Zero VAP Rate in the ICU by Reducing Time on Sedation

​Mercy Hospital

Buffalo, New York, USA


The Mercy Hospital team is a charter member of IHI's Passport program.


Mercy Hospital's strategy to eliminate ventilator-associated pneumonia (VAP) for patients in the intensive care unit (ICU) includes reliable implementation of the IHI Ventilator Bundle, with a special focus on reducing the amount and duration of sedation for patients on ventilators in the ICU. One of the key elements of the IHI Ventilator Bundle is daily "sedation vacations" and assessment of readiness to extubate the patient.


Linda Horton, Vice President of Clinical Innovations and Outcomes, credits her organization’s participation in the IHI Expedition on Preventing Complications in the ICU for the increase in the reliability of their care for ICU patients. After their Expedition participation, their VAP rate has stayed at zero for almost a year and a half.



To reduce the risk of developing hospital acquired ventilator pneumonia for patients in ICU, with 50 percent reduction in the amount and duration of sedation and 30 percent reduction in ventilator days by September 2011.


Actions Taken

  • Physician leader rounding daily
  • Use of ventilator order sheet
  • Protocol-driven sedation tools for propofol use
  • Support from interdisciplinary team: pharmacy, respiratory therapy, nurses, physicians
  • Education to associates on MAAS scores
  • Daily sedation vacations scheduled
  • Communication
  • Streamline documentation
  • Ventilator Bundle education
  • Implementation of oral care policy and oral care kits every 4 hours
  • Head of bed elevation: 30 degrees



The Mercy team tracked data on the percent of their patients on propofol exceeding three days. They report a 77.2 percent reduction in days on propofol and an 82.2 percent reduction in doses dispensed. They also report that the VAP rate for ICU patients has been at zero for almost a year and a half.




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