Introduction: A protocol for management of sedation and pain for mechanically ventilated patients at Flagstaff Medical Center (FMC) was implemented in August 2013. It was unknown whether the protocol is being adhered to or whether it has had an impact on patient outcomes. Objectives: To develop an audit and feedback mechanism to monitor adherence to sedation protocol at FMC and determine whether the protocol has impacted patient outcomes. Methods: A retrospective manual chart review was conducted including all mechanically ventilated adult patients for four, one-month periods: 1) pre-protocol; and 2) one month, 3) six months, and 4) 12 months post-protocol implementation. Results: 132 total patients were included (32 pre; 100 post-protocol). Mean weighted adherence score for post-protocol study groups were 5.0±0.6, 5.0±0.7, and 5.2±0.7 (p=0.926) out of ten. Time of mechanical ventilation (p=0.003) and hospital length of stay (LOS) (p=0.023) were reduced post (56±58h; 9.8±7.9days) vs. pre-protocol (90±67h; 13±7days). The adherence score was weakly correlated with hospital LOS but not time of mechanical ventilation. Conclusion: This project demonstrates improvements in patient outcomes from utilization of a sedation protocol. However, this project also highlights several challenges associated with the monitoring of protocol adherence. A lack of audit and feedback may be a factor in the observed unchanged adherence over time. Both research and monitoring activities are impaired by EHR systems that do not allow for the easy extraction of data. Ensuring that adequate audit and feedback strategies are designed and available prior to implementation of new protocols is an essential step in planning the implementation of a new protocol.
| Identifer | oai:union.ndltd.org:arizona.edu/oai:arizona.openrepository.com:10150/556004 |
| Date | January 2015 |
| Creators | Kent, Keith Wesley |
| Contributors | Gephart, Sheila M., Gephart, Sheila M., Gephart, Sheila M., Buchner, Brian R., Piotrowski, Kathleen |
| Publisher | The University of Arizona. |
| Source Sets | University of Arizona |
| Language | en_US |
| Detected Language | English |
| Type | text, Electronic Dissertation |
| Rights | Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author. |
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