Assessing data quality in manual entry of ventilator settings

Abstract

Objective: To evaluate the data quality of ventilator settings recorded by respiratory therapists using a computer charting application and assess the impact of incorrect data on computerized ventilator management protocols. DESIGN An analysis of 29,054 charting events gathered over 12 months from 678 ventilated patients (1,736 ventilator days) in four intensive care units at a tertiary care hospital.

Measurements: Ten ventilator settings were examined, including fraction of inspired oxygen (Fio (2)), positive end-expiratory pressure (PEEP), tidal volume, respiratory rate, peak inspiratory flow, and pressure support. Respiratory therapists entered values for each setting approximately every two hours using a computer charting application. Manually entered values were compared with data acquired automatically from ventilators using an implementation of the ISO/IEEE 11073 Medical Information Bus (MIB). Data quality was assessed by measuring the percentage of time that the two sources matched. Charting delay, defined as the interval between data observation and data entry, also was measured.

Results: The percentage of time that settings matched ranged from 99.0% (PEEP) to 75.9% (low tidal volume alarm setting). The average charting delay for each charting event was 6.1 minutes, including an average of 1.8 minutes spent entering data in the charting application. In 559 (3.9%) of 14,263 suggestions generated by computerized ventilator management protocols, one or more manually charted setting values did not match the MIB data.

Conclusion: Even at institutions where manual charting of ventilator settings is performed well, automatic data collection can eliminate delays, improve charting efficiency, and reduce errors caused by incorrect data.

Figure 1

Computer charting application in the HELP System used by respiratory therapists to document ventilator settings (far left column) along with other patient-specific ventilator and respiratory data. This screen is specific to the Puritan Bennett 840 ventilator operating in Assist/Control mode. Similar screens were displayed depending on the type of ventilator and mode of operation.

Figure 2

Example of instructions generated by a HELP computerized ventilator management protocol. The protocol logic relied on Fio ₂, PEEP, respiratory rate, tidal volume, and pressure support settings that were manually charted by respiratory therapists. Fio ₂ = fraction of inspired oxygen, PEEP = positive end-expiratory pressure.

Figure 3

Examples of charting errors that affected the percentage of time that manually charted values were correct. (a) The delayed recording of an Fio ₂ setting change is shown near (1), where a setting change occurred at time 14:22, but was not manually charted until 15:25. The Fio ₂ setting was correct 86.9% of the time in this 8-hour window. (b) A failure to record an Fio ₂ setting change is shown near label (2), and the recording of an incorrect value is shown near (3). The Fio ₂ setting was correct 78.1% of the time in this 8-hour window. Fio ₂ = fraction of inspired oxygen.

Figure 4

Example of an incorrect Fio ₂ setting that was used to generate protocol instructions. Fio ₂ = fraction of inspired oxygen.