875

Abstract

Introduction: A rounds-based pharmacist-driven interdisciplinary quality improvement (QI) program conducted between March and July of 2012 resulted in earlier steps taken towards liberation from sedation and mechanical ventilation as measured by fewer continuous drug infusions and improved compliance and coordination of the SAT/SBT protocol. Methods: Following the above-described QI program, we tested a post-QI (PQI) program that included pharmacist-driven education on performance and coordination of SATs and SBTs; daily discussion of the SAT/SBT on interdisciplinary rounds, oversight of performance, documentation, and coordination of the SAT/SBT; and weekly performance reports to staff. The pharmacist (JLS) collected details regarding analgesia and sedation, compliance and coordination of SAT/SBT between January and August 2013 to assess sustainability of the previously successful QI program. Data are reported as proportions. Results: SAT safety screens were performed on 563/580 (97%) QI patient days and 216/216 (100%) of PQI patient days (p=0.25). On days assessed, 444 (79%) and 175 (81%) passed the SAT screen during QI and PQI periods (p=0.86). There was no difference in how often the SAT was conducted in the QI and PQI periods [157 (35%) vs. 58 (33%), p=0.88]. The proportion of patients receiving continuous sedative or analgesia infusions in the QI and PQI periods [269 (46%) vs. 103 (48%, p=0.75] was similar. Additionally, on 172 (30%) days in the QI group and 81 (37%) in PQI group, patients were not receiving any form of analgesia or sedation (p=0.37). An SBT was done in 342 (99%) QI group and 106 (100%) PQI group days with a passed SBT safety screen. Coordination of the SAT/SBT occurred in 65 of 70 (92%) days where patients received continuous analgesia or sedation during the QI period as compared to 103 (100%) in the PQI period. Conclusions: This post-QI program yielded sustainable results for the first year in terms of success with compliance in the daily interruption of sedation and mechanical ventilation to assess readiness for liberation. Further work in non-academic hospital settings should explore the utility of pharmacist-driven quality improvement efforts.