of ICU patients on mechanical ventilation, according to a recent study that was supported in part by the Agency for Healthcare Research and Quality (HS11902). Within 2 months, the QI program increased the percentage of ventilator days on which patients received all four care processes from 30 to 96 percent. Within a year, patients received all four care processes on 100 percent of the ventilator days.

The researchers estimate that this improved compliance may have prevented 27 deaths and 754 excess hospital and ICU days and yielded $825,000 in savings per year in the ICU. They calculated the percentage of ventilator days per week when patients at a hospital surgical ICU received all four recommended care processes both before and after QI program implementation. The program included administering a questionnaire to identify barriers to compliance with the four care processes; implementing an educational program to increase awareness of the evidence supporting the use of these processes; and implementing a checklist to be completed daily during ICU rounds to ask providers whether patients were receiving these therapies.

See "Improving care for the ventilated patient," by Sean M. Berenholtz, M.D., M.H.S., Shelley Milanovich, R.N., A.C.N.P., Amanda Faircloth, R.N., B.S.N., and others, in the April 2004 Joint Commission Journal on Quality and Safety 30(4), pp. 195-200.

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