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IHI Campaign to Save 100,000 Lives Pediatric Node presents: Preventing Ventilator Associated Pneumonia

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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). – PowerPoint PPT presentation

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Title: IHI Campaign to Save 100,000 Lives Pediatric Node presents: Preventing Ventilator Associated Pneumonia


1
IHI 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)

2
Pre-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

3
IHI 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

4
Pediatric 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

5
IHI 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

6
IHI 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).

7
Key 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.

8
IHI 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.

9
Additional Resources
  • www.chca.com
  • www.childrenshospitals.net
  • www.nichq.org
  • www.ihi.org
  • For information on Campaign data submission, go
    to www.ihi.org.

10
VAP 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

11
Reducing Morbidity and Mortality from Ventilator
Associated Pneumonia
12
Please note that all data presented are for Peer
Review/Quality Improvement only.
13
Impact 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)

14
Impact 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.

15
Changing 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

16
Ventilator 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

17
Bacterial causes Bad bugs - 1
  • EarlyOnset Pneumonia
  • Pathogens
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Staphylococcus aureus
  • Community-acquired
  • Antibiotic-sensitive

18
Bacterial causes Bad bugs - 2
  • Late-Onset Pneumonia
  • Pathogens
  • Pseudomonas aeruginosa
  • Methicillin resistant Staphylococcus aureus
  • Acinetobacter
  • Enterobacter
  • Other hospital-acquired
  • Antibiotic-resistance increasing

19
Risk 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

20
Risk 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

21
Implications of VAP
  • Increased LOS
  • Increased ventilator days
  • Increased risk of infection
  • Increased costs
  • Increased morbidity and mortality

22
The 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.

23
The 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.

24
Adult 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

25
Adult 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

26
Head 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.
27
Sedation 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.
28
PEDIATRIC 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

29
Given 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

30
Adult 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

31
Given 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)

32
  • AJRCC 200571388-416

Guidelines 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
33
Modifiable 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

34
Modifiable 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

35
Modifiable 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.

36
Use of Saline During ETT Suctioning
CHB MSICU Practice Guideline
37
Modifiable 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.

38
Modified 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
39
Adapted from Randolph et al. (2002) JAMA, 288
2561
40
Modifiable 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)

41
Modifiable 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

42
Comprehensive 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.

43
Modifiable 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)

44
Give 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!

46
ZAP 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

47
Prevention 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

50
ZAP VAP
  • Decreasing the risk of aspiration is key in
    preventing VAPs.
  • Elevate HOB gt 30 degrees (unless contraindicated)
  • Monitor gastric residuals q 4 hrs

51
ZAP 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

52
ZAP 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?

56
Please note that all data presented are for Peer
Review/Quality Improvement only.
57
Please note that all data presented are for Peer
Review/Quality Improvement only.
58
The Game Begins
  • Nightingale metrics
  • Spring 04
  • Motivation Link process measures to outcome
    measures

59
MMAAS Scoring Q4H
Benchmark 100
Percent of total
Please note that all data presented are for Peer
Review/Quality Improvement only.
60
MMAAS Scoring Q4H
Benchmark 100
Percent of total
Please note that all data presented are for Peer
Review/Quality Improvement only.
61
Mouth 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
62
If 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
63
Extubation 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
64
To 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

65
ZAP 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

66
QUESTIONS AND DISCUSSION
67
Speaker 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.
68
Speaker 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.

69
Speaker 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.

70
Past 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

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Future 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

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Other Resources Available
  • Things that Work Hot Topics in Pediatric
    Patient Safety
  • American Academy of Pediatrics conference call
    series
  • www.aap.org/visit/thingsthatworkcall.htm
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