Implementing the Richmond Agitation Sedation Scale and Wake Up and Breath Protocol to Reduce Ventilator Days

The ultimate goal for patients who are mechanically ventilated is to promptly and safely discontinue their dependence on mechanical ventilation to promote recovery from illness. It is accepted practice to perform a spontaneous breathing trial (SBT) with a patient connected to the ventilator to assess his or her readiness to breathe without mechanical assistance. Paired with the SBT, the hospital performed a spontaneous awakening trial (SAT) to adjust sedation levels based on patient response to the daily SBT. Performing an SBT and reducing sedation after an SAT are integral components of the Institute for Healthcare Improvement Ventilator Bundle. Use of these protocols has been correlated with a reduction in the rate of ventilator-acquired pneumonia due to prolonged mechanical ventilation and deep sedation.

This project was implemented to improve clinical outcomes of intubated patients by using the Richmond Agitation Sedation Scale and Wake Up and Breath protocol. Secondary goals included minimizing patient dependence on ventilators and intravenous sedation, reducing ventilator-associated infections and decreasing the patient's length of stay.

This case study is part of the Illinois Health and Hospital Association's annual Quality Excellence Achievement Awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals and health systems in continually improving and transforming health care in the state. These organizations are improving health by striving to achieve the Triple Aim—improving the patient experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of health care—and the Institute of Medicine's six aims for improvement—safe, effective, patient centered, timely, efficient, and equitable. To learn more, visit https://www.ihaqualityawards.org/javascript-ui/IHAQualityAward/