The impact of a multidisciplinary weaning team on a general intensive care unit

The majority of patients needing mechanical ventilation are weaned rapidly and easily, but a significant minority (20–30%) require more gradual withdrawal. Evidence suggests that a structured approach to this process, involving a multidisciplinary team, is likely to be the most successful. This article describes the process of setting up a multidisciplinary weaning team on a general intensive care unit in a regional hospital. A team drawn from nursing, physiotherapy and anaesthetic staff was created and a decision was made to introduce protocol-directed weaning. Change management theory and published evidence-based guidelines were used to make this introduction. Pre- and post-protocol introduction data were collected on staff perceptions and weaning outcomes. The team overcame a number of barriers to change and protocol-directed weaning was successfully embedded into routine practice. Protocol-directed weaning reduced the reintubation rate from 16% to 3.4% (P=0.015). The process of introducing the changes necessary to use protocols for weaning also altered the attitudes and perceptions of unit staff and improved interdisciplinary working relationships. Introducing changes to weaning practice required concerted efforts over a lengthy period of time, during which it was essential to support all the staff involved. However, the process has been an important step for the service, allowing the authors to develop new ways of working that are directed at improving patient care