REFERENCES

1. Background Goal To improve compliance with the individual components of sedation order set and to increase all-or-none compliance by 30% before March 1st, 2011. This may translate into decreased costs and complications, such as ventilator associated pneumonia and barotrauma. CONCLUSIONS REFERENCES Wake Up Call! Improve Compliance With Sedation Order Set In The Medical Intensive Care Unit (MICU) Moreno Franco P, Elmer J, Schramm G, Ortiz-Diaz E, Olson J, Bowron C, Danielson R, Ramar K. MICU Multidisciplinary Quality Improvement Team Mayo Clinic College of Medicine, Rochester, MN • Spontaneous awakening trials (SATs) in critically ill patients who require mechanical ventilation decreases ventilator days and ICU length of stay (ICU-LOS)1,2. • Gap: The MICU sedation order set calls for a daily interruption, with intermittent boluses and a 50% decrease in rate, if sedation is restarted. We hypothesize the compliance with each of these steps is highly variable and non-standardized. • Scope: Adult mechanically ventilated patients in the MICU at St. Mary's Hospital, Mayo Clinic Rochester with a prescribed sedation order set. RESULTS morenofranco.pablo@mayo.edu METHODS • Baseline all-or-none compliance with the sedation order set was assessed in 14 patients undergoing mechanical ventilation,with a total of 26 ventilator days. • Provider specific teaching sessions were created with tools to overcome each barrier. • Subsequent multidisciplinary education was used as the intervention to improve compliance and coordination of care. Education was completed using the following provider specific modalities: • One-on-one education for all MICU nurses on order set rationale and execution • Pharmacists instructed to discuss order set profile, including duration and dosing during rounds • Physician education on order set utilization, sedation practices, and contraindications to SAT • Compliance was re-evaluated after these interventions over a second 27 ventilator day audit looking at 21 patients undergoing mechanical ventilation. • Barriers to completing SATs were identified by surveying ICU providers and grouped under recurrent themes. • Educational interventions increased utilization of daily SATs and all-or-none compliance. • Additional barriers and quality defects identified by post-implementation survey to providers are being evaluated in order to generate new interventions that will be incorporated into Plan-Do-Study-Act cycles. • This may include education to new staff upon joining MICU, automated computerized reminders to nursing, morning briefing during shift change, balanced staffing, delirium and pain management action plans. • Replication potential: High • Status: Ongoing 1. Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily Interruption of Sedative Infusions in Critically Ill Patients Undergoing Mechanical Ventilation. N Engl J Med. 2000;342:1471-1477. 2. Girard TD, Kress JP, Fuchs BD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet. 2008;371:126-134.