Decreasing Ventilator Mortality in the ICU
Evidence based research shows that early mobility in respiratory failure patients is safe and beneficial for critically ill patients. In May 2011, nurses attending a national critical care conference learned new evidence based practices related to early mobility while on the ventilator. The nurses were eager to put this new knowledge into clinical practice.
A multidisciplinary team developed or revised practices and protocols to increase mobility and earlier withdrawal of ventilator support including:
- Increased multidisciplinary rounding to daily from three times a week
- Revised ventilator checklist to include new mobility protocol
- Increased spontaneous breathing trials to twice daily
By December 31, 2012 the hospital ICU aimed to decrease their Hospital Standardized Mortality Ratio – Texas (HSMR-TX) for patients on ventilators to a ratio of less than one (1) per quarter. This was done through an effort to decrease ventilator days of non-chronic ventilator dependent patients to less than 2.5 days per patient per week by:
- Daily multidisciplinary goal directed rounds
- Spontaneous Breathing Trails (SBT) twice daily
- Initiate early progressive mobility protocol
- Revising the Ventilator Checklist to include above goals and monitor use.
CAM= Confusion Assessment Method
Ventilator days (time on ventilator) averages below goal of 2.5 days per week.
Hospital Standardized Mortality Ratio (HSMR) remains under goal and under hospital system benchmark.
Began using mobility protocol and practices for all ICU patients, not just those on the ventilator.
Several aspects of this project have become part of the health care system ventilator order sets.
Texas Hospital Association (THA) Annual Meeting in Austin, TX, Feb 2013: Project was chosen as one of top three for the Innovations Award. Presentation made for Innovations session.
Received call and shared project with hospital in San Antonio.
Poster presented at Texas Association for Healthcare Quality (TAHQ) Austin, October, 2012. Received 1st place in poster judging and many positive comments.
Multiple in-services for improved care of ventilator patients at local Long Term Care Facilities (LTAC).