SESSION TITLE: Critical Care
SESSION TYPE: Slide Presentation
PRESENTED ON: Saturday, March 22, 2014 at 04:15 PM - 05:15 PM
PURPOSE: This QI intervention is aimed at reducing delirium,increasing implementation of goal directed sedation and improving patient’s functional status by early physical therapy (PT) in CCU. Based on current data, this can effectively decrease delirium and neuromuscular deconditioning in intensive care patients. Our goals are to: 1) Increase delirium recognition by consistent implementation of Confusion Assessment Measurement (CAM-ICU), 2) reduce deep sedation by goal directed sedation protocols, 3)improve patients’ functional mobility by increasing the number and earlier timing of PT treatments.
METHODS: CDATA[Two strategies, Define-Measure-Analyze-Improve-Control (DMAIC) and Plan-Do-Study-Act (PDSA), are being used to implement this systematic and multidisciplinary effort in a 16 bed CCU at a tertiary academic center. Analysis comparing 3-month pre- and 3-month post-intervention patient outcomes, including amount of sedatives used, assessment of sedation and delirium, rehabilitation treatments, and disposition variables will be performed at the end of intervention period in February 2014. Baseline patient characteristics and outcome variables were obtained through surveys and review of the electronic medical records.
RESULTS: This is an active project in stage of intervention nearing its completion.In a 3 month period prior to intervention, 80 patients received mechanical ventilation or non-invasive positive pressure ventilation, 72.5% of patients had inconsistent CAM-ICU assessments. 83.75% patients received benzodiazepines. PT was consulted on 27.5% of patients, with a median of 3.5 days (0.75-6.5) after admission. Only 44% patients were discharged directly to home and 56% required rehabilitation.
CONCLUSIONS: Using DMAIC, following system issues were identified: 1) low implementation of CAM-ICU, 2) delay of PT consultation and treatment, 3) low use of goal directed sedation protocols with frequent use of benzodiazepines and continuous infusions resulting in overdose and delay of PT, 4) lack of awareness of the importance of early mobilization and reducing sedation in improving patient outcomes.
CLINICAL IMPLICATIONS: A multidisciplinary, coordinated and systematic approach is needed to cause the shift of paradigm towards awake , functional and interactive mechanically ventilated patients
DISCLOSURE: The following authors have nothing to disclose: Jasleen Pannu, Sarah Lee, Dereddi Raja Reddy, Pramod Guru, Mazen Al-Qadi, Bernardo Selim
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