Date Available

4-25-2024

Year of Publication

2024

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Candice Falls

Clinical Mentor

Dr. Jill Clemmons

Committee Member

Dr. Sheila Melander

Abstract

Background: The trauma intensive care unit (ICU) at University of Kentucky (UK) Healthcare uses a ventilator separation protocol which provides specific guidelines on the successful weaning of patients from mechanical ventilation. However, many of the nurses are not aware of this protocol as formal education is not included in their orientation or training. This lack of knowledge can lead to risks such as increased patient morbidity, mortality, ICU length of stay, and healthcare-related costs. Research shows that using structured mechanical ventilator weaning tools in the ICU can shorten the duration of mechanical ventilation, which in turn, lowers these associated risks.

Purpose: The purpose of this DNP project was to improve the knowledge, confidence, utilization, and competency among trauma ICU nurses at UK Healthcare by examining the impact of an educational intervention concerning the benefits of using the UK Ventilator Separation Protocol and utilization of an in-room laminated assessment tool to increase use of the UK Ventilator Separation Protocol in order to improve patient outcomes such as decreasing mechanical ventilator days and ICU length of stays.

Methods: This was a single-center, multimodal project designed to examine the impact of an educational intervention using a pre- and post-survey and an in-room assessment tool, as well as fifteen patient chart audits as measurement to determine 1) if there was an improvement in baseline knowledge and confidence regarding use of the UK Ventilator Separation Protocol among the trauma ICU nurses, 2) how often did the trauma ICU nurses adhere to using the UK Ventilator Separation Protocol, and 3) if there was improvement in patient mechanical ventilator days and ICU length of stays. Descriptive statistics like means, standard deviations, medians, and interquartile ranges were used to compare nursing knowledge and confidence. Demographic variables such as age, gender, body mass index (BMI), ethnicity, tobacco use, and comorbidities including chronic obstructive pulmonary disease (COPD), hypertension (HTN), hyperlipidemia (HLD), type 2 diabetes mellitus (T2DM), and heart failure with reduced ejection fraction (HFrEF) were used to compare mechanical ventilator days and ICU length of stays. Two-sample t-tests, chi-square tests, and Mann-Whitney U tests via SPSS software were used to analyze the data and interpret significance to clinical practice.

Results: A total of 21 trauma ICU nurses completed the pre-survey and 17 trauma ICU nurses completed the post-survey after an educational intervention and in-room assessment tool were implemented. There were no statistically significant differences seen in the demographic variables and prevalence of specific comorbidities. Most of the pre-intervention patients were over 65 years of age and most of the post-intervention patients were under 65 years of age. The post-intervention patients were nearly all male (93%), while over one-quarter of the pre-intervention patients were female (27%). Nearly half of the pre-intervention patients had a BMI >30 and were considered obese or morbidly obese (47%), while only 20% of the post-intervention patients had a BMI >30. Ethnicity was similar for the pre- and post-intervention patients with white being the most prevalent (86%), followed by black and Hispanic. Tobacco use was slightly higher in the pre-intervention patients (67%) compared to the post-intervention patients (60%). COPD was most prevalent in the pre-intervention patients (80%) compared to 47% of the post-intervention patients. The incidence of HTN was higher among the post-intervention patients (67%) compared to 60% of the pre-intervention patients. The prevalence of HLD was equal among both patient groups. The incidence of T2DM was higher in the pre-intervention patients (47%) compared to 27% in the post-intervention patients. HFrEF was more prevalent in the pre-intervention patients (27%) compared to only 7% in the post-intervention patients. Statistically significant increases were observed in I have heard of the protocol (p = .008), I feel comfortable using the protocol (p = .003), I feel confident speaking to the provider about the protocol (p = .006), and I know where to find information about the protocol (p = .012). A statistically significant increase in protocol adherence was observed when comparing fifteen post-intervention chart audits to post-assessment tool chart audits (p = .010). Additionally, statistically significant decreases were observed in both mechanical ventilator days (p = .001) and ICU length of stays (p =

Conclusion: Results from this study suggest that web-based educational interventions and in-room assessment tools can be effective in improving the confidence, utilization, and competency among ICU nurses caring for mechanically ventilated patients, along with improving patient outcomes such as decreased mechanical ventilator days and ICU length of stays. The pre-intervention patients had demographic variables and comorbidities that made them more susceptible to requiring increased mechanical ventilator days and, therefore, increased ICU length of stays such as they were older, had higher BMIs, more tobacco use, and higher incidence of COPD, T2DM, and HFrEF compared to the post-intervention patients. Future research should focus on continued staff education, exploring unit-specific barriers to protocol use perceived by ICU nurses, utilization of eICU physicians for extubation support, and exploring patient variables and contributing factors that could have led to increased mechanical ventilator days and ICU length of stays.

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