1. Standardization of Weaning Practices for Adult Ventilator Patients Multidisciplinary Task Force Committee: Critical Care Services (Anesthesiology, Pulmonary, Trauma, Neurosurgery) Department of Respiratory Care - clinical staff and team leaders Center for Clinical Effectiveness

2. Opportunity Statement and Desired Outcome There is an opportunity to improve the outcomes of the ventilator-assisted patient. In 2001, a house- wide ventilator weaning protocol was developed and implemented by a multidisciplinary task force. Goal: 50% reduction in weaning time

3. Most Likely Causes for Current Opportunity Suboptimal communication among physician, nurse and respiratory care team members Variation in weaning practices among critical care services Need for ongoing education regarding best practices for weaning

4. Solutions Implemented Increased involvement of medical leadership in selected ICUs Education to all healthcare providers Proactive assessment and response to data at regular ICU QI meetings Consistent and ongoing communication between Nursing and Respiratory Care staff to ensure appropriate implementation of the protocol

5. Average Weaning Hours Neuro Sciences Average Weaning Hours Extubated Mechanically Ventilated Adults Patients Greater Than 2 Days CY00 Q1CY00 Q2CY00 Q3CY00 Q4CY01 Q1 CY01 Q2 CY01 Q3 CY01 Q4 CY02 Q1CY02 Q2 CY02 Q3CY02 Q4 CY03 Q1 CY03 Q2 CY03 Q3CY03 Q4 CY04 Q1 CY04 Q2 CY04 Q3 CY04 Q4CY05 Q1CY05 Q2CY05 Q3CY05 Q4 0 10 20 30 40 50 60 70 80 90 Mean = 42.3 Hours Mean = 32.6 Hours Data Description: Extubated Adult ICU Patients On a Ventilator Greater Than 2 Days Who Were Successfully Weaned. The average time it took (in hours) to successfully wean patients off of the ventilator. Source: PIMS CCE Analyst: Penny Bleffer-Riding Confidential Material for Quality Improvement Purposes

6. Weaning Mode Usage NeuroSciences Weaning Mode Protocol Usage Extubated Mechanically Ventilated Adult Patients Greater Than 2 Days CY00 Q1 CY00 Q2CY00 Q3 CY00 Q4 CY01 Q1 CY01 Q2 CY01 Q3 CY01 Q4CY02 Q1CY02 Q2CY02 Q3 CY02 Q4CY03 Q1CY03 Q2 CY03 Q3CY03 Q4 CY04 Q1 CY04 Q2 CY04 Q3CY04 Q4 CY05 Q1 CY05 Q2CY05 Q3 CY05 Q4 0% 20% 40% 60% 80% 100% Mean = 39% Mean = 68% Data Description: Extubated Adult ICU Patients On a Ventilator Greater Than 2 Days Who Were Successfully Weaned. The percent of successfully weaned extubated adult population using the protocol for discontinuation of mechanical ventilation. Source: PIMS CCE Analyst: Penny Bleffer-Riding Confidential Material for Quality Improvement Purposes

7. 4ICU Average Weaning Hours Average Weaning Hours Surgical ICU Average Weaning Hours Extubated Mechanically Ventilated Adult Patients Greater Than 2 Days CY00-Q1CY00-Q2 CY00-Q3CY00-Q4CY01-Q1 CY01-Q2 CY01-Q3 CY01-Q4CY02-Q1CY02-Q2CY02-Q3CY02-Q4 CY03-Q1 CY03-Q2CY03-Q3CY03-Q4 CY04-Q1 CY04-Q2 CY04-Q3CY04-Q4CY05-Q1CY05-Q2CY05-Q3CY05-Q4 0 20 40 60 80 100 120 Mean = 54.5 Hours Mean = 47.3 Hours Data Description: Extubated Adult ICU Patients On a Ventilator Greater Than 2 Days Who Were Successfully Weaned. The average time it took (in hours) to successfully wean patients off of the ventilator.. Source: PIMS CCE Analyst: Penny Bleffer-Riding Confidential Material for Quality Improvement Purposes

8. Weaning Mode Usage Surgical ICU Weaning Mode Protocol Usage Extubated Mechanically Ventilated Adult Patients Greater Than 2 Days CY00-Q1 CY00-Q2 CY00-Q3CY00-Q4CY01-Q1CY01-Q2 CY01-Q3CY01-Q4 CY02-Q1CY02-Q2CY02-Q3 CY02-Q4 CY03-Q1CY03-Q2CY03-Q3CY03-Q4CY04-Q1 CY04-Q2CY04-Q3 CY04-Q4 CY05-Q1 CY05-Q2 CY05-Q3CY05-Q4 0% 20% 40% 60% 80% 100% Mean = 58% Mean = 64% Data Description: Extubated Adult ICU Patients On a Ventilator Greater Than 2 Days Who Were Successfully Weaned. The percent of successfully weaned extubated adult population using the protocol for discontinuation of mechanical ventilation. Source: PIMS CCE Analyst: Penny Bleffer-Riding Confidential Material for Quality Improvement Purposes

9. Average Weaning Hours 2ICU Average Weaning Hours Extubated Mechanically Ventilated Adult Patients Greater Than 2 Days CY00 Q1 CY00 Q2CY00 Q3 CY00 Q4 CY01 Q1 CY01 Q2 CY01 Q3 CY01 Q4CY02 Q1CY02 Q2CY02 Q3 CY02 Q4CY03 Q1CY03 Q2 CY03 Q3CY03 Q4 CY04 Q1 CY04 Q2 CY04 Q3CY04 Q4 CY05 Q1 CY05 Q2CY05 Q3 CY05 Q4 0 10 20 30 40 50 60 70 80 90 Mean = 42.2 Hours Data Description: Extubated Adult ICU Patients On a Ventilator Greater Than 2 Days Who Were Successfully Weaned. The average time it took (in hours) to successfully wean patients off of the ventilator.. Source: PIMS CCE Analyst: Penny Bleffer-Riding Confidential Material for Quality Improvement Purposes

10. Weaning Mode Usage 2ICU Weaning Mode Protocol Usage Extubated Mechanically Ventilated Adult Patients Greater Than 2 Days CY00 Q1 CY00 Q2 CY00 Q3CY00 Q4CY01 Q1CY01 Q2CY01 Q3 CY01 Q4 CY02 Q1CY02 Q2 CY02 Q3CY02 Q4 CY03 Q1 CY03 Q2 CY03 Q3CY03 Q4CY04 Q1CY04 Q2 CY04 Q3 CY04 Q4 CY05 Q1 CY05 Q2 CY05 Q3CY05 Q4 0% 20% 40% 60% 80% 100% Mean = 37% Data Description: Extubated Adult ICU Patients On a Ventilator Greater Than 2 Days Who Were Successfully Weaned. The percent of Successfully weaned extubated adult population using the protocol for discontinuation of mechanical ventilation. Source: PIMS CCE Analyst: Penny Bleffer-Riding Confidential Material for Quality Improvement Purposes

11. Conclusions and Next Steps Utilization of the protocol has increased dramatically in the Neurosciences and Surgical Intensive Units. Weaning time has decreased by more than 50% in those units consistently using the protocol. Usage of the protocol in selected areas is inconsistent. Leadership and communication issues remain opportunities for improvement.