Improving care for the ventilated patient.

CONTEXT Despite evidence that the use of specific interventions can decrease morbidity and mortality for patients receiving mechanical ventilation, a gap exists between best evidence and practice. A prospective cohort study was conducted in a surgical intensive care unit (ICU) that included all patients who were mechanically ventilated. The study was designed to ensure that for 90% of ventilator days, patients receive processes associated with improved outcomes, including semirecumbent positioning, daily interruption of sedative-drug infusions, peptic ulcer disease prophylaxis, and deep venous thrombosis prophylaxis. INTERVENTION The improvement model included three interventions: (1) administering a questionnaire to identify barriers to compliance with the four care processes, (2) implementing an educational intervention, and (3) implementing a checklist to be completed daily during ICU rounds to ask providers whether patients were receiving these therapies. RESULTS Overall, 80% of nurses did not know there was evidence to support at least one of the four therapies. During the study period (March 4-April 29, 2002), the percentage of ventilator days on which patients received all four care processes increased from 30% to 96% (p < .001). DISCUSSION Evidence-based therapies for mechanically ventilated patients can reduce morbidity, mortality, and costs of care.

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