Ventilator-Associated Pneumonia Ventilator-Associated Pneumonia: - - PowerPoint PPT Presentation

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Ventilator-Associated Pneumonia Ventilator-Associated Pneumonia: - - PowerPoint PPT Presentation

Nov 12, 2022 126 likes •379 views

Ventilator-Associated Pneumonia Ventilator-Associated Pneumonia: Sustaining the Gain A Success Story Ventilator-Associated Pneumonia Presenters: Georgia Jackson, BSN, RN, MPH Unit Director Medical Intensive Care Unit Monica Maher, BA, RN,

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Ventilator-Associated Pneumonia

Ventilator-Associated Pneumonia: Sustaining the Gain

A Success Story

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Ventilator-Associated Pneumonia

Presenters:

Georgia Jackson, BSN, RN, MPH Unit Director Medical Intensive Care Unit Monica Maher, BA, RN, CIC Infection Prevention and Control Coordinator Emory University Hospital Midtown

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Emory University Hospital Midtown

VENTILATOR-ASSOCIATED PNEUMONIA

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0.00 2.00 4.00 6.00 8.00 10.00 12.00 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

#VAP/Vent Days x 1000

EUHM Cumulative ICU Ventilator-Associated Pneumonia Rate 2000-2012

Alcohol Gel in Patient Rooms

New VAP Definition Ventilator Bundle Hand Hygiene Campaign

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0.00 3.00 6.00 9.00 12.00 15.00 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 # VAP / 1000 Vent Days

Ventilator-Associated Pneumonia 21ICU Cardiac Surgery

0.00 3.00 6.00 9.00 12.00 15.00 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 #VAP / 1000 Vent Days

Ventilator-Associated Pneumonia 31ICU Neurosurgery

0.00 3.00 6.00 9.00 12.00 15.00 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 #VAP / 1000 Vent Days

Ventilator-Associated Pneumonia 41ICU Cardiac Care

0.00 3.00 6.00 9.00 12.00 15.00 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 #VAP / 1000 Vent Days

Ventilator-Associated Pneumonia 71ICU Medical/Surgical Teaching

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Staff Engagement was high due to sustained decrease in rates Staff did not wish to see competing priorities impact the excellent work that had already been done

VENTILATOR-ASSOCIATED PNEUMONIA

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Multidisciplinary Team:

  • Representatives include front line champions and unit based VAP Team

members

  • Respiratory Therapy
  • ICU Intensivist Teams
  • Physician Champions

VENTILATOR-ASSOCIATED PNEUMONIA

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Clinical Excellence Executive Oversight Committee (CEEOC)

  • Establishment of high level Administrative Support for all HAI

Prevention Teams

  • Comprised of CEO, CMO, CNO for each entity
  • Progress, Results and Barriers identified at monthly meetings
  • Ability to identify barriers and needs and obtain support on
  • ngoing basis
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The EUHM VAP Team meets bimonthly VAP Cases Reported to staff in real time Root Cause Analysis (RCA) done On every identified case of ventilator-Associated Pneumonia by the front line care providers to help identify areas for improvment

VENTILATOR-ASSOCIATED PNEUMONIA

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Process Measures

Need for true assessment of where we were with Bundle Compliance

VENTILATOR-ASSOCIATED PNEUMONIA

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Rigorous data collection efforts 24/7 collection of bundle compliance data on every ICU ventilated patient every 12 hours for 6 months

VENTILATOR-ASSOCIATED PNEUMONIA

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The Team looked at barriers in completing the

  • ral care task

Survey Monkey to nursing staff to determine real time barriers to performing oral care for ventilated patients

VENTILATOR-ASSOCIATED PNEUMONIA

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Ventilator-Associated Pneumonia

Test of Change #1 for FY 2012

standardized placement of oral care kits for a 24 hour period of care outside of each room visible to all staff.

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Test of Change #2 for FY 2012 Incorporating oral care as a line item in bedside change of shift report allowed for increased accountability.

VENTILATOR-ASSOCIATED PNEUMONIA

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ORAL CARE SELF ASSESSMENT ZOOMERANG TOOL

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ORAL CARE SELF ASSESSMENT REASONS ORAL CARE IS MISSED

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Ventilator-Associated Pneumonia

Test of Change #3 for FY 2012 Beginning November 30th 2011 for all new admissions to ICU , Oral Care fires as a task in I-View which is our electronic documentation system

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EUHM Pareto Charts Pre Oral Care Task vs. Pareto Post Oral Care task

Oral care accounted for 40% of defects prior to task Oral care accounts for 10%

  • f defects post task

Oral care went from largest defect to 4th largest defect

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Recommendations/Next Steps

Sedation Pause/Daily Awakening Trials Team divided into subgroups with physician champion leads Change to a randomized collection of bundle compliance data (2 days a week at 7am and 7pm Tuesdays and Saturdays) Continue the important work of doing RCA’s on identified VAP’s

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Ventilator-Associated Pneumonia

Test of Change #4 for FY 2012

Transport Bundle

  • Suction patient before transporting
  • Attempt to maintain HOB 30 degrees during transport
  • OR patients from recovery to ICU’s-maintain HOB

elevation

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Conclusions Sustained VAP rates for the last 4 and a half years

  • 63% reduction in EUHM VAP rates compared to same time period in FY

2011.

  • Bundle compliance data monitoring across all ICU’s to identify areas for

improvement (every ventilated patient every 12 hours 2 days a week)

  • Oral Task Firing in Emory electronic Medical Record (eeMR) improved the

largest defect in bundle compliance

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Recommendations/Next Steps

We anticipate a sustained decrease in VAP rates and a decrease in length of stay on a ventilator as a benefit of the ICU model Established by Emory Healthcare’s Critical Care Center for Excellence:

  • 24/7 ICU Intensivist/Midlevel providers
  • Promotes Timelier Extubation
  • Decreased Ventilator Utilization
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THANK YOU

(Some of EUHM’s VAP Team)