Download Prevention of VAP And Reduction in Total Ventilator Hours 2012

2012 SCONL Meeting
Best Practice
Prevention of VAP
And
Reduction in Total Ventilator Hours
Donna McCauley RN,MSN,CCRN
Critical Care CNS
Jarrod Goforth RN, BSN
Director of Critical Care Services
Joseph Whitten, RRT,RCP
Director of Respiratory Care
St. Francis Downtown
Introduction
IHI recommendation bundles for the prevention of
VAP has consistently been part of the practice in
caring for ventilated patients at St. Francis. Over
the course of the past 2 years, the Critical Care
Division, including nursing staff, the Critical Care
Intensivists, clinical pharmacists and the
respiratory therapists have worked together to
implement many changes in the care provided to
those who are mechanically ventilated.
Major Implementations and Additions to Care
Management of the Respiratory Failure Patient in
2010 and 2011 included:
1. VAP protocol education reinforced with emphasis on sedation vacation and fine
tuning of individual patients’ sedation needs with reassessment of patient
response
3. Addition of new oral care kit which facilitates ease of q 2 hour oral care for the
ventilated patient as well as chlorhexidine oral wash q 12 hrs for the prevention
of VAP
2. Addition of high-flow nasal O2 into our arsenal of options for the respiratory
failure patient with impact back on the reduction of patients needing to be
intubated as well as patients getting extubated sooner with this therapy utilized
as a bridging therapy
4. Greater attention to lung protective strategies by utilizing ARDS net
5. Lung recruitment strategies including bi-level ventilation and lung expansion
protocols.
6. Therapist driven ventilator weaning protocols.
Results and Significance of Implementation
• Incidence of VAP via IHI reporting is as follows:
– 2008 – less than 1%
– 2009 – 0%
– 2011 -- 0.42% and
– 2012 VAP rate of 0.00%.
Results and Significance of Implementation cont…
• Also, along with reduction of VAP, the total ventilator
days has been reduced by 20% since 2008..
– Reported ventilator days for
• 2008 = 7.6 days,
• 2009 = 6.7 days
• 2010 = 5.4 days
• 2011 = 5.4 days
• 2012 = 4.2 days
– Vent days reduced from 2357 in 2011 to 2017
days for 2012
Results cont…
Ventilator Utilization
2009-2010
2010-2011
54%
51%
BiPAP Utilization
2009-2010
2011-2012
28%
15%
Financial Impact
5000 / 12 = 450 patients – 1 day x 450 = 450
450 patient days x $2,000 per day = $900,000
Financial Impact cont…
Overall hospital LOS for patients receiving
BiPAP
Reduced by 4.5 days
Potential savings > $4,000,000
With a multidisciplinary approach to treatment of
the mechanically ventilated patient, both VAP
and ventilator days have been reduced and
modifications /additions to the IHI bundle delivery
has assisted our team in not only reducing vent
days but also keep VAP rates at an absolute
minimum/absent.
Summary of Outcomes
• Minimal to no VAP
• Continued reduction in
ventilator days
• Continued reduction in
BiPAP utilization
Lessons learned?
A continued team approach to delivery of care to
the complex, critically ill patient dramatically
improved patient care outcomes!