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Adding Spontaneous Awakening Trial (SAT) to the Nursing Critical Care Flowsheet
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The fields in the "Sedation Vacation/Daily Awakening Trial" section prompted nurses to document if the patient had received a SAT that day or why the patient had failed to receive a SAT, if the sedative infusion was resumed, and why the sedation was resumed. The "Exercise/Mobility" section prompted nurses to document if the patient received an early mobility assessment that day, or why the patient did not receive an early mobility assessment, and what level of mobility the patient achieved (Figure 1).
Documenting Spontaneous Breathing Trial (SBT) in Respiratory Therapy Structured Notes
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Creation of the Patient Viewer for the ABCDE Bundle
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In addition the design team created an "ABCDE" tab in the existing Patient Care Viewer that provided a summary of SAT, SBT, delirium (CAM-ICU), and early mobility assessments, to promote quick viewing of the bundle elements received by individual patients and enhance interdisciplinary communication (Figure 3).
Example of Monthly Bundle Performance Report for a Study ICU
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As a temporary solution, we created monthly ICU reports (Figure 4) with graphs displaying the percent of missing data elements; performance of SATs, SBTs, delirium assessment (CAM-ICU), and early mobility over time; and reasons why patients did not receive these assessments.
Percentage of Undocumented ABCDE Bundle Elements in the Critical Care Flowsheet
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We tracked the percent of ABCDE bundle elements captured in the critical care flowsheet and structured notes for the 11 months following the EHR modifications to assess adherence to the new documentation processes and bundle element data capture (Figure 5).
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