NURS 8740 Week 5 Results Section Draft Example

Results: A Nurse-Led Protocol for Sitting Up Ventilated Patients in a Fourteen-Bed Community ICU, Four Baseline and Eight Protocol Weeks

Student Name

College of Nursing, Walden University

NURS 8740: Doctoral Seminar IV

Instructor Name

Month Day, Year

Results: A Nurse-Led Protocol for Sitting Up Ventilated Patients in a Fourteen-Bed Community ICU, Four Baseline and Eight Protocol Weeks

Records Included

The cleaned extract held 276 qualifying ventilator days from 49 patients: 90 days from 15 patients before the protocol (January 5 through February 1) and 186 days from 34 patients across the eight protocol weeks that ran from February 2 through March 28. Fourteen days had no mobility level recorded (four baseline, ten protocol) and were counted as not reaching level 3, as the operational definition specified. Characteristics of patients and days are reported in Tables 1 and 2 of the descriptive section. Results are reported below in the order the measures were introduced in the measurement plan: the outcome, two process measures and two balancing measures. Run charts were read using the rules set out in the methods (Perla et al., 2011).

Outcome: Sitting-Up Days

In the baseline period, 20 of 90 qualifying days (22.2%) reached level 3 or above on the ICU Mobility Scale (Hodgson et al., 2014). In the protocol weeks, 75 of 186 days (40.3%) did so. Weekly values ranged from 19.0% to 25.0% in the baseline and from 27.3% to 48.0% in the protocol weeks (Figure 1).

All eight protocol weeks fell above the baseline median of 22.2%, which met the shift rule beginning in the week of February 2. The trend rule was met by five successive increases in value, starting with the last baseline week and ending with the week beginning February 23. The series contained two runs, fewer than the lower limit of three for twelve points. No astronomical point was identified. From the week of March 2, weekly values ranged from 42.9% to 48.0%.

Results differed by day of the week. On weekdays, 15 of 64 baseline days (23.4%) and 64 of 134 protocol days (47.8%) reached level 3 or above. On weekends, 5 of 26 baseline days (19.2%) and 11 of 52 protocol days (21.2%) did so (Table 3).

A sensitivity check counted all fourteen blank-level days as reaching level 3. Under that assumption, the baseline figure was 24 of 90 days (26.7%) and the protocol figure 85 of 186 days (45.7%). The direction and approximate size of the difference between periods were the same under both treatments of blank days, and the run chart reading did not change, because every protocol week remained above the baseline median recalculated on the same basis.

Process Measure 1: Screens Recorded by 0600

A safety screen result was recorded by 0600 on 158 of 186 protocol days (84.9%). Weekly values were 63.6% in the week of February 2, 80.0% in the week of February 9 and between 83.3% and 92.0% in each week from February 16 onward. Of the 28 days without a recorded screen, 17 fell on nights when the night champion was not working. Screens were not part of practice in the baseline period, so no baseline value exists for this measure.

Screen completion differed by day type: screens were recorded by 0600 on 121 of 134 weekday protocol days (90.3%) and on 37 of 52 weekend protocol days (71.2%). The night champion recorded 61 of the 158 screens; charge nurses and bedside nurses recorded the remaining 97.

Process Measure 2: Passed Screens Followed by an Attempt

Of the 158 recorded screens, 104 (65.8%) were passed. A mobilization attempt to level 3 or above was recorded on 81 of the 104 days with a passed screen (77.9%). On weekdays, attempts followed 70 of 82 passed screens (85.4%); on weekends, 11 of 22 (50.0%). Of the 81 attempts, 70 reached level 3 or above. The remaining five days at level 3 or above in the protocol period had no passed screen recorded; on all five, a physical therapist note documented the session.

Balancing Measure 1: Mobilization Events

Six of the 81 sessions (7.4 per 100 sessions) were stopped under the stopping rules: three for oxygen saturation below the threshold, two for a fall in mean arterial pressure and one for agitation. In every one of the six, the threshold was crossed no later than the moment the patient reached the edge-of-bed position, and the vital signs returned to the pre-session range within 15 minutes according to the event form. No falls occurred, and no endotracheal tube, central line, arterial line or drain was dislodged during a session. One peripheral intravenous catheter was removed by a patient during a session and was replaced. Event forms were completed for all six stopped sessions, as checked against nursing notes.

Balancing Measure 2: Respiratory Therapist Response Time in the Emergency Department

Across February and March, the paging log held seven late-morning ventilator pages from the emergency department, all falling between 0900 and 1200. The median time from page to arrival was 6 minutes (range 2 to 19). In February and March of the previous year, eight calls were recorded, with a median of 4 minutes (range 1 to 12). One call this year exceeded 15 minutes. The supervisor's review recorded that the responding therapist was assisting with a mobilization session in the ICU when paged and that the second therapist was attending a rapid response call.

Measures Not Reported

The measurement plan listed function at discharge as outside the scope of the project, and it is not reported. Monthly length of stay, which appears in the hospital's quality report, was not a project measure and is not reported here. The first monthly point, for April, will be added when the April extract has been cleaned.

Table 3 summarizes the outcome and process measures by period and day type.

Table 3

Outcome and Process Measures by Period and Day Type

Note. N = qualifying ventilator days, except in the last row, where N = days with a passed screen. Reporting followed SQUIRE 2.0 guidance on presenting results for each measure in the order of the plan (Ogrinc et al., 2016).

References

Hodgson, C., Needham, D., Haines, K., Bailey, M., Ward, A., Harrold, M., Young, P., Zanni, J., Buhr, H., Higgins, A., Presneill, J., & Berney, S. (2014). Feasibility and inter-rater reliability of the ICU Mobility Scale. Heart & Lung, 43(1), 19-24. https://doi.org/10.1016/j.hrtlng.2013.11.003

Ogrinc, G., Davies, L., Goodman, D., Batalden, P., Davidoff, F., & Stevens, D. (2016). SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Quality & Safety, 25(12), 986-992. https://doi.org/10.1136/bmjqs-2015-004411

Perla, R. J., Provost, L. P., & Murray, S. K. (2011). The run chart: A simple analytical tool for learning from variation in healthcare processes. BMJ Quality & Safety, 20(1), 46-51. https://doi.org/10.1136/bmjqs.2009.037895