2007 OPEN FORUM Abstracts
STANDARD WEAN TIME ENHANCES COMPLIANCE WITH IHI BUNDLE TO DECREASE VAP RATES.
L. Cracchiolo1, D. Clayton1, A. Hueffmeier1, P. Gillen1, D. Prentice1, M. Kollef2
Objective: Determine a process to facilitate reduction of Ventilator-Associated Pneumonia (VAP) rates in the Medical Intensive Care Unit (MICU) at Barnes-Jewish Hospital
Design: Develop a team to identify interventions needed to decrease the VAP rate. In 2005, the VAP Standardized Infection Ratio (SIR) in the MICU had increased 30% from 2004. The 2005 year-to-date SIR was 1.1, which exceeded the 2005 hospital goal of 1.0 and 2006 goal of 0.5. During May, 2006 the VAP intervention team introduced and implemented the Institute for Health care Improvement (IHI) evidence-based bundle to the MICU. The goal was to decrease the MICU VAP SIR to 0.5 in 2006 by increasing compliance with IHI bundle components, particularly elevation of the head of bed (HOB) and weaning. Clinician-directed versus physician-directed weaning has been proven in literature to be beneficial. A weaning protocol was already in place although compliance was lacking due to workload and availability of respiratory therapists and nurses.
Method: A daily standard wean time, 0430-0630, was implemented. The ICU was divided into 4 pods, each with a specific wean time assigned during the standard time frame. Therapists and nurses assessed patient readiness to wean, based on criteria identified. If the patient passed the safety check, sedation was weaned to a Ramsey score of 2-3 to prepare for the trial at the assigned time. A spontaneous breathing trial (SBT) was performed for 30-60 minutes. Therapists and nurses provided continuous assessment during the weaning trial. If the patient passed, based on the criteria, the physician was notified and an order to extubate obtained.
Results: Pre-intervention data between May, 2005 and April, 2006 shows 18 infections/ 4,017 ventilator days, resulting in 4.5 infections/1,000 ventilator days. Post-intervention data between May, 2006 and February, 2007 shows 2 infections/3,220 ventilator days, resulting in 0.6 infections/1,000 ventilator days. Mantel-Haenszel Chi-Square = 9.61; P value = 0.002; RR (95% CI): 7.2 (1.7-31.0). Patients treated prior to implementation of the standard wean time were 7.2 times more likely to develop VAP.
Conclusion: A standard daily time for weaning assessment and subsequent trial enhances compliance with a weaning protocol. Increased compliance, when applied with other IHI bundle components, significantly reduces VAP rates.