Vicki Stogsdill, RN, MBA, Senior Vice President of Operations
Liz Hobgood, RN, MSN, MBA, Assistant Vice President, Jewish Hospital, Executive Director, Cardiovascular Services, OMHS
Sherry O’Bryan, RN, MSN, Manager of Intensive Care Unit
William O’Bryan, MD, Critical Care Medical Director, Pulmonologist
Lisa Thompson, RHIT, RN, BS, Director of Quality and Safety
Mike Sisley, RRT, Manager of Respiratory Therapy

To decrease the ventilator-associated pneumonia rate by 50 percent over an 18-month period

• Incidence of ventilator-associated pneumonia
• Compliance with the Ventilator Bundle
• Number of ventilator days
• Number of days between ventilator-associated pneumonia infection cases

The team utilized the Institute for Healthcare Improvement’s (IHI) Ventilator Bundle as a basis for our change. By tailoring it to our specific institutions needs and culture, we were able to achieve significant reductions in our ventilator-associated pneumonia (VAP) rate.

• Assured that ventilator patients had the head of bed elevated 30 degrees (or more) when patient condition allowed
• Revised oral care policy to include not only oral care every two hours, but brushing of teeth every 12 hours and more aggressive suctioning of oropharyngeal secretions
• Formulated a Ventilator Bundle order set to be used on all ventilator patients which included all aspects of the Ventilator Bundle
• Reinforced the aspects of the Ventilator Bundle in multidisciplinary rounds every day as an independent redundancy
• Instituted a daily sedation vacation with criteria to be done every morning at 6:00 AM
• Instituted a daily screen for readiness for weaning from the ventilator

We exceeded our goal of decreasing our VAP rate by 50 percent over an 18-month period and achieved a zero VAP rate for eight consecutive months in the ICU. We saw some improvement very quickly. Significant, sustained improvements, however, took time, patience, and a long-term commitment to this project.

Lessons Learned

• Remember that head of the bed elevation is very important.  (This became clear in December 2004 when we had four VAPs and all four patients were unable to have their head elevated for a period of days because of their clinical condition.)
• Teach new staff members the importance of implementing the Ventilator Bundle.
• Obtain buy-in from nursing. It is critical to success.
• Make the changes as easy as possible for the nursing staff.
• Identify a physician champion.
• Remember that cultural changes take time.
   

Barriers

• Keep in mind that some physicians will/do not buy in early on.
• Avoid trying to start too many projects at once.

Next Steps

• Continue to keep energy level high for this project!!

Sherry O’Bryan, RN, MSN, Manager Intensive Care Unit
Owensboro Medical Health System
Email: sobryan@omhs.org