Title: IHI Campaign to Save 100,000 Lives Pediatric Node presents: Preventing Ventilator Associated Pneumonia
1IHI Campaign to Save 100,000 Lives Pediatric
Node presentsPreventing Ventilator Associated
Pneumonia
- July 20, 2005
- 200 PM - 330 PM (ET)
- 100 PM - 230 PM (CT)
- 1200 PM - 130 PM (MT)
- 1100 AM - 1230PM (PT)
2Pre-Game Housekeeping
- Phone lines have been muted to reduce background
noise - 7 to unmute
- 6 to mute
- Please do not put your phone on hold
- 30 minutes for Q A at the conclusion of the
presentations - Session is being recorded and will be available
on CHCA, NACHRI, NICHQ and IHI websites
3IHI Campaign to Save 100,000 Lives Pediatric
Node presentsPreventing Ventilator Associated
Pneumonia
- Moderator
- Paul Kurtin, MD
- Vice President, Clinical Innovation
- Director, Center for Child Health Outcomes
- Childrens Hospital and Health Center, San Diego
- Research Professor
- Director of Maternal and Child Health Program
- San Diego State University
4Pediatric Node Leadership Team
- CHCA David Bertoch, Jeff Brandon
- jeff.brandon_at_chca.com
- david.bertoch_at_chca.com
- NACHRI Ellen Schwalenstocker
- eschwalenstocker_at_nachri.org
- NICHQ Connie Crowley Ganser, RN, Emily Crites,
and Paul Kurtin, MD -
- ccganser_at_nichq.org
- ecrites_at_nichq.org
- pkurtin_at_chsd.org
5IHI Campaign to Save 100K Lives
- Launched December 2004
- Pediatric Node Launched January 2005
- 5 Initiatives Relevant to Pediatrics
- Prevention of Adverse Drug Events using
Reconciliation of Medications (6/15/05) - 82 hospitals 354 individuals participated in
webcast - Deployment of Rapid Response Teams (6/22/05)
- 86 hospitals 345 individuals participated in
webcast - Prevention of Ventilator-Associated Pneumonia
(7/20/05) - Prevention of Central Line Infections (7/27/05)
- Prevention of Surgical Site Infections (8/17/05)
- Note time change (1200N-130PM ET) this session
only
6IHI Campaign Objectives
- Save 100K lives through the introduction of six
proven health care improvement interventions over
18 months. (end date 6/14/06 at 9AM). - Enroll a minimum of 1600 hospitals to join IHI in
this work. (To date, over 2500 hospitals have
signed on to the Campaign).
7Key Campaign Principles
- Some is not a number soon is not a time.
- Get the hard count.
- Welcome anyone at any level.
- We do this together.
8IHI Campaign Pediatric Node
- Commitment of 3 major pediatric leadership
organizations to convene learning collaboratives
(Summer Series webcasts) featuring experts in the
field. - First ever learning initiative involving the
whole pediatric community (FREE). - CHCA, NACHRI, and NICHQ applaud the experts and
their respective organizations for their
willingness to share their expertise with the
whole pediatric community. - CHCA, NACHRI and NICHQ applaud the whole
pediatric community for their commitment and hard
work in creating high quality healthcare for
children.
9Additional Resources
- www.chca.com
- www.childrenshospitals.net
- www.nichq.org
- www.ihi.org
- For information on Campaign data submission, go
to www.ihi.org.
10VAP Faculty
- Vanderbilt Childrens Hospital
- Jay Deshpande, MD
- Professor of Anesthesiology
- Childrens Hospital, Boston
- Martha A. Q. Curley, PhD, RN
- Director Critical Care and Cardiovascular
Nursing Research
11Reducing Morbidity and Mortality from Ventilator
Associated Pneumonia
12Please note that all data presented are for Peer
Review/Quality Improvement only.
13Impact of Ventilator-Associated Pneumonia (VAP)
- 15 of all hospital acquired infections
- 2nd most common nosocomial infection
- 20-33 attributable mortality rates
- Increased ICU stay 4.3-6.1 days
- Excess costs of approximately 40,000/patient
- (Centers for Disease Control, 2003)
14Impact of Ventilator-Associated Pneumonia (VAP) -
continued
- Ventilator-associated pneumonia (VAP)is a common
complication in the ICU. - Incidence of VAP ranges from 9 to 70.
- Mortality ranges from 13 to 55.
- VAP increases average hospital stay from 6 days
to more than 30 days. - VAP increases cost up to 50,000 per hospital
stay - Rumbak, M. J. (2000). Strategies for prevention
and treatment. Journal of Respiratory Disease, 21
(5), p. 321.
15Changing Views on VAP
- No longer just an unfortunate occurrence
- Viewed as medical error
- Institute of Medicine
- Leapfrog Group
- JCAHO hospitals will be required to show VAP
prevention/reduction measures
16Ventilator Associated Pneumonia
- Nosocomial Pneumonia
- Hospital acquired
- Diagnosis is imprecise.
- Combination of
- Clinical factors - fever change in secretions
amount and quality cough apnea/bradycardia
tachypnea - Microbiological factors blood, sputum, tracheal
aspirate and/or pleural fluids - Radiographic factors - new or increased
infiltrates
17Bacterial causes Bad bugs - 1
- EarlyOnset Pneumonia
- Pathogens
- Streptococcus pneumoniae
- Haemophilus influenzae
- Staphylococcus aureus
- Community-acquired
- Antibiotic-sensitive
18Bacterial causes Bad bugs - 2
- Late-Onset Pneumonia
- Pathogens
- Pseudomonas aeruginosa
- Methicillin resistant Staphylococcus aureus
- Acinetobacter
- Enterobacter
- Other hospital-acquired
- Antibiotic-resistance increasing
19Risk Factors for Nosocomial Pneumonia
- Number 1 risk factor endotracheal intubation
and mechanical ventilation! - Factors that enhance colonization of the
oropharynx /or stomach - Administration of antibiotics
- Admission to ICU
- Underlying chronic lung disease
- Conditions favoring aspiration into the
respiratory tract or reflux from GI tract - Supine position GERD
- NGT placement Comatose
- Intubation and self-extubation
- Immobilization
- Surgery of head/neck/thorax/upper abdomen
20Risk Factors for Nosocomial Pneumonia (continued)
- Conditions requiring prolonged use of mechanical
ventilatory support - And potential exposure to contaminated
respiratory devices /or contact with
contaminated hands. - Host Factors
- Extremes of age
- Malnutrition
- Immunosuppression
- Underlying condition/disease process
21Implications of VAP
- Increased LOS
- Increased ventilator days
- Increased risk of infection
- Increased costs
- Increased morbidity and mortality
22The Ventilator Bundle
- .is a package of evidence-based interventions
that, when implemented together for all patients
on mechanical ventilation, results in dramatic
reduction in the incidence of ventilator-associate
d pneumonia.
23The Ventilator Bundle
- The power of a bundle is that it brings
together evidence-based practices that
individually improve care, but when applied
together result in substantially greater
improvement. - The science behind the bundle is so well
established that it should be considered a
standard of care. - The focus of measurement is then completion of
the entire bundle as a single intervention,
rather than completion of its individual
components.
24Adult Ventilator Bundle
- Elevation of the head of the bed to between 30
and 45 degrees - Daily Sedation Vacation and daily assessment of
readiness to extubate - Peptic ulcer disease prophylaxis
- Deep vein thrombosis (DVT) prophylaxis
25Adult Ventilator Bundle
- Preventing VAP
- Elevation of the head of bed to 30 and 45 degrees
- Reduction in the risk of aspiration of gastric
contents and improved ventilation - Daily sedation vacation daily extubation
readiness testing (ERT) - Reduce the duration of mechanical ventilation and
the risk of VAP - Preventing other complications associated with
mechanical ventilation - Peptic ulcer disease prophylaxis
- Deep vein thrombosis prophylaxis
26Head of the Bed 30-45o
- Randomized controlled trial 86 adult intubated
patients on mechanical ventilation assigned to
semi-recumbent (45o) or supine position -
Semi-recumbent Supine - Suspected VAP 8 34
- (CI for difference 10-42 p0.003)
- Confirmed VAP 5 23
- (CI for difference 4-32 p0.018)
Drakulovic MB. Lancet.19993541851-1858.
27Sedation Vacation
- 128 adults on mechanical ventilation randomized
to daily interruption of sedation until the
patient was awake. - Duration of ventilation
- 4.9 days vs. 7.3 days (p0.004)
Kress JP. N Engl J Med. 2000 342 1471-1477.
28PEDIATRIC CRITICAL CARE MEASURES (NACHRI/CHCA/MMP)
- Ventilator-associated pneumonia not included in
initial core measure set - difficulty of differentiating ventilator-associate
d from community-acquired pneumonia in children - lack of evidence in the pediatric population with
regard to effective practices for preventing
infection
29Given the lack of evidence Are kids different?
- Same
- Aspiration of oropharyngeal or gastric secretions
contaminated with potentially pathogenic
organisms around the endotracheal tube. - Colonization of the ETT with bacteria encased in
biofilm may result in embolization into the
alveoli during suctioning. - Different (aside from the obvious)
- Development - Dentation
- Use of uncuffed tubes
- Use of saline during ETT suctioning
- Open suctioning
30Adult Pediatric Ventilator Bundle
- Elevation of the head of the bed to between 30
and 45 degrees - Daily Sedation Vacation and daily assessment of
readiness to extubate - Peptic ulcer disease prophylaxis
- Deep vein thrombosis (DVT) prophylaxis
31Given the Lack of Evidence What Should a
Pediatric Ventilator Bundle Include?
- Standard of Care
- Best practices
- Should implement low-risk practices
- Should collect data to support the implementation
of potentially high-risk practices (Do no harm)
32Guidelines for Preventing Health-Care--Associated
Pneumonia, 2003 Recommendations of CDC and the
Healthcare Infection Control Practices Advisory
Committee
http//www.cdc.gov/mmwr/preview/mmwrhtml/rr5303a1.
htm
33Modifiable Risk Factors General prophylaxis
(Standard of Care)
- Effective infection control measures
- Staff education
- Compliance with hand disinfection
- Isolation to reduce cross-infection with
multidrug-resistant (MDR) pathogens - Surveillance of ICU infections
- Identify and quantify endemic and new MDR
pathogens - Guide appropriate antimicrobial therapy
34Modifiable Risk factorsIntubation and mechanical
ventilation
- Avoid intubation and reintubation
- Use noninvasive ventilation whenever possible
- Use orotracheal/orogastric tubes to prevent
nosocomial sinusitis (direct causality not
proven) - If cuffed ETTs, inflate them to maintain cuff
pressure no greater than 20 cm H2O
35Modifiable Risk factorsIntubation and mechanical
ventilation
- Avoid neuromuscular blockade
- Prevent ventilator circuits condensate from
entering ETT or in-line medication nebulizers
. Use closed ETT suctioning and eliminate saline
instillation.
36Use of Saline During ETT Suctioning
CHB MSICU Practice Guideline
37Modifiable Risk factorsIntubation and mechanical
ventilation
- Use protocols to improve the use of sedation and
to accelerate weaning - Avoid constant heavy sedation
- Minimal yet effective sedation
- Sedation scoring every 4 hours
- Goal directed therapy
- Sedation vacation
- Use extubation readiness test
- Assure adequate nurse staffing and use
nurse-implemented protocols to improve infection
control practices and reduce duration of
mechanical ventilation.
38Modified Motor Activity Assessment Scale Score as
patients response to Voice ? Touch ? Noxious
Stimuli (suctioning or nail
bed pressure)
Chemically Paralyzed OR Developmentally Dysmature Score Definition Ventilation
Unresponsive No autonomic response to noxious stimuli -3 Unresponsive No spontaneous respiratory effort
Unresponsive No autonomic response to noxious stimuli -2 Responsive only to noxious stimuli Spontaneous but ineffective respiratory effort
Responsive lt 20 increase in HR BP to a noxious stimulus -1 Responsive to touch or name Spontaneous Effective Vt
Responsive lt 20 increase in HR BP to a noxious stimulus 0 Calm cooperative Spontaneous Effective Vt
Responsive lt 20 increase in HR BP to a noxious stimulus 1 Restless but cooperative Spontaneous Effective Vt
Hyper-responsive ? 20 increase in HR BP to a noxious stimulus 2 Agitated Difficulty synchronizing with ventilator
Hyper-responsive ? 20 increase in HR BP to a noxious stimulus 3 Dangerously agitated, uncooperative Unsynchronized with ventilator
From Curley et al. (2001). Critical Care Nursing
of Infants and Children
39Adapted from Randolph et al. (2002) JAMA, 288
2561
40Modifiable Risk factors Aspiration, body
position, and enteral feeding
- Position HOB up 3045 to prevent aspiration,
especially when receiving enteral feeding - Continuous rotational therapy and prone
positioning - Use enteral nutrition to decrease risk of
bacterial translocation - Use post-pyloric feeding in high risk patients
(depressed gag reflex, delayed gastric emptying,
gastro-esophageal reflux and severe bronchospasm)
41Modifiable Risk factors Modulation of
colonization oral antiseptics and antibiotics
- Consider prophylactic systemic antibiotics for 24
hours post emergent intubation (closed head
injury) - Modulate oropharyngeal colonization with oral
chlorhexidine (need more data) - Mouthcare and oral/nasal suction practice
guideline (follow ADA guidelines gentle
oral/nasal suction with supplies that are changed
daily) - Anne Bisch, RN, MSN St Louis U ACB3886_at_bjc.org
- Cindy Munro, RN, PhD R01NR007652, Oral care
intervention in mechanically ventilated adults - Mavilde Pedreira, RN, PhD Federal University of
São Paulo
42Comprehensive Oral Care Program
- The Good Shepherd
- Retrospective study
- VAP rate after practice change showed decrease
of 3.4 per 1000 ventilator days - Cost savings approximately 30,000 per VAP
- Schleder, B., Stott, K., Lloyd, R.C. (2002).
The effect of a comprehensive oral care protocol
on patients at risk for ventilator-associated
pneumonias. Journal of Advocate Health Care,
3(1), 1-8.
43Modifiable Risk factorsStress bleeding
prophylaxis
- If needed, stress bleeding prophylaxis with
either H2 antagonists or sucralfate (Reduced VAP
with sucralfate but slightly higher rate of
clinically significant gastric bleeding)
44Give your patient a fast hug (at least)
once a dayJean-Louis Vincent, MD, PhD, FCCM
- Fast Hug mnemonic (Feeding, Analgesia, Sedation,
Thromboembolic prophylaxis, Head-of-bed
elevation, stress Ulcer prevention, and Glucose
control) - Identify and check key aspects in the general
care of all critically ill patients.
- Feeding (bowel regimen) Family
- Analgesia
- Sedation
- Thromboembolic prophylaxis, Tubes Test
(extubation readiness) - Head-of-bed elevation Honeymoon paralytics
- Ulcer prevention (peptic and skin)
- Glucose control, GI Prophylaxis and Get OOB
Crit Care Med 2005 3312251229
45- ZAP-VAP initiative at Vanderbilt
- Together we can make a difference!
46ZAP VAP Team at Childrens Hospital
- Ann Johnson - CNS
- Chris Lynn RT
- Trish Campbell - RN
- Tracy Hann I.C.
- Jill Kinch - PCCNP
- Rick Barr - MD
- Sandra Dennis
- Cheryl Burney-Jones
- Lisa Chumley
- Shawn Austin
- Liz Taketani
- Stormie Eldred
- J. K. Deshpande MD
- Pat Throop Qual Consultant
- Our thanks to the
- Surgical Intensive Care Team (J. Morris, MD
Chair) - Missy Travis RN, CIC
- Tom Talbot MD, IC
- Addison May MD
- Devin Carr RN
47Prevention Practices
- Basic infection control measures
- Bundle of treatments to improve patient outcomes
- Started on admission
- Maintained by RNs, RTs, NPs, and MDs by daily
care practices - Considered as Standards of Care for intubated
patients
48 Ways we will ZAP VAP!
- Numero Uno-
- Wash Hands!
- Wash Hands!
- Wash Hands!
49 Perform Hand Hygiene
- Upon reporting for work
- Before gloving
- After glove removal
- Before and after each patient contact or contact
with the patient environment (e.g. bed, table) - After handling contaminated objects
- Before handling medications
- Before eating
- After using the restroom
- When leaving the facility
50ZAP VAP
- Decreasing the risk of aspiration is key in
preventing VAPs. - Elevate HOB gt 30 degrees (unless contraindicated)
- Monitor gastric residuals q 4 hrs
51ZAP VAP
- Aggressive oral care with documentation every 2
hours with Sage Q-Care Oral Cleansing and
Suctioning system. - Special pieces include
- A covered Yankauer
- A Y-connector to establish a dedicated oral care
line - A suction toothbrush
- A suction oral swab
- Perox-a-mint mouthwash
- Mouth moisturizer
- A new suction canister and kit will be obtained q
24 hrs
52ZAP VAP
- Hypopharyngeal suctioning will be performed
before suctioning the ETT, before repositioning
the ETT, before deflating the cuff, and before
repositioning your patient to prevent aspiration
of pooled secretions.
53 ZAP VAP
- Equipment care for patient care
- Use Ballard system or use 2 people (per policy)
- Keep saline jet, end of vent circuit, Simms
adapter, and patients bag off the bed. Hang
them up or place them on a sterile paper (from
gloves or gauze). - Help keep the vent circuit free from accumulated
water by draining water away from the patient. - Change the suction canister and mouth care kit
every 24 hours. - CATHETERS-TUBING-CIRCUITS-KITS-CANNISTERS-BALLARDS
-ADAPTERS-JETS -
54 ZAP VAP STARTS WITH YOU!
- Be PROACTIVE
- Be your patients ADVOCATE
- Be a REMINDER to others
- Be a POSITIVE INFLUENCE on our outcomes
- Be VIGILENT in your care
55- ZAP VAP initiative at Vanderbilt
- SO WHAT?
56Please note that all data presented are for Peer
Review/Quality Improvement only.
57Please note that all data presented are for Peer
Review/Quality Improvement only.
58The Game Begins
- Nightingale metrics
- Spring 04
- Motivation Link process measures to outcome
measures
59MMAAS Scoring Q4H
Benchmark 100
Percent of total
Please note that all data presented are for Peer
Review/Quality Improvement only.
60MMAAS Scoring Q4H
Benchmark 100
Percent of total
Please note that all data presented are for Peer
Review/Quality Improvement only.
61Mouth Care
Benchmark 100
Percent of total
Please note that all data presented are for Peer
Review/Quality Improvement only.
Question read Mouth care once in 24hrs in
August 04 Mouth care
twice in 24hrs in November 04
62If Ventilated, Head of Bed Elevated
Percent of total
Incline of bed measured in Nov 04, Feb05, May
05
Please note that all data presented are for Peer
Review/Quality Improvement only.
See VAP practice alert at AACN.org
63Extubation Readiness Test Discussed on Rounds
3 month Baseline 04 N10 August 04 N5 Nov 04 N5 Feb 05 N4 May 05 N0
Trached patients 6 1 4 2 0
ERT discussed in rounds 4/4 4/4 1/1 1/2 0
Please note that all data presented are for Peer
Review/Quality Improvement only.
Intubated ventilated (not trached) OI lt 6
spontaneous breathing vent settings decreased
over the past 12 hours
64To Be Successful
- Set an aim Improve the health and well-being of
ventilated patients by reducing the VAP
rate. - Set goals Reduce VAP rate by 50 by April
2006. Implement use of ventilator bundle with
greater than 95 reliability. - Plan well Adopt a change methodology that
- accelerates improvement such as The Model for
Improvement. - Benchmark Virtual PICU
65ZAP VAP
- Thank you all for listening and participating
in the discussion, - Martha Curley and Jay Deshpande.
-
- Contact Information
- Martha A.Q. Curley, RN, PhD
- Martha.Curley_at_Childrens.Harvard.edu
- Jay Deshpande, MD
- jay.deshpande_at_Vanderbilt.Edu
- Paul Kurtin, MD
- pkurtin_at_chsd.org
66QUESTIONS AND DISCUSSION
67Speaker Bios Martha A.Q. Curley, RN, PhD, FAAN
Martha A.Q. Curley, RN, PhD, FAAN is Director of
Critical Care and Cardiovascular Nursing Research
and serves on the faculty of the Program for
Patient Safety and Quality at Childrens
Hospital, Boston. She holds several academic
appointments, including Assistant Clinical
Professor of Anesthesia at Harvard Medical
School. Dr. Curley serves on numerous hospital,
regional and national committees. She is chair
of the Nursing Research Council at Childrens
Hospital and a member of the Research Steering
Committee of the Institute for Nursing
Healthcare Leadership. Among her many national
committee assignments, she has served as a member
of the Committee on Clinical Guidelines and
Levels of Care for PICU of the Society of
Critical Care Medicine. At the international
level, she co-chaired the Scientific Committee
for the 4th World Congress of the World
Federation of Pediatric Intensive and Critical
Care Societies. As a member of the American
Association of Critical Care Nurses (AACN)
Certification Board of Directors, she contributed
to the development of acute care nurse
practitioner standards of care and the agreement
to co-sponsor a joint certification for acute
care nurse practitioners by AACN and the ANA
the first of its kind in the history of nursing.
Dr. Curley has made substantive contributions
in research, teaching and clinical care. Her
pioneering studies on the Nursing Mutual
Participation Model of Care serve as a foundation
for the contemporary role of parents as partners
in the care of critically ill children. She
developed and published a phase one safety and
efficacy study on early and repeated prone
positioning in pediatric patients with acute lung
injury and is the principal investigator of a
large federally funded randomized control trial
on prone positioning. Dr. Curley received the
American Journal of Nursing Critical Care Book of
the Year Award in 1997 and 2002 and was invited
to contribute the lead article in Volume 1 of the
Journal of the Society of Pediatric Nurses and to
serve as guest editor of Volume 1 of Excellence
in Nursing Knowledge. She was the primary
architect of the Synergy Model, which serves as
the blueprint for the CCRN and CCNS certification
as well as a framework for nursing care delivery
in pediatric and adult hospitals across the
country. Dr. Curley was awarded lifetime
membership in the American Association of
Critical Care Nurses, the Norma J. Shoemaker
Award for excellence in critical care nursing
from the Society of Critical Care Medicine and
the distinguished alumna award from Yale
University. She was inducted into the American
Academy of Nursing in 1998.
68Speaker Bios Jay K. Deshpande, MD, MPH
- Jay Deshpande, MD, MPH is Director of the
Division of Pediatric Critical Care Medicine and
Medical Director of Performance Management and
Improvement at Vanderbilt Childrens Hospital.
He is Professor of Pediatrics and Anesthesiology
and serves as Vice Chair for Clinical Affairs in
the Department of Pediatrics and Vice Chair for
Faculty Affairs in the Department of
Anesthesiology at Vanderbilt University Medical
Center (VUMC). Dr. Deshpande is engaged in
numerous professional activities, most recently
as the Vice President/President Elect of the
Society for Pediatric Anesthesia and Chairman of
the Education Committee for the Society. He
serves on several hospital committees, including
the VUMC Executive Safety Committee and the VUMC
Executive Quality Council. He is a member of the
Board of Directors of The Vanderbilt Medical
Group. Dr. Deshpande has served as a mentor to
numerous fellows, interns and graduate students.
He has authored multiple journal articles and
book chapters and is editor of The Pediatric Pain
Handbook (1996, 2004 with J.D. Tobias). - Dr. Deshpande currently is Principal
Investigator under a Tennessee Emergency Medical
Services for Children State Partnership Grant and
a Collaborating Investigator on an AHRQ sponsored
study on testing improvement strategies in
critical care. - Dr. Deshpande earned his medical degree from the
University of Tennessee, completed his residency
training in pediatrics at LeBonhuer Childrens
Medical Center and in anesthesia at the Hospital
of the University of Pennsylvania. He completed a
fellowship in pediatric anesthesia and critical
care at the Childrens Hospital of Philadelphia
and was a research fellow in the Department of
Anesthesia at the University of Pennsylvania and
Laboratory for Experimental Brain Research at the
University of Lund, Sweden. He completed a
Masters of Public Health, with a focus on quality
improvement at Vanderbilt Medical Center. Dr.
Deshpande is certified by the Subspecialty Board
in Critical Care Medicine.
69Speaker BiosPaul Kurtin, MD
- Paul Kurtin, MD is widely recognized for his
work in quality measurement and improvement. In
his roles as Vice President for Clinical
Innovation and Director of the Center for Child
Health Outcomes at Childrens Hospital and Health
Center, Dr. Kurtin led the establishment of a
culture focused on quality of care and
evidence-based medicine. His work was
instrumental in the recognition of Childrens
Hospital and Health Center eoyj the JCAHO Ernest
Codman award in 2002. - Dr. Kurtin is a pioneer in the area of child
health care improvement. He was involved in the
formation of the Child Health Accountability
Initiative (CHAI) and served as its medical
director for five years. He is a member of the
Executive Committee of the National Advisory
Board of the Child and Adolescent Health
Measurement Initiative and leads the strategic
advisory committee for NICHQ. - A nationally recognized leader in measure
development and its use to improve care, Dr.
Kurtin has authored numerous articles and
publications on quality and outcomes and has
served as an expert panelist or consultant to
several organizations, including the Institute of
Medicine, American Academy of Pediatrics and RAND
Corporation. He was a participant in an
invitational National Quality Forum Workshop on
Childrens Healthcare Quality Measurement and
Reporting. - Dr. Kurtin has led numerous community-wide
initiatives to assess the needs and improve the
health of children in San Diego. He is a member
of the San Diego Center for Patient Safety and
was named its Member of the Year in 2003. - Dr. Kurtin is Research Professor and Director of
the Maternal and Child Health Program in the
Graduate School of Public Health at San Diego
State University. He received his medical degree
from the New York University School of Medicine
and is board certified in internal medicine and
nephrology. He is a fellow of the American
College of Pediatrics.
70Past Broadcasts
Materials from past Web casts (Medication
Reconciliation, Rapid Response Teams) are
available. Materials from todays session will
be available soon.
- CHCA www.chca.com
- jeff.brandon_at_chca.com
- david.bertoch_at_chca.com
- NACHRI www.childrenshospitals.net
- eschwalenstocker_at_nachri.org
- NICHQ www.nichq.org
- ccganser_at_nichq.org
- ecrites_at_nichq.org
- pkurtin_at_chsd.org
71Future Broadcasts
- July 27 Central Line Infection
- (200 pm ET, 100 pm CT, 1200 pm MT, 1100 am
PT) - August 17 Surgical Site Infection
- (1200 pm ET, 1100 am CT, 1000 am MT, 900 am
PT) - To register e-mail webcasts_at_chca.com
72Other Resources Available
- Things that Work Hot Topics in Pediatric
Patient Safety - American Academy of Pediatrics conference call
series - www.aap.org/visit/thingsthatworkcall.htm