1135

Abstract

Introduction: The purpose of this study was to evaluate the use of a daily awakening and spontaneous breathing trial (DA-SBT) protocol and to identify opportunities to improve use. Hypothesis: It was hypothesized that a survey of ICU team members would reveal areas for DA-SBT protocol improvement relating to communication and documentation. Methods: This study assessed use of a DA-SBT protocol in two medical intensive care units and surveyed nurses, respiratory therapists, and prescribers about how closely the protocol was followed and how the ICU team communicated about sedation and analgesia. Survey responses were compared between respondents using the Wilcoxon rank sum test. The following were retrospectively collected: demographic and clinical data, sedative and analgesic use, percentage of time patients spent at their goal levels of pain and sedation, and duration of mechanical ventilation, ICU stay, and hospitalization. Rates of self-extubation were compared to the three years preceding protocol implementation. Results: Data were gathered on 87 eligible subjects hospitalized over 7 months. The mean age was 65, 49.4% were male, and the mean acute physiology score and chronic health evaluation II score was 20. Subjects spent 54.3% of the time at their goal sedation level and 38.4% of the time below their goal level of consciousness. The mean duration of ventilation was 162.4 hours, mean ICU stay was 9.6 days, and mean hospital stay was 15.7 days. The rates of self-extubation and re-intubation were unchanged versus the previous three years. The survey response rate was 43% (70 of 163). Opportunities for improving use of the protocol related to agreement in pain and sedation scoring and communicating patient status and sedation plans between team members. Comparison of responses from nurses and respiratory therapists versus providers revealed significantly different perceptions of the clarity of sedation plans and consistency in pain and sedation scoring, with providers feeling that plans were communicated more clearly and pain and sedation scoring was more consistent. Conclusions: Use of a DA-SBT protocol may be improved with better multidisciplinary communication and greater consistency in scoring pain and sedation.