How One Facility’s Ventilator Wean Rate Went From 45% to 70%
Fri May 20 08:19:00 CDT 2016
DiAnn Larson, RRT, RCP
DeKalb Medical LTAC
Several years ago our team was asked to establish a protocol for prolonged mechanical ventilation. Our unit at DeKalb Medical in Georgia specializes in mechanical ventilation. Patients receive physical, occupational, speech and nutritional therapies as well as pain management and help with anxiety. A weaning protocol was developed and approved by our medical staff.
The goal was to wean appropriate patients from the ventilator in 15 days. When we started the protocol, we had a wean rate of 45% — 5% below the national average. Today, after more than a decade with the protocol in place, our wean rate is about 70%. How did we do this?
First, we educated ourselves on how best to work with these patients. We learned about the important components that need to come together — both from a clinical standpoint and a human caring view — to best wean these patients. We also applied for a disease-specific Respiratory Failure On a Ventilator for Weaning certification. We have held this certification since 2006.
We work with patients who have undergone a severe trauma, so patients come to our unit sedated, malnourished, and unconscious. Long Term Acute Care (LTAC) units need to meet certain criteria, but our protocol sought to address issues beyond that like feeding and progressive mobility — things to make the patient’s success most likely.
Key to our success was determining when patients reach their highest level of function. We give them a couple days to rest after reaching our unit. But we make it a point to help patients wean from the ventilator every day. Treating their pain and anxiety is also crucial, but we want patients alert and able to participate in their own care as best as they can. Involving family in care has improved success, too. It really takes a village to wean patients from prolonged mechanical ventilation.
Under our protocol, we carefully track patient success. We meet daily on the status of the patients in our 44-bed unit, and physicians join us weekly for multidisciplinary case reviews. The doctors often tell us they are amazed by patients’ progress in the unit, and that they never expected some of them to wean — especially in just 15 days.
Our team of 24 employees is passionate and dedicated. The respiratory therapists in the unit are happy with their jobs — and they stay with us for a long time. High employee satisfaction helps us maintain high standards of quality and clinical efficiency.
DiAnn Larson, RRT, is the Respiratory Manager in the Respiratory Care Services group of DeKalb Medical, Long Term Acute Care at Downtown Decatur, Georgia.