FHA Call to Action: Eliminating Infection-Related - - PowerPoint PPT Presentation

▶
fha call to action eliminating infection related
SMART_READER_LITE
LIVE PREVIEW

FHA Call to Action: Eliminating Infection-Related - - PowerPoint PPT Presentation

Dec 05, 2023 109 likes •538 views

FHA Call to Action: Eliminating Infection-Related Ventilator-Associated Complications IVAC Bi-Monthly Webinar #2 May 3, 2018 Agenda FHA MTC Call to Action for IVAC Data Review HRET HIIN Hospital Peer Sharing Meryl Montgomery, RN,

slide-1
SLIDE 1

FHA Call to Action: Eliminating Infection-Related Ventilator-Associated Complications IVAC Bi-Monthly Webinar #2 May 3, 2018

slide-2
SLIDE 2

Agenda

  • FHA MTC Call to Action for IVAC
  • Data Review
  • HRET HIIN Hospital Peer Sharing

– Meryl Montgomery, RN, MSN Sonya Floyd, RN, BSN,CIC Valerie Fox, RRT Medical Center Navicent Health

  • Available Resources
  • Closing Remarks
slide-3
SLIDE 3

SAVE LIVES: Cleaner hands are safer hands May 5, 2018

For resources and more information, visit the World Health Organization’s World Hand Hygiene Day page

http://www.who.int/infection-prevention

slide-4
SLIDE 4

Call to Action

  • FHA Quality Committee
  • FHA Annual Meeting
  • CEO Call to Action
slide-5
SLIDE 5

How are We Doing?

Oct 2016 Nov 2016 Dec 2016 Jan 2017 Feb 2017 Mar 2017 Apr 2017 May 2017 Jun 2017 Jul 2017 Aug 2017 Sep 2017 Oct 2017 Nov 2017 Dec 2017 Jan 2018 Feb 2018 FL Rate 1.75 1.72 2.33 2.42 2.49 2.56 1.95 2.59 1.92 1.50 2.37 2.52 2.43 1.02 1.91 1.25 1.49 # Reporting 89 89 90 93 93 93 90 91 92 92 92 92 91 89 86 74 66

0.00 0.50 1.00 1.50 2.00 2.50 3.00

Rate per 1,000

Baseline Rate = 2.15 Effective date: April 13, 2018 FHA Board Call to Action

slide-6
SLIDE 6

Polling

– Do you round daily to ascertain both bundle compliance? – Do you also assess for appropriative indications during rounds? – Do you use endotracheal tubes with subglottic secretion drainage? – Do you investigate each IVAC occurrence? – Which condition is the most frequent contributor to your IVAC cases?

  • Trauma
  • Sepsis
  • Abdominal Trauma
  • Thoracic Trauma
  • Other
slide-7
SLIDE 7

SONYA FLOYD, RN, BSN, CIC VALERIE FOX, RRT MERYL MONTGOMERY, RN, MSN

H.A.C.ING VAE’S

FHA 5.3.18

slide-8
SLIDE 8

Medical Center Navicent Health Macon, GA

  • 637 beds, 5 adult ICUs (86 beds)
  • 2015- 94 VAE, 2016- 74 VAE
  • 2015- 10 VAP, 2016- 8 VAP
slide-9
SLIDE 9

Aim and Background

Ai Aim How m uch im provem ent? By w hen? For w hom ?

By 9/ 30/ 17, decrease Ventilator Associated Events 30% (from 74 to 52) in the five adult ICUs.

Background Why this project and w hy now ? While VAP rate <10, the five adult ICUs under- performed compared to NDNQI and HRET HIIN benchmarks. Ventilator utilization rates

  • n the rise with higher

acuity; need to focus on preventing VAE.

9

slide-10
SLIDE 10

“But, our PVAP rate is low!”

10

  • Resting on our laurels of low VAP for several years →

complacency in 5 adult ICUs (86 beds)

  • In 2013, CDC criteria changed to VAE= VAC+ IVAC+ PVAP

– PVAP no longer the only issue- keeping up with the change

  • Impact of bench-marking:

– HRET HIIN: our VAE rates nearly double average of hosp average – NDNQI-4Q under-performance

0% 10% 20% 30% 40% 50% 60% 70% 1Q15 2Q15 3Q15 4Q15 1Q16 2Q16

% ICUs that outperform NDNQI >500 bed mean

% out-perform target

slide-11
SLIDE 11

Methodology

  • VAE task force with MD, executives,

interdisciplinary

  • Use of 6 sigma DMAIC and PDSA/ rapid

cycle change

  • Deep dive RCA trends
  • Data- benchmark HRET HIIN, NDNQI
  • Process and outcome measures
  • Multi-modal education
  • Front line and leader engagement
  • Participation in HRET HIIN AI fellowship
slide-12
SLIDE 12
  • Outcome Measures:

How is the system perform ing? What are the results? – VAE incidence overall and by unit – VAC, IVAC, VAP incidence rates – Benchmark comparisons: GHA HEN, HRET HIIN, NDNQI

  • Process Measures:

Are the parts or steps in the process or system perform ing as planned? – CLRT, Turn q 2 hr, HOB ≥30◦, CHG, oral hygiene, hi-lo ETT, separate oral/ ETT suction- observation/ interview/ documentation audit

  • Balance Measures:

What happened to the system as w e im prove the outcom e and process m easures? – Ventilator days – LOS for ventilator patients – Mortality rate for ventilator patients

12

Key Performance Measures

slide-13
SLIDE 13

Driver Diagram

13

slide-14
SLIDE 14

Key Changes Since Fall 2016

  • Re-education
  • Documentation parameters PEEP FiO2
  • Transport protocol
  • PAD (Pain Agitation Delirium) protocol
  • Focus on basics- hand hygiene, vent bundle,

mobility

  • Hardwired accountability
  • Adequate material resources
  • Closed ICUs (intensivists)
  • Standardize all changes across ICUs, services

14

slide-15
SLIDE 15

VAE Improvement Timeline

slide-16
SLIDE 16

Data driven timeline

16

slide-17
SLIDE 17

Communication of “burning platform” of VAE reduction

  • Tied to goals in performance review
  • Post/ review data, transparency
  • Committees, staff meetings, huddles
  • Involvement of front line staff in solutions/

engagement

  • Education of all levels
  • Paying attention to expected behavior
  • Administrative, interdisciplinary involvement-

incorporated into rounds- PAD, bundles, mobility, de-escalation, alternatives

  • Newsletters, BB, signs, “Potty Training”
slide-18
SLIDE 18

RCA form

slide-19
SLIDE 19

Vent Bundle monitoring tool

slide-20
SLIDE 20

Transport monitoring tool

slide-21
SLIDE 21

Outcomes

slide-22
SLIDE 22

KPI: VAE Incidence Rates/ month all adult ICUs

8.16 9.16 10.16 11.16 12.16 1.17 2.17 3.17 4.17 5.17 6.17 7.17 8.17 9.17 10.17 11.17 12.17 1.18 2.18 3.18 VAE/ 1000 pt days 12.4 8.2 10.2 2.5 6.4 4.5 5.6 2.8 2.1 2 2.6 1 5.4 3.9 0.9 1.8 3.3

  • 2

2 4 6 8 10 12 14

VAE/1000 pt days

VAE Incidence 8/16-3/18

slide-23
SLIDE 23

#IVAC/ PVAP over time

5 10 15 20 25 30 35 40 #IVAC #PVAP

#IVAC PVAP 2015-FY18

2015 2016 2017 YTD18

slide-24
SLIDE 24

ICU mobility: with a smile on his face!

slide-25
SLIDE 25

Cost savings

  • Reduced VAE by 60% (2016-78, 2017-31)
  • Met GHA HRET HIIN two year 20% target

reduction in year one (our baseline was 84)

  • HRET HIIN cost calculator= $ 21,000 / ”VAC”
  • Total estimated savings due to ↓VAE:

$987,000

slide-26
SLIDE 26

Benchmarking

  • HRET HIIN benchmarks both IVAC and

“VAC” (=CDC VAE definition which includes VAC, IVAC, VAP)

– VAC- ↑ FiO2 and/or PEEP for ≥ 2 days – IVAC- ↑ FiO2 and/or PEEP for ≥ 2 days, infection S/S (T >38, wbc>12,000), antibiotics started in infection window/ continued for 4 days

slide-27
SLIDE 27

Adult ICU vs HRET HIIN VAE-1

slide-28
SLIDE 28

HRET HIIN VAE IVAC rate

slide-29
SLIDE 29

Adult ICU vs NDNQI >500 bed

  • units. N 174 units

4Q15 1Q16 2Q16 3Q16 4Q16 1Q17 2Q17 3Q17 4Q17 % out-perform 60% 20% 80% 60% 100% 80% 100% 100% 100% target 51% 51% 51% 51% 51% 51% 51% 51% 51% 0% 20% 40% 60% 80% 100% 120% % units outperform NDNQI +

VAE: % Adult ICU outperform NDNQI >50 0 bed m ean rolling 8 quarters

slide-30
SLIDE 30

Sustaining the drop! #1 accountability

30

  • Accountability

– Interdisciplinary team – Interdisciplinary bedside rounds – Nursing leadership rounds- PAD? Mobility? – Intensivist model- 4 of 5 closed units by spring 2018

slide-31
SLIDE 31

Having what staff need

31

  • Portable suction machines
  • Portable vents- ↓ circuit breaks
  • Sufficient suction regulators
  • Hi/ Lo ETT
  • Cuff manometers

39% 95% 0% 20% 40% 60% 80% 100% Jan-Jun 2016 2017

% pts transport on vent vs "ambu"

slide-32
SLIDE 32

Back to the Basics- hand hygiene

32

slide-33
SLIDE 33

Transport protocol audits

33

  • RRT supv audit use of transport protocol
  • 79% ↓ in VAE correlated with transport

pre implement post implement # VAE w transports 31 3 % VAEs 72% 15% 0% 10% 20% 30% 40% 50% 60% 70% 80% 5 10 15 20 25 30 35

#/ % VAE pts w transports off unit

#/ % of patients w VAEs with transports off unit within 4 days of event

slide-34
SLIDE 34

How about bundle compliance?

34

  • Average of 200 vent pts/ week are audited

– observation/ documentation review- all units

  • Average 98%, minimum 92.% compliance
slide-35
SLIDE 35

Celebrating milestones

  • Respiratory staff and managers- Pay for

performance- BPR goals

  • Individual and group “Good Catch,”

+feedback re posted data

  • Admin and leadership rounds- observations

and feedback

  • Huddles, staff meetings, interdisciplinary

rounds

  • Pizza party for overall reduction in VAE and

bundle compliance

slide-36
SLIDE 36

Goal vs Outcome

36

Goal Results Stat us ↓VAE in five adult ICUs by 25% in 12 months

  • ↓ by 44.6% (from 74 to 41)

met

↓transport-related VAE by 25%

↓ by 79% met

Achieve ventilator bundle compliance >90%

Average 98%. Lowest at 92.6% compliance. met

Out-perform benchmark NDNQI the majority of quarters from 4Q16- 4Q17

Out-performed the past 6 quarters met

Out-perform benchmark HRET HIIN majority of months since October 2016

Out-performed all project

  • rganizations 13 of 16 mos.

met

slide-37
SLIDE 37
  • Lessons Learned

Reflections/ Lessons Learned

  • Lessons Learned

Overcom ing key barriers

  • build in EMR- refocus IT and engage Executive Sponsors
  • cultural change to embrace need to reduce VAE- leadership change, benchmark

comparison, reporting through HARM Committee structure

  • prior unsuccessful attempt to implement mobility and PAD- nurse-driven mobility

protocol, PAD in EMR

Surprises

  • Key clinical leaders reluctant to adopt changes
  • Failure of timely documentation triggered VAEs
  • Insufficient working suction regulators, bedside patient chairs, among others
  • LOS and vent days did NOT drop as VAE rate decreased. We did see a 12%↓in vent≥3d mortality

Advice

  • Complete RCAs and establish trends, use national benchmarks to drive

initiatives

  • Evaluate documentation to assure not causative of VAE
  • Develop transport protocol to eliminate procedure related breaks in circuit
  • Keep an eye on all KPIs

37

slide-38
SLIDE 38
  • Firm up PAD utilization via

intensivists, Pharmacy, Nursing staff

  • Implement mobility protocol
  • Build EMR reports for PAD/ mobility
  • Expand usage of hi-lo ETT.
  • Regular status check with front line

staff re barriers and needed resources.

38

2018 action items:

slide-39
SLIDE 39

2018 continued

  • Real time hip phone for alerts for vent

setting changes in PEEP and FiO2

  • Expand electronic hand hygiene

monitoring system from CVICU to all ICUs

  • Ongoing education and monitoring
  • Intensivist model, including NP, expanded

to 3 of 5 ICU’s

  • Dedicated ICU PT’s to support mobility
slide-40
SLIDE 40

Questions? Contact us!

  • Sonya Floyd

Floyd.sonya@navicenthealth.org

  • Valerie Fox

Fox.Valerie@navicenthealth.org

  • Meryl Montgomery

Montgom ery.Meryl@navicenthealth.org

slide-41
SLIDE 41

http://www.fha.org/health-care-issues/quality-and-safety/ir-vac.aspx

FHA IVAC Resource Toolkit

slide-42
SLIDE 42

We are here to help! HIIN@fha.org 407-841-6230 SAVE THE DATE! IVAC Bi-Monthly Webinar #3 July 5 @ 12pm ET

Registration: https://cc.readytalk.com/r/edqq2ie567np&eom

Contact Us