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Dissertation
Implementation and Evaluation of a Modified Wake-up and Breathe Protocol in a Medical Intensive Care Unit
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2024
Abstract
Background: 20 million people worldwide receive invasive mechanical ventilation (Perkins et al., 2019). MV can lead to longer stays in the ICU and if not used correctly, death (AHRQ, 2017). The ABCDEF bundle (Marra et al., 2017) is an evidence-based guideline that reduces delirium and assesses patient readiness for extubation. Per the guideline, SAT and SBT are directly associated with reductions in ICU mortality (Stollings et al., 2019). Purpose: The purpose of this project is to implement an evidence-based SAT/SBT protocol via a modified version of the Wake-up and breathe protocol in the medical intensive care unit (MICU) at a large academic hospital to improve outcomes for patients receiving mechanical ventilation. Methods: This project was done at a large academic hospital MICU. Vanderbilt’s Wake-up and Breathe Guidelines and the policies at the large academic hospital were combined to make a unit-specific SAT/SBT protocol. A laminated version was taped to the outside of patient doors and in common spaces. Investigator-designed pre and post-knowledge surveys were distributed via Qualtrics to all RNs and RTs. Data was obtained via direct observation and interaction with RNs and RTs onto a paper/pencil data collection tool. Findings: 74 patients were extubated during the project. 248 patients were surveyed, and of those, 74% passed their SAT screen, compared to the pre-project 68%. 79% passed their SBT screen compared to 80% pre-project. The median ICU LOS in the pre-intervention group was 2.84 compared to the post-intervention group at 3.08. Wilcoxon testing p-value 0.143. The median ventilator duration days in the pre-intervention group was 1.63, compared to the post-intervention group at 1.86. Wilcoxon testing p-value 0.235. In the initial survey, 61% got the survey quiz question correct compared to the post of 64%. Discussion: The protocol was effective at helping nurses restart sedation more appropriately, improve knowledge of SATs, and remain consistent with ICU LOS, and days on MV (not statistically significant).
Details
- Title: Subtitle
- Implementation and Evaluation of a Modified Wake-up and Breathe Protocol in a Medical Intensive Care Unit
- Creators
- Michaela Christine Kennedy - University of Iowa
- Contributors
- Julie Stanik-Hutt (Chair) - University of Iowa
- Resource Type
- Dissertation
- Project Type
- Poster
- Degree Awarded
- Doctor of Nursing Practice (DNP), University of Iowa
- Degree in
- Adult/Gerontology Nurse Practitioner (Acute Care)
- Date degree season
- Spring 2024
- Publisher
- University of Iowa
- Number of pages
- 1 page
- Copyright
- Copyright © 2024 Michaela Christine Kennedy
- Language
- English
- Academic Unit
- College of Nursing; Doctor of Nursing Practice Projects
- Record Identifier
- 9984627257202771
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