A Quality Improvement Initiative to Increase Spontaneous Awakening Trial Compliance

Abstract

Background: Prolonged use of mechanical ventilation (MV) has been shown to contribute to harmful complications, such as ventilator-associated pneumonia, delirium, and lasting cognitive and musculoskeletal impairment known as post-intensive syndrome (Olsen et al., 2023). Early liberation from MV has been shown to significantly reduce mortality, decrease the number of days spent on MV, and decrease overall length of stay (Balas et al., 2022). Despite sufficient evidence supporting the implementation or increased adherence to screening protocols, such as the SAT, several barriers have contributed to their limited utilization in ICUs. Purpose: This quality improvement project aimed to increase spontaneous awakening trial (SAT) compliance in an intensive care unit by utilizing evidence-based quality improvement methodologies. These methodologies involved enhancing the awareness of a pre-existing SAT bundle tool and protocol. Methods: This quality improvement initiative aimed to enhance SAT bundle compliance by increasing staff nurses’ awareness of a pre-existing protocol through the incorporation of teaching into daily nursing huddles, the use of run charts, posters, and unit-wide emails. Utilizing the Plan-Do-Study-Act model for improvement, this project aimed to identify and resolve existing barriers to increase compliance. Results: A total of 27 (n=27) participants completed the pre-intervention knowledge survey, with 15 (n=15) of the original participants having completed the post-intervention knowledge survey. Knowledge enhancement was observed across several response categories in the SAT protocol compared with the pre-intervention period. A statistically significant increase in SAT compliance and SAT included patient agitation, lack of physician direction, high patient acuity, and knowledge gaps related to SAT protocol items. Conclusions: Implementing education on SAT protocols during nursing huddles, combined with posters, educational emails, and bedside in-services, enhances nurses’ knowledge and correlates with increased compliance. This QI project offers a framework for the Scripps Mercy San Diego Intensive Care Unit to enhance compliance with the SAT protocol, a crucial first step in preventing ventilator- and delirium-associated complications. Further research is necessary to better understand the prevalence and impact of over-sedation, as well as its association with adverse outcomes.