Meagan Latham, BCCCP, BCPS, PharmD
Clinical Pharmacy Specialist - Medical ICU
Franciscan Health Olympia Fields
Olympia Fields, Illinois
Disclosure information not submitted.
.jpg "Richard Mioni, BCCCP, BCPS, PharmD photo")
Richard Mioni, BCCCP, BCPS, PharmD
Critical Care Clinical Pharmacy Specialist
Franciscan Health Olympia Fields
Olympia Fields, Illinois
Disclosure information not submitted.
Ted Thachenkary, MD
MD
Franciscan Health Olympia Fields, United States
Disclosure information not submitted.
Nidal Jibawi, DO
DO, Critical Care Fellow
Franciscan Health Olympia Fields, United States
Disclosure information not submitted.
Katherine Haddad, Postdoctoral Trainee
Postdoctoral Trainee
Franciscan Health Olympia Fields, United States
Disclosure information not submitted.
Caley Schroeder, MSN, RN, NE-BC
ICU/CCU Nursing Manager
Franciscan Health Olympia Fields, United States
Disclosure information not submitted.
Carlyn Husband, BSN
Critical Care Nurse
Franciscan Health Olympia Fields, United States
Disclosure information not submitted.
Ravi Sundaram, DO
Intensivist/ Pulmonologist
Franciscan Saint James Health, United States
Disclosure information not submitted.
Jeanette Burke, MSN, RN
Nurse Educator
Franciscan Health Olympia Fields, United States
Disclosure information not submitted.
Erica Sampson, MS, BS, RRT
Respiratory Care Manager
Franciscan Health Olympia Fields, United States
Disclosure information not submitted.
Title: Reducing Sedative Use by Implementation of A-F Bundle
Introduction: The ICU Liberation Bundle (A-F) provides the roadmap for implementing the evidenced-based recommendations in the 2018 Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Studies have shown that implementation of the bundle, including a ventilator weaning protocol and maintaining light levels of sedation, improve patient outcomes. However, “real-world” application of the A-F Bundle had been unsuccessful at the study site prior to the multidisciplinary quality improvement project.
Methods: This quality improvement project was conducted in a 31-bed adult ICU beginning in February 2021. First, the electronic medical record, documentation, and policies/procedures were redesigned to follow the A-F Bundle elements. Then, the multidisciplinary leadership team, including nursing, respiratory therapy, pharmacy, and administration, created a spontaneous awakening trial (SAT) and spontaneous breathing trial (SBT) protocol. Lastly, extensive multidisciplinary education was provided to nursing (6 hours), respiratory therapy (1.5 hours), and prescribers (1 hour) to review the evidenced-based recommendations, A-F Bundle, and SAT/SBT protocol. This quality improvement project then compared the amount of propofol used per patient, ventilator days, ICU length of stay (LOS), hospital LOS, and mortality pre (January 2021) and post (June 2021) completion of the project.
Results: Twenty-five adults were included in the pre-group and 29 in the post. Median amount of propofol used per ventilator day decreased from 11 mcg/kg/min to 9 mcg/kg/min when comparing the pre to the post-group. This decrease was also seen in median amount of propofol used per patient (600 mL to 400 mL) and per ventilator day (150 mL vs. 83 mL). Ventilator days were the same between the two groups (5 days). However, median ICU LOS and hospital LOS were lower in the post-group (ICU LOS: 14 vs. 9 days, hospital LOS 20 vs. 14 days). Morality rate in the pre-group was 64% vs. 31% in the post-group.
Conclusions: The studied quality improvement project, which included A-F bundle implementation and multidisciplinary education, decreased sedative use and LOS.