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. 2

Team Form ation Rapid Cycle Improvement: • VAP team o 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 3

AIM and Measure Selection • To reduce VAP rate to zero within one year 10 9 9.46 8 7 6 CHAIPI grant 5.91 5 Product change 4 3 2 1 0 3 1 1 1 1 1 1 1 r r r r r r r r t t t t t t t t Q Q Q Q Q Q Q Q 5 6 7 8 9 0 1 2 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 4

Tests of Change • Discontinued use of the new oral hygiene kit • Reimplementation of the previously used oral hygiene kit adding Chlorhexidine (new) • Implemented protected specimen brushings to diagnose VAP 5

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 6

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 7

Wrap Up and Next Steps • Summary • Questions? • Next Test of Change: Periodically check for oral hygiene performance: (# of kits vs. ventilator days - 1:1) 8