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Reducing Complications from Ventilators: Ventilator Associated Pneumonia

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700 bed tertiary care medical center. Strong health is a Trauma Center, Transplant ... Change in sputum. Radiographic evidence of new or progressive infiltrates ... – PowerPoint PPT presentation

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Title: Reducing Complications from Ventilators: Ventilator Associated Pneumonia


1
Reducing Complications from Ventilators
Ventilator Associated Pneumonia
  • University of Rochester
  • Strong Health

700 bed tertiary care medical center. Strong
health is a Trauma Center, Transplant Center
(bone marrow, kidney, liver heart). 4 adult
ICUs MICU (17 beds), SICU (14 beds),
Burn/Trauma (17 beds), and Cardiovascular ICU (14
beds)
2
MICU Critical Care Team Members
  • Team Leader Michael Apostolakos, MD, Director
    Adult Critical Care
  • Day to day leadership
  • Michael Apostolakos, MD.
  • Isabelle Michaud, MD, Critical Care Attending
  • Mary Wicks, RN, MPA, Associate Director, Adult
    Critical Care
  • Barry Evans, MSN, Adult Critical Care QI Data
    Coordinator
  • Tim Kehl, RN, Nurse Leader
  • Janice Bell, RN, Nurse Leader
  • Additional key members
  • Lucille Nelson, RN, MICU Care Coordinator,
  • Jennifer Carlson, RRT, Supervisor Critical Care
    Respiratory Therapy

3
Why is reduction of VAP a priority?
  • Mortality
  • 50-70
  • Increased LOS
  • ICU 17.7 vs 6.1
  • Complications
  • ARDS
  • Atelectasis
  • Pneumothorax
  • Sinusitis
  • Cost of treating 1 case of VAP
  • 5,000 27,000

4
VENTILATOR BUNDLE
  • Elevate HOB 30 degrees unless contraindicated
  • Sedation Holiday
  • Reduce or turn off sedation daily
  • DVT Prophylaxis
  • PUD Prophylaxis
  • Test for readiness to wean or ability to extubate
    daily

5
HMOPREVENT VENTILATOR ASSOCIATED PNEUMONIA
  • HOB
  • HOB is elevated at 30 degrees unless medically
    contraindicated
  • Reduces aspiration of oropharyngeal/gastric
    secretions
  • Mobility
  • Turn Q 2 hrs/ OOB when appropriate
  • Mobilizes secretions
  • Oral Care
  • Perform Oral Care Q 2 hrs following structured
    oral care protocol
  • Removes pathogens from oropharynx

6
VAP CRITERIA
  • gt 48 hours on ventilator
  • At least 3 out of 5
  • Fever
  • Leuckocytosis
  • Change in sputum
  • Radiographic evidence of new or progressive
    infiltrates
  • Worsening O2 requirements
  • Final determination of VAP diagnosis is made by
    the attending physician

7
Vent Bundle Compliance
8
Frequency of Ventilator Associated Pneumonia
1
1
1
2
2

1 Vent Bundle implemented 2 Reeducation
9
Days between incidences of VAP MICU
492 Days
212 Days
2
1
1 Vent bundle reeducation 2 Oral Care Protocol
10
Ventilator Bundle Cycles of Improvement
  • Numerous, rapid PDSA cycles of vent bundle as
    part of goal sheet on a few patients led to
    refinement of goal sheet.
  • Support of Medical Director and nurse leaders key
    to implementation
  • Training of attendings, residents and bedside
    nurses vitally important (education)
  • Posting results, positive reinforcement leads to
    more excitement
  • Focusing all initiatives on patient centered care
    and not in isolation
  • Importance of initiatives echoed by senior
    leadership during walk rounds
  • PDSA cycles continue as utilization continues to
    vary (ie percentage utilization decreases under
    certain attendings)
  • Constant feedback from nurses
  • Forms remain as permanent record

11
Keys to Success, Barriers and Lessons Learned
  • Involve key front line staff
  • Ongoing education.why are we doing this?
  • Participation by senior leaders
  • Medical Director and Nurse Manager must be fully
    supportive
  • Administrative assistance
  • Resistance to change
  • Perceived increased workload
  • Another QI project which will go away
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