دانلود رایگان مقاله انگلیسی تأثیر آموزش کارکنان و نظارت بر رویدادهای الکترونیکی بر پایبندی به توصیه تنفس محافظ ریه - الزویر 2018

Abstract:

Purpose: To investigate long-term effects of staff training and electronic clinical decision support (CDS) on adherence to lung-protective ventilation recommendations. Materials and Methods: In 2012, group instructions and workshops at two surgical intensive care units (ICUs) started, focusing on standardized protocols for mechanical ventilation and volutrauma prevention. Subsequently implemented CDS functions continuously monitor ventilation parameters, and from 2015 triggered graphical notifications when tidal volume (VT) violated individual thresholds. To estimate the effects of these educational and technical interventions, we retrospectively analyzed nine years of VT records from routine care. As outcome measures, we calculated relative frequencies of settings that conform to recommendations, case-specific mean excess VT, and total ICU survival. Results: Assessing 571,478 VT records from 10,241 ICU cases indicated that adherence during pressure-controlled ventilation improved significantly after both interventions; the share of conforming VT records increased from 61.6% to 83.0% and then 86.0%. Despite increasing case severity, ICU survival remained nearly constant over time. Conclusions: Staff training effectively improves adherence to lung-protective ventilation strategies. The observed CDS effect seemed less pronounced, although it can easily be adapted to new recommendations. Both interventions, which futures studies could deploy in combination, promise to improve the precision of mechanical ventilation.

5. Conclusion

On ICUs adherence to recommended mechanical ventilation with low tidal volume can still be low. Staff training, protocols, standardization and other actions to improve this situation are highly effective but complex and need a repetitive effort. CDS promises to facilitate adherence, especially in larger teams where repeated staff training requires enormous resources. Once implemented, a CDS – can also be updated easily to new recommendations or to changing limits, thereby avoiding or at least reducing the need of repeated staff training. A seamless monitoring of ventilator parameters can thus help making mechanical ventilation more precise and its application safer for critically ill patients. Maybe the combination of both – education and electronic decision support – are the bundle of measures needed to achieve a lasting effect.