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Ventilator Associated Pneumonia

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Title: Ventilator Associated Pneumonia


1
Ventilator Associated Pneumonia
  • Lisa Hamel, Cardiopulmonary Services Director
  • March 2005

2
What is Ventilator Associated Pneumonia?
3
Why Is It Important ?
  • The mechanical ventilation (mv) care bundle
    combines a number of practices we already perform
  • This is intended to make us more effective and
    efficient

4
Why Is It Important ?
  • Ventilator-associated pneumonia is an important
    cause of hospital acquired infection
  • These infections are serious and may be life
    threatening

5
Why Is It Important ?
  • There is good evidence in the medical literature
    that we can reduce the risk of pneumonia to our
    patients
  • The mechanical ventilation care bundle should
    assure the best practice for every patient.

6
IHI Idealized Intensive Care
Care Team Reliable Processes Application of Best
Practices Patient and Family Participation in
care Climate of Collaboration
Leadership and System Infrastructure Measures Qual
ity, Safety, Productivity Goals Financial
Viability
Patient Daily Goals Interdisciplinary
Rounds Monitoring with Control Charts Anticipation
of Risk
Idealized Intensive Care that delivers
outstanding patient outcomes is characterized
by A leadership system that assures organized,
systematic ICU care An ICU care team and
executive leadership that assures continuous
improvement Efficient and timely delivery of
services within a system of care Shared
decision making between family and staff A safe
and orderly environment to patients, families,
and staff A skilled, coordinated, and
collaborative care team
7
Immanuel St. Josephs Mayo Health System 2004
Strategy Map
Vision Immanuel St. Josephs will be an
accessible, interdisciplinary Regional Medical
Center
  • Mission Immanuel St. Josephs -- Mayo Health
    System will provide care that is
  • patient-centered
  • safe
  • effective
  • timely
  • efficient
  • equitable

Preventative Care
Patients Community
Urgent Unusual
Chronic Care
  • Values
  • The needs of the patient come first
  • Embody integrity and pride in everything we do
  • Patient, community and staff are engaged in
  • decision making and planning for our future

Strategic Actions

Reduce Costs

Increase Revenue
Enhance Facilities
Promote
Services
Standardize Processes
Nurture Employees
Integrate Region
Create New Models of Care Be
24/7 Leverage Technology
Understand VOC Align Leadership Structure
  • Results when the Vision is reached
  • Patient experience exceeds their expectations
  • Patients will choose to receive most of their
    care locally
  • Excellent opportunities for staff members

Current State
8
Align ICU to Strategy
  • Standardize Processes
  • Care Bundles- Ventilator Associated Pneumonia,
    Deep Vein Thrombosis Prophylaxis
  • Create New Models of Care
  • Rapid Response Team
  • Intensivist Lead ICU
  • Understand the Voice of the Customer
  • Interdisciplinary Rounds/Daily Goals
  • Regional Referral to 24/7 ICU
  • Reduce Costs
  • Care Pathways

9
Project CharterMechanical Ventilation Care Bundle
Scope Inbounds DVT Project Order Sets Prevention
  • Project Objective
  • All patients receiving mechanical ventilation
    will receive the same standard of care.
  • Minimize Ventilator Associated Pneumonia (VAP) to
    zero
  • Monitor compliance to the MV care bundle.

How would they be Impacted? Safe, equitable,
LOS Efficient More involved/efficiency
  • Who would be impacted?
  • Patients/families
  • Physicians
  • ICU direct/indirect caregivers

Scope Out of Bownds Treatment of VAP Other types
of Prevnetion
Business Case (Why, Why now?) Prevention is key
to minimize risk/cost Part of the larger ICU
Improvement Project
Expected Benefits Less complications/adverse
reactions Interdisciplinary communication/standard
ize process
Potential Risks Resources utilized over the
learning curve of staff.
10
Care Bundles
  • a set of evidence-based interventions grouped
    together to improve patient outcome.

11
What does the Care Bundle Include ?
  • Weaning patient off of breathing machine every
    day
  • 30 degrees with the head of the bed elevated
  • Stress ulcer prophylaxis - drugs
  • Sedation vacation every day
  • DVT prophylaxis- drugs

12
Order Sets
  • Define specifically what care to be ordered.
  • Does not tell you how the care should be done or
    by whom
  • Signed by the physician

13
Clinical Pathways
  • Define the care and expected outcomes for each
    diagnosis
  • Define the role(s) for the interdisciplinary care
    team
  • Should create efficiencies and effectiveness with
    care delivery leading to lower costs.

14
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15
Who Participates in the MV Care Bundle ?
RTs
R.N.s
PHYSICIAN's
SOCIAL WORKER's
INFECTION CONTROL
PRACTITIONER's
PHARMACIST's
P.T.s/O.T.'s
DIETITICIAN's
16
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17
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18
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19
Quantifying Reliability
  • Reliability Number of actions that achieve the
    intended result total number of actions taken
  • Defect rate 1 minus Reliability
  • It is convenient to use defect rate as an index,
    expressed as an order of magnitude (e.g. 10-2
    means that 1 time in 100, the action fails to
    achieve its intended result)

20
Healthcare Process Reliabilities
For further reading, see McGlynn EA, Asch SM,
Adams J, et al. The quality of healthcare
delivered to adults in the United States. New
England Journal of Medicine. 2003348.
21
Intent, Vigilance and Hard Work 10-1 Performance
  • Level 1 (designing basic failure prevention)
  • Common equipment, standard orders sheets
  • Personal checklists
  • Working harder next time
  • Feedback of information on compliance
  • Awareness and training

22
Human Factors and Reliability Science 10-2
Performance
  • Level 2 (designing sophisticated failure
    prevention, basic failure identification and
    mitigation)
  • Decision aids and reminders built into the system
  • Desired action the default (based on evidence)
  • Redundancy
  • Scheduling
  • Takes advantage of habits and patterns
  • Standardization of process

23
Reliability/Redundancy for VAP
  • Order set
  • ICU Rounds daily- SUP/DVT
  • ICU Nurses/Respiratory Therapist interactions
    HOB- Weaning- Sedation vacation
  • Monitoring done by ICU manager/RT supervisor-
    Daily collection.

24
2004 Vent Assoc. Pneumonia
  • No cases reported for 2004 YTD
  • 5 cases projected YTD based on 2003 data
  • Cost Savings of approx. 12,000 per VAP case
    reported.
  • 72,000 in savings YTD
  • Goal- 100 compliance with VAP bundle

Warren et al. Outcome and attributable cost of
ventilator-associated pneumonia, Critical Care
Medicine 2003
25
Ventilator Associated Pneumonia Rapid Action Team
  • Team Champion- Sharon Schneller
  • Team Leader- Lisa Hamel
  • Members
  • Judy Webber -IC RN Kathleen Frederick- ICRN
  • Marie Griffin- ICU RN Carol Reichel-ICU RN
  • Tom Pankonin- DPh Lance Lothert- CRTT
  • George Elliot- RD Irene Pfeffer- SW
  • Dr. Scott Sanders- Pulmonologist
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