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Implementing a Weaning Protocol for Cardiac Surgery Patients Using Simulation

A Quality Improvement Project

Tierney, Catherine C. DNP, RN, ACNP-BC; Oermann, Marilyn H. PhD, RN, ANEF, FAAN; Molloy, Margory A. DNP, RN, CNE, CHSE; Brien, Lori MS, RN, ACNP-BC; Neisler, Cherith BSN, RN, CCRN-CSC

doi: 10.1097/DCC.0000000000000373
Educational DIMENSION
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Background Mechanical ventilation is the standard of care after cardiac surgery, but it imposes physiologic and psychological stress on patients. The Society of Thoracic Surgery recommends 6 hours as the goal for extubation, but 60% of our patients were not meeting this metric.

Objectives The objectives of this project were to decrease cardiac surgery patients' ventilation hours and intensive care unit length of stay using a ventilator weaning protocol.

Methods An evidence-based ventilator weaning protocol was developed, and nurses were prepared for its implementation using a simulation education program.

Results Ventilator hours were reduced from 7.74 to 6.27 (t = 2.5, P = .012). The percentage of patients extubated in 6 hours increased from 40% to 63.5% (χ2 = 7.757, P = .005). There was no statistically significant decrease in cardiovascular intensive care unit length of stay (17.15 to 15.99, t = 0.619, P = .537). Nurses' scores on a knowledge test increased significantly from pre (6.11) to post (7.79) (t = −5.04, P < .001). Their perception of confidence increased in weaning from pre (median, 4; IQR, 4,4) to post (median, 4; interquartile range [IQR], 4,5), z = −2.71, P = .007, and also in using the protocol from pre (median, 4; IQR, 3,4) to post (median, 4; IQR, 4,5) (z = −3.17, P = .002).

Discussion Using a nurse-led ventilator weaning protocol resulted in decreased ventilator hours for patients and increased knowledge and confidence for nurses.

Catherine C. Tierney, DNP, RN, ACNP-BC, is a nurse practitioner for cardiovascular and thoracic surgery, Virginia Hospital Center, Arlington.

Marilyn H. Oermann, PhD, RN, ANEF, FAAN, is a Thelma M. Ingles Professor of Nursing at Duke University School of Nursing, Durham, North Carolina.

Margory A. Molloy, DNP, RN, CNE, CHSE, is an assistant professor and director of the Center for Nursing Discovery, Duke University School of Nursing, Durham, North Carolina.

Lori Brien, MS, RN, ACNP-BC, is a nurse practitioner for cardiovascular and thoracic surgery, Virginia Hospital Center, Arlington.

Cherith Neisler, BSN, RN, CCRN-CSC, is a nurse educator of cardiovascular and thoracic surgery, Virginia Hospital Center, Arlington.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Address correspondence and reprint requests to: Catherine C. Tierney, DNP, RN, ACNP-BC, 914 Malta Ln, Silver Spring, MD 20901 (catherine.tierney@duke.edu).

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