2.50
Hdl Handle:
http://hdl.handle.net/10755/148324
Type:
Presentation
Title:
Reduction of Ventilator Associated Pneumonia
Abstract:
Reduction of Ventilator Associated Pneumonia
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:November 10 - 14, 2001
Author:Murray, Theresa
P.I. Institution Name:Community Hospitals Indianapolis
In January 1998 our Critical care Quality Improvement team reviewed reports from the infection control department which revealed our institution’s rate of ventilator associated pneumonia (VAP) was greater than the national benchmark, National Nosocomial Infection Surveillance System (NNIS). Based on the above information, a unified team was formed between the ICU group and the infection control department sharing a common goal of reducing the VAP rate below the NNIS 25th percentile across our organization. This effort was co-led by the critical care clinical nurse specialist and the infection control nurse. VAP increases the mortality rate of intensive care patients up to ten times over patients without pneumonia. Pneumonia also extends the hospital stay, and increases cost of care. The cost is difficult to quantify, but has been reported as low as $5800 and as high as $40,000 in some facilities. Many disciplines were represented on the VAP Reduction Team: Pharmacy; Respiratory Therapy; Infection Control; Clinical Education; Medicine; and Nursing. Each discipline conducted a literature review within their own field for documented evidence of interventions or therapies that had the potential to impact the development of pneumonia in the mechanically ventilated patient. The role of the multidisciplinary team, the impact of the clinical nurse specialists, the role of national benchmarking in decision-making as well as the type of organizational support required to sustain the practice changes were all critical to our success. Several initiatives were generated from review of the literature: Incorporating into daily care a sedation scale and the Development of Sedation Scale Guidelines: This tool provided staff an objective method to address their patients’ comfort needs. This resulted in consistency of care at a lower cost. We determined that for some patients, sedation was a reason the patient was unable to be mobilized, and then weaned from the ventilator. Development of a Standardized Weaning Protocol: The process for ventilator weaning was standardized which also decreased variation in care. Development of H2 blocker guidelines: The goal was to reduce the use of this medication, without causing harm to the patient Development of criteria to utilize continuous Lateral Rotational Therapy. Patient care practices: hand washing, mobility, positioning, oral care, care of the ventilator circuit. Based on an evaluation of observed clinical practice, the need for education became evident. Because so many aspects of care were involved in behavior changes, a novel approach to education was paramount. Full support was elicited from the network’s administration. Two hour mandatory education sessions were approved for all nursing and respiratory staff. A ten minute video was produced in which the network’s CEO acted as the patient and the Medical Director of the ICU and the Hospital Epidemiologist were actors, role-playing the various aspects of ventilator patient care management. The video was used as the introduction to the educational extravaganza. The remainder of the education program consisted of six stations, attended by an expert in the area of practice: Ventilator modes, Weaning Protocol, Sedation, Care of the Ventilated Patient, Hand washing, and a testing station. As each staff member moved through the stations, an expert was there to highlight the information and to answer questions individually. At the testing station a mock patient room was set up, including a simulated patient on a ventilator. Each staff member was required to demonstrate what they had learned; passing a written test was also part of the competency. Upon completion of the education, staff were held accountable to the written expectations. Evaluations of the educational sessions from the staff were very positive. They expressed approval for the unique strategy for learning, and indeed the practice learned in this session began to become part of the everyday care of ventilated patients. Evaluation of the success of our project was based on the ongoing data collection by our Infection Control Department and comparing results to the NNIS data. Following completion of the educational program in May of 1999, results for the remainder of the year were extremely positive. At the major hospital in the four hospital network system, the VAP rate dropped to the NNIS 10th percentile and remained at the 25th percentile rate for the entire next year. At the next larger hospital, accounting for less than 30% of the network’s ventilator days, the rate remained nearly the same, slightly above the 50th percentile for the remainder of the year. Over the next full year, the target goal was achieved at the 25th NNIS percentile. The two smaller hospitals, which have a small ventilator population, were able to meet the target goal over the next full year. Noteworthy is the fact that immediately following the education, there was no VAP reported for 137 days at the largest ICU, which had a predicted VAP every 8 days previous to the education. Lesson’s learned as a result of this project are many. Probably most important is the value of teamwork amongst the disciplines involved. Members’ work was fueled by principles of collaboration, cooperation, and open-mindedness. Secondly, success of the project was dependent upon having “champions” from all disciplines at all sites to constantly role model the changes in practice and constantly support the process changes. Another influencing factor was the innovative design of the educational program. Combining the various methods of learning was beneficial. Lastly, administrative support for the project was an invaluable contribution to its positive outcome. Without their support the same level of success could not have been achieved.
Repository Posting Date:
26-Oct-2011
Date of Publication:
10-Nov-2001
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleReduction of Ventilator Associated Pneumoniaen_GB
dc.identifier.urihttp://hdl.handle.net/10755/148324-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Reduction of Ventilator Associated Pneumonia</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">November 10 - 14, 2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Murray, Theresa</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Community Hospitals Indianapolis</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">theresa.murray@ehealthindiana.</td></tr><tr><td colspan="2" class="item-abstract">In January 1998 our Critical care Quality Improvement team reviewed reports from the infection control department which revealed our institution&rsquo;s rate of ventilator associated pneumonia (VAP) was greater than the national benchmark, National Nosocomial Infection Surveillance System (NNIS). Based on the above information, a unified team was formed between the ICU group and the infection control department sharing a common goal of reducing the VAP rate below the NNIS 25th percentile across our organization. This effort was co-led by the critical care clinical nurse specialist and the infection control nurse. VAP increases the mortality rate of intensive care patients up to ten times over patients without pneumonia. Pneumonia also extends the hospital stay, and increases cost of care. The cost is difficult to quantify, but has been reported as low as $5800 and as high as $40,000 in some facilities. Many disciplines were represented on the VAP Reduction Team: Pharmacy; Respiratory Therapy; Infection Control; Clinical Education; Medicine; and Nursing. Each discipline conducted a literature review within their own field for documented evidence of interventions or therapies that had the potential to impact the development of pneumonia in the mechanically ventilated patient. The role of the multidisciplinary team, the impact of the clinical nurse specialists, the role of national benchmarking in decision-making as well as the type of organizational support required to sustain the practice changes were all critical to our success. Several initiatives were generated from review of the literature: Incorporating into daily care a sedation scale and the Development of Sedation Scale Guidelines: This tool provided staff an objective method to address their patients&rsquo; comfort needs. This resulted in consistency of care at a lower cost. We determined that for some patients, sedation was a reason the patient was unable to be mobilized, and then weaned from the ventilator. Development of a Standardized Weaning Protocol: The process for ventilator weaning was standardized which also decreased variation in care. Development of H2 blocker guidelines: The goal was to reduce the use of this medication, without causing harm to the patient Development of criteria to utilize continuous Lateral Rotational Therapy. Patient care practices: hand washing, mobility, positioning, oral care, care of the ventilator circuit. Based on an evaluation of observed clinical practice, the need for education became evident. Because so many aspects of care were involved in behavior changes, a novel approach to education was paramount. Full support was elicited from the network&rsquo;s administration. Two hour mandatory education sessions were approved for all nursing and respiratory staff. A ten minute video was produced in which the network&rsquo;s CEO acted as the patient and the Medical Director of the ICU and the Hospital Epidemiologist were actors, role-playing the various aspects of ventilator patient care management. The video was used as the introduction to the educational extravaganza. The remainder of the education program consisted of six stations, attended by an expert in the area of practice: Ventilator modes, Weaning Protocol, Sedation, Care of the Ventilated Patient, Hand washing, and a testing station. As each staff member moved through the stations, an expert was there to highlight the information and to answer questions individually. At the testing station a mock patient room was set up, including a simulated patient on a ventilator. Each staff member was required to demonstrate what they had learned; passing a written test was also part of the competency. Upon completion of the education, staff were held accountable to the written expectations. Evaluations of the educational sessions from the staff were very positive. They expressed approval for the unique strategy for learning, and indeed the practice learned in this session began to become part of the everyday care of ventilated patients. Evaluation of the success of our project was based on the ongoing data collection by our Infection Control Department and comparing results to the NNIS data. Following completion of the educational program in May of 1999, results for the remainder of the year were extremely positive. At the major hospital in the four hospital network system, the VAP rate dropped to the NNIS 10th percentile and remained at the 25th percentile rate for the entire next year. At the next larger hospital, accounting for less than 30% of the network&rsquo;s ventilator days, the rate remained nearly the same, slightly above the 50th percentile for the remainder of the year. Over the next full year, the target goal was achieved at the 25th NNIS percentile. The two smaller hospitals, which have a small ventilator population, were able to meet the target goal over the next full year. Noteworthy is the fact that immediately following the education, there was no VAP reported for 137 days at the largest ICU, which had a predicted VAP every 8 days previous to the education. Lesson&rsquo;s learned as a result of this project are many. Probably most important is the value of teamwork amongst the disciplines involved. Members&rsquo; work was fueled by principles of collaboration, cooperation, and open-mindedness. Secondly, success of the project was dependent upon having &ldquo;champions&rdquo; from all disciplines at all sites to constantly role model the changes in practice and constantly support the process changes. Another influencing factor was the innovative design of the educational program. Combining the various methods of learning was beneficial. Lastly, administrative support for the project was an invaluable contribution to its positive outcome. Without their support the same level of success could not have been achieved.</td></tr></table>en_GB
dc.date.available2011-10-26T09:43:31Z-
dc.date.issued2001-11-10en_GB
dc.date.accessioned2011-10-26T09:43:31Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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