COLLABORATIVE PRACTICE IN PAEDIATRIC INTENSIVE CARE
Keogh, S J
Queensland
University of Technology, Brisbane, Australia
Royal
Children’s Hospital, Brisbane, Australia
Clinical practice tools are cited as
one means of ensuring research utilisation. This paper discusses the
process of developing and implementing multidisciplinary guidelines.
Objective: To standardise the PICU team’s approach to weaning
paediatric patients from mechanical ventilation.
Method: The Australian National
Health and Medical Research Council’s (NHMRC) document provided the
framework for the development process. A national survey of weaning
practices in Australian PICUs, a retrospective analysis of weaning
outcomes, and an extensive literature review of related studies were all
part of the development process. A draft of the guidelines was developed
then validated by a multidisciplinary panel of PICU experts. The guidelines
were then piloted on the study unit for one month.
Results: Outcome indicators were
compared between the pilot sample (n=11) and the retrospective sample
(n=107). All times were longer in the pilot sample however none of the
median differences were significant. The mean difference in outcome
indicators between groups was total ventilation time (TVT) 24 hours (MWp<0.065);
weaning duration (WD) 5 hours (MWp<0.48); length of stay (LOS) 22 hours
(MWp<0.190). The quality indicators were comparable between groups, with
12(11%) weaning failures and 3(2.8%) reintubations in the pretest sample
(n=107) and 1(9%) weaning failure in the pilot sample (n=11).
Conclusions: The pilot test demonstrated that the
multidisciplinary weaning guidelines were a safe and effective clinical
practice tool. The guidelines were fully implemented for a 12-month period
and data collection will continue till October 2001.