Improvement Report: Reducing Ventilator-Associated Pneumonia
Naval Medical Center San Diego
San Diego, California, USA
Team
CAPT Scott Parrish, MD, FCCP, Director, Critical Care Medicine
CDR Carla Tolbert, RN, MS, CEN, Department Head, Critical Care Nursing
CDR Joe Rappold, MD, Surgical Intensivist
CDR Rich Mahon, MD, Medical Intensivist
LCDR Kim Newell, RN, MSN, CCRN, CNS, Clinical Nurse Specialist, Critical Care Nursing Department
LT Laura Ledyard, RN, MS, Division Officer, Intensive Care Unit
LT Leanne Mader, RN, BSN, Division Officer, Cardiac Care Unit
LT Angie Klinski, PharmD, Clinical Pharmacist
Aim
To reduce average ventilator days and ventilator-associated pneumonia by 26 percent
Measures
- Ventilator bundle utilization
- Average mechanical ventilator days
- Ventilator-associated pneumonia rate
Changes
- Gathered baseline ventilator bundle ("vent bundle") compliance data
- Added 5th and 6th components to vent bundle: Respiratory Therapy weaning readiness assessment and antibacterial hand foam at bedside and on ventilator
- Vent bundle protocol instituted, refined, and included as a part of the nursing assessment documentation
- Conducted more nursing staff education
- Performed daily bedside rounds emphasizing protocol education
- Finetuned computerized charting/data collection tool
- Replaced previous data collector
- Collected data daily vs. weekly
Results
  
Summary of Results / Lessons Learned / Next Steps
Implementation, and increased utilization, of a ventilator bundle resulted in a small trend downward in the average mechanical ventilator days and a reduction in ventilator-associated pneumonia by almost 100 percent.
Lessons Learned
- Engage senior leadership early: Makes them aware of projects and goals, which is important when additional resources (personnel, financial, administrative, etc.) are needed
- Change takes time and effort: Do not expect goal attainment or 100 percent compliance within the first month or so of implementation
- Start with small changes: Bedside clinical staff have limited time for "big picture" projects, so starting small lets them grow with the project
- Implement one change at a time: Too many simultaneous changes can be overwhelming for bedside clinical staff to learn and apply to daily practice, and for collaborative team members to develop, test and monitor
Contact Information
LCDR Kim Newell, NC, USN
Clinical Nurse Specialist
Critical Care Nursing Department
Naval Medical Center San Diego
34800 Bob Wilson Drive
San Diego, CA 92134
kjnewell@nmcsd.med.navy.mil
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