Zapping the VAP Pamela Brotherton-Sedano MS, RN CPHRM, CPHQ, HACP, - - PowerPoint PPT Presentation

Zapping the VAP

Pamela Brotherton-Sedano MS, RN

CPHRM, CPHQ, HACP, CHC, CCEP Vice President, Patient Safety/ Corporate Responsibility Officer

O’Connor Hospital, California

Objectives and About Us

• List the five components of the Ventilator

Associated Pneumonia (VAP) Bundle

• Calculate compliance with oral hygiene
• Consider utilization of protected specimen

bronchial brushings when diagnosing VAPs

• O’Connor Hospital is a 358 bed

community-based Catholic hospital located in San Jose, CA.

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Team Form ation

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Rapid Cycle Improvement:

• VAP team
• Validated compliance with the VAP bundle
• Findings:

Noncompliance with oral hygiene care

• Recommendation:

Change oral hygiene products Utilize protected specimen brushings to confirm VAP diagnosis

AIM and Measure Selection

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1 2 3 4 5 6 7 8 9 10 2 5 Q t r 3 2 6 Q t r 1 2 7 Q t r 1 2 8 Q t r 1 2 9 Q t r 1 2 1 Q t r 1 2 1 1 Q t r 1 2 1 2 Q t r 1

CHAIPI grant 9.46 5.91

• To reduce VAP rate to zero within one year

Product change

Tests of Change

• Discontinued use of the

new oral hygiene kit

• Reimplementation of

the previously used

• ral hygiene kit adding

Chlorhexidine (new)

• Implemented protected

specimen brushings to diagnose VAP

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Barriers, and How We Resolved those Barriers

• No feedback from staff regarding problems

with new product

(i.e.: difficulty in opening package and sponge breaking in patient’s mouth)

• Lack of hardwiring of the complete VAP

bundle (oral hygiene)

• Now- if clinical criteria for VAP is met,

physician notified and a bronchoscopy with protected specimen brushing is performed to confirm VAP

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Advice for Fellows

• Perform periodic PDSA’s
• Implement small tests of change and

celebrate successes with team

• Talk with team- educate and reeducate
• Rounding schedule
• Ensure all bundle components are followed
• Add protected specimen brushings to

confirm VAP

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Wrap Up and Next Steps

• Summary
• Questions?
• Next Test of Change:

Periodically check for oral hygiene performance: (# of kits vs. ventilator days - 1:1)