The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts


Jon C. Inkrott, Christopher Orabella, Andrea L. Yates, Victoria Roelker, April Gochberg, Kathryn Brown, Myrkol Bolden, Molly Johantgen, Jude Gamel, Amy Russell, Kathy Bierman, Nancy Stamp, Robin Meisberger, Terri Kunkemoeller, Laura Powers, Karen Poleyeff, Donna Butler, Christopher Schmitt, Mark D. Johnson, Linda S. Baas, Anita Bennett, Evan Crawford, Michelle Sexton, Linda Kemper, Amy Shaw; The Christ Hospital, Cincinnati, OH

BACKGROUND: It is well estalished that VAP, the associated costs and resulting poor patient outcomes are of continued significance for the Respiratory Care profession and its practitioners. After two cases were confirmed in one of our three ICU's, a root cause analysis was performed. A Ventilator Management Committee (VMC) was organized to review and develop further guidelines. The objective was to eliminate VAP at our institution. The VMC is a multidisciplinary committee including MDs, RNs, RTs, RDs, Infection Control, Environmental Services, and Performance Improvement Specialists who were empowered by administration to make appropriate changes. METHOD: Current key components of The Ventilator Bundle and guidelines were reviewed from IHI, NIH, and the CDC. Interdisciplinary communication and definition of professional roles were also reviewed. The VMC expanded on the vent bundles to include the Richmond Agitation Sedation Scale (RASS), and subglottic suctioning for mechanically ventilated patients. These values are recorded on a two and four hour basis, respectively. Interdisciplinary collaboration was expanded by cross populating electronic charting for bedside caregivers to be able to review all information included in the vent bundle. Defined roles, techniques, and consistency in practice were also included in these guidelines. All ICU bedside caregivers were then educated on the new vent bundles, role definitions, and electronic charting changes. Chart audits and compliance of the expanded vent bundle values is audited weekly through the electronic medical record charting. The results are broken down unit specific as well as to individual compliance. RESULTS: Since the organization of the VMC in the second quarter of 2010, our institution has recorded zero VAP's in all three ICU's. The graph included shows this timeline and related cases per 1000 ventilator days. CONCLUSION:. Developing interprofessional collaboration is paramount for quality performance, preventing VAP and improving patient outcomes. The focus of continued training and compliance in the expanded vent bundles is the continued goal of this institution to maintain a zero VAP incident rate.
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