Implementing Sedation Vacation, Spontaneous Breathing Trial, and Confusion Assessment Method in a Medical Intensive Care Unit

Background: According to the Society of Critical Care Medicine, more than 5 million Americans are admitted to intensive care units (ICUs) annually. Of these admissions, 20%-40% require mechanical ventilation. Patients on mechanical ventilation usually receive continuous sedation medication. Such sedation without breaks can lead to an increase in mechanical ventilation days, which puts patients at increased risk of delirium. The purpose of this quality improvement project aimed to educate and implement interventions that included pairing sedation vacations with spontaneous breathing trials, stopping or restarting the continuous sedation medications by half the original dose on mechanically ventilated patients, and documenting the confusion assessment method in the intensive care unit (CAM-ICU) in an attempt to decrease ventilator days.Methods: The quality improvement project was performed in a medical ICU, level-one-trauma teaching hospital.Quantitative data were collected using reports from the electronic medical record (EMR) along with daily report sheets filled out by nursing staff to establish a baseline for retrospective data (pre-education). The nurses received a pre-education survey to assess their knowledge of medical ICU sedation and CAM-ICU education policies and standards. An educational PowerPoint was developed and presented using retrospective data and current policies and standards. After the presentation the nursing staff received a post-education survey. A paired t-test was utilized for the pre/post-education surveys to evaluate improvement of the nurse's knowledge on the education. The educational interventions were then implemented. Prospective (post-education) data were then collected and compared to retrospective data utilizing chi-square test.Results: This study identified 107 patients mechanically ventilated in the medical intensive care unit: 72 patients retrospective and 35 patients prospective. Number of patients excluded: 31 retrospective and 24 prospective. A paired t-test for pre/post-education indicated the nurses demonstrated an increased knowledge of educational interventions as evidenced by a pvalue <.05.The chi-square test was utilized to compare the retrospective and prospective nursing interventions that were documented for pairing the spontaneous breathing trial (SBT) with a sedation vacation identified a pvalue > .05. Sedation vacation documentation from the alaris pump for day shift identified a pvalue > .05 and night shift with a pvalue > .05. Nursing documentation per EMR, a sedation vacation was charted: day shift with apvalue > .05 and night shift with a pvalue > .05. The CAM-ICU documentation on day shift identified a pvalue of < .05, and night shift a pvalue of < .05. The ages of the patients included in this study ranged from 22 years old to 81 years old; with 27 males and 25 females. The ICU experience of the 22 nurses who participated in the survey ranged from 0 years to greater than 6 years. Conclusion: The quality improvement project identified statistical significance in nursing knowledge of policies and standards and CAM-ICU. There were fewer patients in the prospective data due to paralytics for COVID-19 patients. The educational PowerPoint should be implemented in the nurse's orientation and to all nursing staff in the medical intensive care unit.