Implementation of a Goal-Directed Mechanical Ventilation Order Set Driven by Respiratory Therapists Improves Compliance With Best Practices for Mechanical Ventilation

Misty A. Radosevich, Brendan T. Wanta, Todd J. Meyer, Verlin W. Weber, Daniel R. Brown, Nathan Smischney, Daniel A. Diedrich

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

Purpose: Data regarding best practices for ventilator management strategies that improve outcomes in acute respiratory distress syndrome (ARDS) are readily available. However, little is known regarding processes to ensure compliance with these strategies. We developed a goal-directed mechanical ventilation order set that included physician-specified lung-protective ventilation and oxygenation goals to be implemented by respiratory therapists (RTs). We sought as a primary outcome to determine whether an RT-driven order set with predefined oxygenation and ventilation goals could be implemented and associated with improved adherence with best practice. Methods: We evaluated 1302 patients undergoing invasive mechanical ventilation (1693 separate episodes of invasive mechanical ventilation) prior to and after institution of a standardized, goal-directed mechanical ventilation order set using a controlled before-and-after study design. Patient-specific goals for oxygenation partial pressure of oxygen in arterial blood (Pao2), ARDS Network [Net] positive end-expiratory pressure [PEEP]/fraction of inspired oxygen [Fio2] table use) and ventilation (pH, partial pressure of carbon dioxide) were selected by prescribers and implemented by RTs. Results: Compliance with the new mechanical ventilation order set was high: 88.2% compliance versus 3.8% before implementation of the order set (P <.001). Adherence to the PEEP/Fio2 table after implementation of the order set was significantly greater (86.0% after vs 82.9% before, P =.02). There was no difference in duration of mechanical ventilation, intensive care unit (ICU) length of stay, and in-hospital or ICU mortality. Conclusions: A standardized best practice mechanical ventilation order set can be implemented by a multidisciplinary team and is associated with improved compliance to written orders and adherence to the ARDSNet PEEP/Fio2 table.

Original languageEnglish (US)
Pages (from-to)550-556
Number of pages7
JournalJournal of Intensive Care Medicine
Volume34
Issue number7
DOIs
StatePublished - Jul 1 2019

Fingerprint

Practice Guidelines
Artificial Respiration
Compliance
Positive-Pressure Respiration
Ventilation
Partial Pressure
Adult Respiratory Distress Syndrome
Intensive Care Units
Oxygen
Practice Management
Mechanical Ventilators
Carbon Dioxide
Length of Stay
Physicians
Lung
Mortality

Keywords

  • computerized physician order entry
  • protocols
  • quality improvement
  • respiratory therapist-driven protocols
  • ventilator management

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Implementation of a Goal-Directed Mechanical Ventilation Order Set Driven by Respiratory Therapists Improves Compliance With Best Practices for Mechanical Ventilation. / Radosevich, Misty A.; Wanta, Brendan T.; Meyer, Todd J.; Weber, Verlin W.; Brown, Daniel R.; Smischney, Nathan; Diedrich, Daniel A.

In: Journal of Intensive Care Medicine, Vol. 34, No. 7, 01.07.2019, p. 550-556.

Research output: Contribution to journalReview article

Radosevich, Misty A. ; Wanta, Brendan T. ; Meyer, Todd J. ; Weber, Verlin W. ; Brown, Daniel R. ; Smischney, Nathan ; Diedrich, Daniel A. / Implementation of a Goal-Directed Mechanical Ventilation Order Set Driven by Respiratory Therapists Improves Compliance With Best Practices for Mechanical Ventilation. In: Journal of Intensive Care Medicine. 2019 ; Vol. 34, No. 7. pp. 550-556.
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abstract = "Purpose: Data regarding best practices for ventilator management strategies that improve outcomes in acute respiratory distress syndrome (ARDS) are readily available. However, little is known regarding processes to ensure compliance with these strategies. We developed a goal-directed mechanical ventilation order set that included physician-specified lung-protective ventilation and oxygenation goals to be implemented by respiratory therapists (RTs). We sought as a primary outcome to determine whether an RT-driven order set with predefined oxygenation and ventilation goals could be implemented and associated with improved adherence with best practice. Methods: We evaluated 1302 patients undergoing invasive mechanical ventilation (1693 separate episodes of invasive mechanical ventilation) prior to and after institution of a standardized, goal-directed mechanical ventilation order set using a controlled before-and-after study design. Patient-specific goals for oxygenation partial pressure of oxygen in arterial blood (Pao2), ARDS Network [Net] positive end-expiratory pressure [PEEP]/fraction of inspired oxygen [Fio2] table use) and ventilation (pH, partial pressure of carbon dioxide) were selected by prescribers and implemented by RTs. Results: Compliance with the new mechanical ventilation order set was high: 88.2{\%} compliance versus 3.8{\%} before implementation of the order set (P <.001). Adherence to the PEEP/Fio2 table after implementation of the order set was significantly greater (86.0{\%} after vs 82.9{\%} before, P =.02). There was no difference in duration of mechanical ventilation, intensive care unit (ICU) length of stay, and in-hospital or ICU mortality. Conclusions: A standardized best practice mechanical ventilation order set can be implemented by a multidisciplinary team and is associated with improved compliance to written orders and adherence to the ARDSNet PEEP/Fio2 table.",
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T1 - Implementation of a Goal-Directed Mechanical Ventilation Order Set Driven by Respiratory Therapists Improves Compliance With Best Practices for Mechanical Ventilation

AU - Radosevich, Misty A.

AU - Wanta, Brendan T.

AU - Meyer, Todd J.

AU - Weber, Verlin W.

AU - Brown, Daniel R.

AU - Smischney, Nathan

AU - Diedrich, Daniel A.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Purpose: Data regarding best practices for ventilator management strategies that improve outcomes in acute respiratory distress syndrome (ARDS) are readily available. However, little is known regarding processes to ensure compliance with these strategies. We developed a goal-directed mechanical ventilation order set that included physician-specified lung-protective ventilation and oxygenation goals to be implemented by respiratory therapists (RTs). We sought as a primary outcome to determine whether an RT-driven order set with predefined oxygenation and ventilation goals could be implemented and associated with improved adherence with best practice. Methods: We evaluated 1302 patients undergoing invasive mechanical ventilation (1693 separate episodes of invasive mechanical ventilation) prior to and after institution of a standardized, goal-directed mechanical ventilation order set using a controlled before-and-after study design. Patient-specific goals for oxygenation partial pressure of oxygen in arterial blood (Pao2), ARDS Network [Net] positive end-expiratory pressure [PEEP]/fraction of inspired oxygen [Fio2] table use) and ventilation (pH, partial pressure of carbon dioxide) were selected by prescribers and implemented by RTs. Results: Compliance with the new mechanical ventilation order set was high: 88.2% compliance versus 3.8% before implementation of the order set (P <.001). Adherence to the PEEP/Fio2 table after implementation of the order set was significantly greater (86.0% after vs 82.9% before, P =.02). There was no difference in duration of mechanical ventilation, intensive care unit (ICU) length of stay, and in-hospital or ICU mortality. Conclusions: A standardized best practice mechanical ventilation order set can be implemented by a multidisciplinary team and is associated with improved compliance to written orders and adherence to the ARDSNet PEEP/Fio2 table.

AB - Purpose: Data regarding best practices for ventilator management strategies that improve outcomes in acute respiratory distress syndrome (ARDS) are readily available. However, little is known regarding processes to ensure compliance with these strategies. We developed a goal-directed mechanical ventilation order set that included physician-specified lung-protective ventilation and oxygenation goals to be implemented by respiratory therapists (RTs). We sought as a primary outcome to determine whether an RT-driven order set with predefined oxygenation and ventilation goals could be implemented and associated with improved adherence with best practice. Methods: We evaluated 1302 patients undergoing invasive mechanical ventilation (1693 separate episodes of invasive mechanical ventilation) prior to and after institution of a standardized, goal-directed mechanical ventilation order set using a controlled before-and-after study design. Patient-specific goals for oxygenation partial pressure of oxygen in arterial blood (Pao2), ARDS Network [Net] positive end-expiratory pressure [PEEP]/fraction of inspired oxygen [Fio2] table use) and ventilation (pH, partial pressure of carbon dioxide) were selected by prescribers and implemented by RTs. Results: Compliance with the new mechanical ventilation order set was high: 88.2% compliance versus 3.8% before implementation of the order set (P <.001). Adherence to the PEEP/Fio2 table after implementation of the order set was significantly greater (86.0% after vs 82.9% before, P =.02). There was no difference in duration of mechanical ventilation, intensive care unit (ICU) length of stay, and in-hospital or ICU mortality. Conclusions: A standardized best practice mechanical ventilation order set can be implemented by a multidisciplinary team and is associated with improved compliance to written orders and adherence to the ARDSNet PEEP/Fio2 table.

KW - computerized physician order entry

KW - protocols

KW - quality improvement

KW - respiratory therapist-driven protocols

KW - ventilator management

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