PROGRESS OF A LARGE-SCALE IMPROVEMENT PROJECT FOR MECHANICAL VENTILATION IN SAUDI ARABIA
Ema, Arabi, Yaseen1; Al Aseri, Zohair; Alaama, Tareef; Alharthy, Abdurahman; Al-Hameed, Fahad; Mandourah, Yasser; Sallam, Hend; Elhazmi, Alyaa; Alghamdi, Adnan; Almekhlafi, Ghaleb; Mady, Ahmed; Qushmaq, Ismeal; Alshahrani, Mohammed; Al Qasim, . 2020
Introduction/Hypothesis: The National Approach to Standardize and Improve Mechanical Ventilation (NASAM) is a national collaborative quality improvement that is conducted across ICUs in Saudi Arabia.
Methods: This initiative is designed as a data-driven project with an electronic portal for data entry that allows real-time performance feedback and benchmarking. The project utilizes the concept of the comprehensive unit-based safety program (CUSP) designed to help clinical teams make care safer by combining improved teamwork, clinical best practices, and the science of safety. This collaborative project aims at improve evidence-based practices specifically: use of subglottic suctioning; spontaneous awakening trial; spontaneous breathing trial, less frequent use of neuromuscular blockers and early mobility. NASAM includes ongoing training, coaching, and peer-learning through regular twice-monthly webinars and site visits. The project is being conducted across 6 healthcare sectors in Saudi Arabia in collaboration with the Johns Hopkins Armstrong Institute for Patient Safety and Quality. The project aims to show improvements in rates of ventilator-associated events.
Results: The project was launched in January 2019. 78 ICUs from 48 hospitals in 27 cities have registered. Data on daily care processes on 20,000 patient days have been collected from the first 6 months (Table). Preliminary data on 20,000 patient days from 78 ICUs representing 48 hospitals across Saudi Arabia Care Process Percentage Subglottic suctioning compliance rate 27.6% Spontaneous awakening trial (SAT) compliance rate 51.0% Percentage of ventilated patient days without sedation 39.8% Spontaneous breathing trial (SBT) compliance rate 54.1% Percentage of actual RASS score (-1 to 1) 35.9% Percentage of achieving RASS target 27.7% Percentage of ventilated patients receiving neuromuscular blocker 5.1% Percentage of ventilated patient days that achieved weight bearing 0.59% (standing and above)
Conclusions: Launching a novel national quality improvement collaborative across Saudi Arabia is feasible. Results from the first 6 months show significant opportunities to improve the care of mechanically ventilated patients
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