Evidence-Based Practices Reduce the Ventilator-Associated Pneumonia Rate for ICU Patients

Lancaster General Hospital
Lancaster, Pennsylvania, USA

 

Team

The team from Lancaster General Hospital is a participant in the IHI Learning and Innovation Community on Improving Outcomes for Critically Ill and High-Risk Patients on Reducing Ventilator-Associated Pneumonia. 

 

Stacey King MSN, RN, NE-BC, Director of Nursing, Project Leader
Dr. Yaroslav Lando, Physician Support
Aimee Anderson, BS, RN, CCRN, ICU Nurse Manager
Adam Becker, RN, ICU Staff Nurse/Quality Council

 

Aim

  • Achieve a 10 percent reduction in average length of stay (ALOS) on mechanical ventilator from a rate of 3.5 per 1,000 ventilator days in fiscal year 2008 (FY08) to 3.15 per 1,000 ventilator days for fiscal year 2009 (FY09)
  • Achieve a 10 percent reduction in ventilator-associated pneumonia (VAP) in the intensive care unit (ICU) from a rate of 4.1 per 1,000 ventilator days in FY08 to 3.7 per 1,000 ventilator days for FY09

Measures
  • VAP rate per 1,000 ventilator days
  • ALOS for mechanical ventilation per 1,000 ventilator days
  • Percent compliance with Ventilator Bundle
  • Percent compliance with multidisciplinary rounds and daily goals
  • Percent compliance with “sedation vacation”
  • Percent compliance with mobility protocol


Changes

In April 2006 Lancaster General Hospital joined the IHI Learning and Innovation Community on Improving Outcomes for Critically Ill and High-Risk Patients on Reducing Ventilator-Associated Pneumonia. The hospital formed a multidisciplinary team to initiate efforts to reduce VAP and ALOS for patients in the ICU on mechanical ventilation and to oversee the improvement efforts. The tests of changes included the following:

  • Initiated daily multidisciplinary rounds, which included daily assessment of the Ventilator Bundle components 
  • Implemented a mobility protocol for ventilated patients
  • Improved oral hygiene for ventilated patients using Sage oral care
  • Tested new endotracheal tube (ET) holder, which eliminated the bite block and allowed for better oral care
  • Established the practice of maintaining the head of the bed at 30 degrees (per the Ventilator Bundle recommendations), including taping the 30 degree mark on the patient’s bed as a visual cue 
  • Developed and implemented twice daily sedation vacation
  • Engaged respiratory therapists to promote head-of-bed elevation and developed a ventilator management protocol that allowed autonomous weaning of ventilator

 

Results

Graph_VAPinICU.jpg

Graph_Lancaster2.jpg

Graph_PatientsinICUwithVentilator.jpg

Graph_PatientswithMDR.jpg

 

Summary of Results / Lessons Learned / Next Steps

  • The team was able to decrease the VAP rate from 7.35 per 1,000 ventilator days in FY07 (beginning of joining the IHI Community) to 1.95 per 1,000 ventilator days in FY09.
  • The team was able to decrease the ALOS on a ventilator from a rate of 3.48 per 1,000 ventilator days in FY07 to 3.03 per 1,000 ventilator days in FY09.
  • The most important lessons learned for us were how important a small test of change is, the importance of staff engagement and education, celebrating successes no matter how small, and learning that a failure is not really a failure if you have learned something from it.
  • Our next steps are to continue the momentum, focus on mobility of ventilated patients, and continue to decrease our VAP rate.


Contact Information

Stacey King MSN, RN, NE-BC
Director of Nursing
Lancaster General Hospital
slking@lancastergeneral.org

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