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How to achieve adherence to a ventilation algorithm for critically ill children?
Anita Duyndam1, Robert Jan Houmes1, Monique van Dijk1
1Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
Insights
A new ventilation algorithm improved physician adherence in a pediatric intensive care unit (PICU). This adherence was sustained over time, demonstrating the algorithm's effectiveness in clinical practice.
Area of Science:
- Pediatric Intensive Care
- Mechanical Ventilation
- Clinical Protocol Implementation
Background:
- Paediatric intensive care units (PICUs) utilize diverse ventilators and ventilation modes.
- A novel algorithm was developed to standardize ventilation mode selection upon patient admission.
- This algorithm was integrated into a broader clinical protocol.
Purpose of the Study:
- To assess physician adherence to a newly implemented invasive mechanical ventilation algorithm.
- To evaluate adherence rates before and after algorithm implementation in a PICU setting.
Main Methods:
- An uncontrolled, pre-post test design study was conducted in a level III PICU.
- The study included 507 pediatric patients on conventional invasive mechanical ventilation across three time periods.
- Physician and nurse education on the algorithm preceded its implementation.
Main Results:
- In patients with lung disease, adherence rates were 79% (pre-implementation), 71% (post-implementation T1), and 84% (post-implementation T2).
- In patients without lung disease, adherence significantly increased from 66% (pre-implementation) to 78% (T1) and 84% (T2) (p=0.015).
- Adherence rates demonstrated a statistically significant improvement and were sustained over time.
Conclusions:
- The implementation of the ventilation algorithm successfully enhanced physician adherence.
- Sustained adherence was attributed to education, reminders, and organizational changes.
- Interdisciplinary collaboration and leadership support are key to protocol adherence.
Aims And Objectives:
To evaluate to what extent physicians on a paediatric intensive care unit (PICU) adhered to a newly implemented ventilation algorithm.
Background:
PICUs worldwide use different ventilators with a wide variety of ventilation modes. We developed an algorithm, as part of a larger protocol, for choice of ventilation mode at time of admission.
Design:
This study was performed in a level III PICU of a university children's hospital and had an uncontrolled, pre-post test design with a period before implementation (T0) and two periods after implementation (T1 and T2).
Methods:
An invasive ventilation algorithm targeted at two patient groups was implemented in October 2008. The algorithm distinguished between lung disease, in which pressure control was considered as the preferred mode, and no lung disease, in which pressure-regulated volume control was preferred. Nurses and physicians were instructed in the use of the algorithm before implementation.
Results:
During three test periods, a total of 507 children with a median age of 5 months [interquartile range (IQR) 0-50] on conventional invasive mechanical ventilation were included. In patients with lung disease, pre-implementation adherence rate was 79% (67/85). At T1 it was 71% (51/72); at T2 84% (46/55). The slight improvement from T1 to T2 was statistically not significant (p = 0·092). In patients with no lung disease, the adherence rate rose statistically significantly from 66% at T0 (62/93) to 78% (79/101) at T1, and 84% at T2 (85/101) (p = 0·015).
Conclusion:
Implementation of a new ventilation algorithm increased physicians' adherence to this ventilation algorithm and the effect was sustained over time. This was achieved by education, reminders and organizational changes such as admission of postcardiac surgery patients with protocolized nursing care including preset ventilator settings.
Relevance To Clinical Practice:
Interdisciplinary collaboration, effective communication, leadership support and organizational aspects may be effective strategies to improve adherence to protocols.
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