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How to achieve adherence to a ventilation algorithm for critically ill children?
Author(s) -
Duyndam Anita,
Houmes Robert Jan,
van Dijk Monique,
Tibboel Dick,
Ista Erwin
Publication year - 2015
Publication title -
nursing in critical care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.689
H-Index - 43
eISSN - 1478-5153
pISSN - 1362-1017
DOI - 10.1111/nicc.12104
Subject(s) - critically ill , medicine , intensive care medicine , mechanical ventilation , ventilation (architecture) , computer science , algorithm , anesthesia , engineering , mechanical engineering
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.