Protocol-Driven Weaning from Mechanical Ventilation: Improving Utilization by the ICU Team

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Captone Advisor: James F. Pelegano, MD, MS, Thomas Jefferson University


We conducted a quality improvement project to increase the utilization of the ventilator weaning protocol in a large tertiary public hospital. The project was launched in response to an observed increase in the risk-adjusted length of mechanical ventilation for patients in respiratory failure. A multidisciplinary team collected baseline data on the current ventilator weaning process, identified barriers to its use, then tested and implemented improvement strategies following a Define, Measure, Analyze, Improve, and Control framework. A current process diagram was constructed based on surveys distributed to ICU nurses and respiratory therapists; Gemba walks that focused on observing the initiation of weaning in the ICU; and feedback from nurses and respiratory therapists obtained at their departmental meetings. The main barriers in the current process were identified and tackled by three consecutive PDSA cycles that introduced a trigger for ventilator weaning initiation, promoted communication between the ICU nurses and respiratory therapists, and added a mandatory early sedation decrease. Additional improvements included a check box in the dayshift to nightshift charge nurse handout for weaning candidacy, and an enhanced education effort on the benefits of protocol guided weaning. In the implementation phase, the rate of the new ventilator weaning protocol utilization rose to 80% compared to a baseline of 12%. The sustainment phase is ongoing with a protocol guided weaning rate target of > 60%. The improvement project resulted in an actual/expected days on the ventilator of 1.05, compared to 1.20 at baseline, a considerable clinical benefit with minimal cost that mostly related to an increase in staff time dedication to ventilator weaning assessment and initiation. By following a DMAIC improvement framework and through a series of PDSA cycles, the rate of ventilator weaning protocol utilization rose significantly with a resultant decrease in respiratory failure related patients’ morbidity.

Presentation: 38 minutes