The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

COMPLIANCE WITH THE VAP BUNDLE ACROSS MULTIPLE INTENSIVE CARE UNITS

R. Wolff1, K. D. Hargett1, B. Green1


Background: Since the publication of the Institute of Medicine report on the quality of health care in America, patient safety has been a major focus. Ventilator bundles were developed as part of the campaign to address the issue of Ventilator Associated Pneumonia (VAP). Ventilator bundles are a set of evidence based practices. Our ventilator bundle consists of 5 components, head of bed (HOB)elevation, deep vein thrombosis(DVT) prophylaxis, stress ulcer prophylaxis, daily sedation holiday, and readiness to extubate. Our VAP rates where below the national average, measuring less than 3/1000 ventilator days. Reducing VAP was not the focus. We focused on measuring our compliance with the ventilator bundle, to ensure our VAP rate remained low and to decrease ventilator days. Our objectives where to ensure that every bundle element was completed daily and to collected data for each element of the bundle on all patients ventilated greater than 24 hours in all 5 ICU’s. We calculated bundle compliance for each element and the total bundle.

Methods:
Each therapist was first introduced to the specific definitions for compliance. They were shown how to identify compliance and exceptions to compliance. Staff was taught how to record the compliance within our electronic chart. Charting of compliance was controlled by only allowing selections from drop down boxes. These selections would identify compliance, non compliance, or exceptions for each element. Auditing and retraining of the data collection and entry occurred daily for 4 weeks. Once we validated that all staff were using the same definitions we started measuring the data. We measured compliance by individual intervention and by total bundle compliance.

Results:
In the first quarter 2007, we audited 979 ventilator days for data and identified the following. The data is presented in the table for each unit and hospital wide compliance.

Conclusion: The use of a ventilator bundle has been shown to be an effective tool in the reduction of VAP. We trained our staff and nursing on the importance of the VAP bundle. We implemented and monitored hospital compliance with the bundle. Focusing on the individual interventions enabled us to identify the low compliance of Sedation Holiday and Readiness to Extubate. Additional performance improvement activities to increase compliance in these two areas are needed. Our goal is to achieve an individual intervention compliance of >95% and a total bundle compliance of >90%.

Zone Head of Bed Stress DVT prophylaxis Stress Ulcer prophylaxis Daily Sedation Holiday Readiness to Extubate Total Bundle Compliance
SICU 99.4% 99.4% 99.4% 68.6% 53.8% 55.2%
CCU 83.8% 99.1% 100.0% 30.0% 61.5% 65.7%
CVICU 88.5% 98.6% 100.0% 64.6% 64.6% 65.6%
MICU 99.1% 99.5%99.5%85.6% 90.5% 83.1%
NICU 99.1% 98.3%98.3% 56.7% 53.4% 61.5%
Hospital 94.0% 99.0%99.4% 60.3% 64.8% 66.2%



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