Impact of Simple New Ventilator Orderset on Measurement of Predicted Body Weight

Abstract

SESSION TITLE: Process Improvement in Obstructive Lung Disease Education, Pneumonia Readmissions and Rapid Response Systems I SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: The use of lung protective mechanical ventilation strategies using tidal volumes based on predicted body weight (PBW) has not only been shown to be protective in ARDS, but also in general critically ill population. The use of tidal volumes <=8ml/kg PBW has been shown to be protective in a wide range of critically ill/surgical patients. However, adherence to lung protective ventilation and direct measurement of patient heights remains poor. In January of 2011, we implemented a ventilator orderset aimed at increasing adherence to lung protective ventilation by promoting direct measurement of patient height and calculation of PBW by respiratory therapists. METHODS: We conducted a retrospective, chart review study looking at two cohorts of patients in the trauma intensive care unit before and after the introduction of our new orderset. We included trauma patients admitted directly from the emergency department who required at least 48 hrs of mechanical ventilation. We looked at documentation of patient height at 24 and 48 hrs of initiation of mechanical ventilation, tidal volumes in ml/Kg PBW and ml/kg actual body weight. RESULTS: In both groups, documentation of patient height at 24h was approximately 25%. In the pre-orderset cohort, only 31% of patients had a height recorded by 48hours vs 75% in the post-orderset cohort. The average tidal volume in mL/kg actual body weight was 6.75 in the pre-orderset cohort and 6.99 in the post-orderset cohort. In patients who had height recorded for PBW calculation, only 44% had tidal volumes <8mL/kg PBW vs. 67% in 2011. Notably, tidal volumes in ml/kg PBW were 20-30% higher than in ml/kg actual body weight. CONCLUSIONS: A simple orderset increased measurement of patient height and calculation of PBW by respiratory therapists, and increased adherence to lower tidal volume ventilation. CLINICAL IMPLICATIONS: Electronic tidal volume orders in ml/Kg PBW can potentially impact adherence to best practice ventilation by respiratory therapists, thus affecting patient outcomes. DISCLOSURE: The following authors have nothing to disclose: Subhraleena Das, Anthony Paluso, Jeffrey Gold, Stephanie Nonas No Product/Research Disclosure Information