Quality Improvement Project to Improve Documentation of Predicted Body Weight
Published Date: 12th May 2020
Publication Authors: Tanqueray E, Cochrane A
Introduction
In patients with acute lung injury or acute respiratory distress syndrome, there is a significantly lower mortality when ventilated with a lower tidal volume (TV) of 6 ml per kg of predicted body weight (PBW) than the traditional TV of 12 ml per kg of PBW.1
In our Intensive Care Unit (ICU), it was noticed that height, PBW and ideal TV were often not being documented on the admission pro forma. There was a guide attached to every ventilator which could be used to aid calculation of ideal TV, however this was not easy to use, requiring multiple conversions between units.
Objective
To improve documentation rates of height, PBW and ideal TV on the ICU admission pro forma.
Methods
All patients that were invasively ventilated at admission were included in the study. Baseline data was obtained from admissions during a 6-week period in August-September 2018. In the first cycle of change, we designed a guide that made estimating height and PBW from ulnar length and then calculation of ideal TV much simpler. This new guide was then attached to every ventilator. Documentation rates were then re-audited during another 6-week period in October-November 2018. In the second cycle of change, tape measures were added to admission packs for convenient measurement of ulnar length. At doctors’ induction, information was given on how to use the new guide and a reminder email was sent out soon afterwards. Documentation rates were then re-audited during another 6-week period in April-May 2019.
Results
At baseline (n = 19), height, PBW and ideal TV documentation rates were 26%, 21% and 26% respectively. After the new guide was attached to ventilators (n = 36), documentation rates were 22%, 25% and 17% respectively. After the addition of tape measures to the admission packs and publicising the new guide (n = 43), documentation rates were 48%, 52% and 56% respectively. There were statistically significant improvements in documentation rates of PBW (X2 = 5.10, p = 0.02) and ideal TV (X2 = 4.68, p = 0.03) after the second cycle of change.
Conclusion
Documentation of PBW and ideal TV on the admission pro forma of invasively ventilated patients improved significantly after the second cycle of change. Before publicising the new guide and explanation of how to use it, there were insignificant changes in documentation rates. This demonstrates the importance of ensuring that people involved in the change process are well informed, understand the need for implementing change and the benefits to patient outcome.
Despite the improvement made, still only just over half of patients being invasively ventilated had their ideal TV documented on their admission pro forma, indicating the need for ongoing improvement. As a result, work has been done to formalise the process of introducing the guide during doctors’ induction, to ensure all doctors new to the unit are informed about the importance of documenting height, PBW and ideal TV.
Syrimi, Z; Tanqueray, E; Cochrane, A. (2020). Quality Improvement Project to Improve Documentation of Predicted Body Weight and Ideal Tidal Volume on the Intensive Care Unit Admission Pro Forma. Journal of the Intensive Care Society. 21 (2), 139