Implementation of a Weaning Protocol Shortens the Duration of Patients Requiring Mechanical Ventilation Support

By NG Kit Yee, RN, BSN, MsSoSc, MsMg (Health Service), FHKAN (Critical Care)

Purpose

The aim of this rapid-cycle small test of change project was to develop and implement a standard weaning protocol for Intensive Care Unit (ICU) medical cases requiring mechanical ventilation support for more than 48 hours. The impact of this protocol implementation was assessed by evaluating the duration of medical cases requiring mechanical ventilation support
and length of stay in the ICU.

Background

In the ICU, weaning from respiratory support is often conducted in an empirical manner, especially in medical cases. Yet, a standard weaning approach has not been developed in the ICU for patients who require mechanical ventilation. Therefore, this project focused on medical cases that required mechanical ventilation support for more than 48 hours.

Methods

This project was conducted from January through June 2016, implementing a standard weaning protocol for medical cases that needed mechanical ventilation support for more than 48 hours. This was compared to retrospective cases from January through June 2015. A total of 55 patients who received mechanical ventilation more than 48 hour were examined. ICU colleagues operated the ventilator setting according to a predesigned weaning protocol for the target group (n=28) and compared to the retrospective cases (n=27).

Results

Demographic characteristics were similar in both groups for age, sex, and diagnosis. After implementation of the standardized weaning protocol, duration of mechanical ventilation time decreased by approximately 1.87 days, ICU length of stay decreased by approximately 1.14 days, and use of sedation and analgesics during mechanical ventilation support period decreased

Discussion

As the ventilation time and ICU length of stay shortened after implementation of the standard weaning protocol, patient and family satisfaction improved regarding nursing care management
and patient’s level of comfort. In addition, ICU colleagues increased their confidence during
weaning process when they utilized the standardized weaning protocol as a guide.

Implications/Conclusion

Although this project sample size was small, results were encouraging. Further evidence-based projects may include a sedation and analgesic protocol in medical ventilation cases or
exploration of nurse’s perceptions and confidence in using protocol in weaning medical patient
with mechanical ventilation.