Streamlining the weaning process within a UK critical care network

Current UK practice demonstrates that weaning from mechanical ventilation (MV) is an ad-hoc process, where weaning is not valued and there is a paucity of research related to weaning compared with North America and other European countries. Evidence exists outside the United Kingdom that proactive approaches to weaning yield benefits to service and coordination form a dedicated, experienced practitioner within a systematic framework generates positive outcomes.

The Surrey Wide Critical Care Network (SWCCN) comprises four district general hospitals with a total of 30 level-3 critical care beds. A weaning audit was undertaken by the SWCCN Nurse Consultant across all four ICUs over a 3-month period in 2003. The audit demonstrated that the process of weaning was often inconsistent and at times haphazard, especially in relation to those patients who have difficulty in weaning from MV. This often led to an unnecessary increase in ICU length of stay (LOS). The audit also established that patients weaning from MV can be identified into three groups: (1) those patients who will wean from MV within 24–72 hours; (2) those patients who will wean from MV within 3–21 days; and (3) those patients who will have a prolonged stay in ICU and a complex weaning process greater than 21 days.

In order to streamline and coordinate the whole weaning process and effectively manage the three groups of weaning patients across the SWCCN, a systematic evidence-based framework with three distinct pathways was developed and implemented within in all four ICUs by the Network Nurse Consultant (Fig. 1).

Figure 1

Weaning pathway.

Following 1 year of implementation the framework was audited and demonstrated the following:

• The process of weaning all three patient groups within all four ICUs was much more systematic and consistent.

• A reduction in ITU LOS in patient groups 1 and 2.

• Quicker identification and placement onto the rehabilitation pathway of those patients who would require a prolonged ITU stay and have complex weaning problems. Their management and care was much more coordinated.

• Symbiosis of ventilation care bundle and weaning framework.

• Identification for the need of a specialist regional weaning unit.