1 © 2009 tmit safe practice 23 care of the ventilated patient nqf-endorsed™ safe practices for...
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1© 2009 TMIT
Safe Practice 23Care of the Ventilated Patient
NQF-endorsed™Safe Practices for Better
Healthcare
Chapter 7: Improving Patient Safety Through
Prevention of Healthcare-Associated Infections
© 2006 HCC, Inc. CD000000-0000XX 2© 2009 TMIT
Slide Deck Overview
Slide Set Includes:
Section 1: NQF-endorsed™ Safe Practices for Better Healthcare Overview
Section 2: Harmonization Partners Section 3: The Problem Section 4: Practice Specifications Section 5: Example Implementation Approaches Section 6: Front-line Success Stories
3© 2009 TMIT
NQF-endorsed™Safe Practices for Better Healthcare
Overview
Safe Practice 23Care of the Ventilated Patient
Chapter 7: Improving Patient Safety Through
Prevention of Healthcare-Associated Infections
4© 2009 TMIT
2010 NQF Safe Practices for Better Healthcare: A Consensus Report
34 Safe Practices
• Criteria for Inclusion
• Specificity
• Benefit
• Evidence of Effectiveness
• Generalization
• Readiness
5© 2009 TMIT
Culture SP 1
2010 NQF Report
CHAPTER 7: Hospital-Associated Infections• Hand Hygiene• Influenza Prevention• Central Venous Catheter-Related Blood Stream
Infection Prevention • Surgical-Site Infection Prevention• Care of the Ventilated Patient and VAP • MDRO Prevention• UTI Prevention
Information Management and Continuity of Care
Medication Management
Healthcare-Associated Infections
Condition-, Site-, and Risk-Specific Practices
Consent & Disclosure
Wrong-siteSx Prevention
Press. Ulcer Prevention
DVT/VTE Prevention
Anticoag. Therapy
VAP Prevention
Central V. Cath.BSI Prevention
Sx-Site Inf.Prevention
Contrast Media Use
Hand HygieneInfluenza
Prevention
Pharmacist Systems Leadership:High-Alert, Std. Labeling/Pkg., and Unit-Dose
Med. Recon.
Culture
CPOE
Read-Back & Abbrev.
Discharge System
PatientCare Info.
LabelingStudies
Culture Meas.,FB., and Interv.
Structuresand Systems
ID and Mitigation Risk and Hazards
Team Trainingand Team Interv.
Nursing Workforce
ICU CareDirect
Caregivers
Workforce CHAPTER 4: Workforce• Nursing Workforce• Direct Caregivers• ICU Care
CHAPTER 2: Creating and Sustaining a Culture of Patient Safety (Separated into Practices]
Leadership Structures and Systems Culture Measurement, Feedback, and Interventions Teamwork Training and Team Interventions Identification and Mitigation of Risks and Hazards
CHAPTER 5: Information Management and Continuity of Care
Patient Care Information Order Read-Back and Abbreviations Labeling Studies Discharge Systems Safe Adoption of Integrated Clinical Systems including
CPOE
CHAPTER 6: Medication Management Medication Reconciliation Pharmacist Leadership Role Including: High-Alert
Med. and Unit-Dose Standardized Medication Labeling and Packaging
CHAPTER 8:• Wrong-Site, Wrong-Procedure, Wrong-Person
Surgery Prevention • Pressure Ulcer Prevention• DVT/VTE Prevention• Anticoagulation Therapy• Contrast Media-Induced Renal Failure Prevention• Organ Donation• Glycemic Control• Falls Prevention• Pediatric Imaging
Informed Consent
Life-Sustaining Treatment
Disclosure
CHAPTER 3: Informed Consent and Disclosure• Informed Consent• Life-Sustaining Treatment• Disclosure• Care of the Caregiver
Consent and Disclosure
Care of Caregiver
MDROPrevention
UTIPrevention
FallsPrevention
OrganDonation
GlycemicControl
PediatricImaging
7© 2009 TMIT
Harmonization Partners
Safe Practice 23Care of the Ventilated Patient
Chapter 7: Improving Patient Safety Through
Prevention of Healthcare-Associated Infections
8© 2009 TMIT
Harmonization – The Quality Choir
9© 2009 TMIT
The Patient – Our Conductor
© 2006 HCC, Inc. CD000000-0000XX 10© 2009 TMIT
The Objective
Care of the Ventilated Patient
Prevent healthcare-associated complications in ventilated patients.
11© 2009 TMIT
The Problem
Safe Practice 23Care of the Ventilated Patient
Chapter 7: Improving Patient Safety Through
Prevention of Healthcare-Associated Infections
© 2006 HCC, Inc. CD000000-0000XX 12© 2009 TMIT
The Problem
© 2006 HCC, Inc. CD000000-0000XX 13© 2009 TMIT
The Problem
Frequency
Reported to range from 1 to 4 cases per 1,000 ventilator days
May exceed 10 cases per 1,000 ventilator days in special populations, such as pediatric and surgical patients
VAP occurs in 8% to 28% of mechanically ventilated patients
[Edwards, Am J Infect Control 2007 Jun;35(5):290-301; NNIS, Am J Infect Control 2004 Dec;32(8):470-85]
© 2006 HCC, Inc. CD000000-0000XX 14© 2009 TMIT
The Problem
Severity
Mortality rate of 14.4% Presence of nosocomial pneumonia prolonged
the length of mechanical ventilation by 10.3 days and mean ICU unit length of stay by 12.2 days
[Klevens, Public Health Rep 2007 Mar-Apr;122(2):160-6; Levinson, Adverse events in hospitals: state reporting systems, 2008; Koulenti, Crit Care Med 2009 Aug;37(8):2360-8]
© 2006 HCC, Inc. CD000000-0000XX 15© 2009 TMIT
The Problem
Preventability
Reduce the duration of mechanical ventilation by assessing patients daily
Maintain patients in semi-recumbent position, with a 30°-45° of elevation of the head of the bed
To reduce bacterial colonization, provide oral care with an antiseptic agent
[Tablan, MMWR Recomm Rep 2004 Mar 26;53(RR-3):1-36; ATS/IDSA, Am J Respir Crit Care Med 2005 Feb 15;171(4):388-416; Dellinger, Crit Care Med 2005;9(6):653-4; Resar, Jt Comm J Qual Patient Saf 2005 May;31(5):243-8; Panchabhi, Chest 2009 May;135(5):1150-6; Segers, JAMA 2006 Nov22;296(20):2460-6; Sona, J Intensive Care Med 2009 Jan-Feb;24(1):54-62]
© 2006 HCC, Inc. CD000000-0000XX 16© 2009 TMIT
The Problem
Cost Impact
Hospitalization costs were $48.9K higher in patients with VAP, and length of hospitalization 25 days longer
Hospital costs due to VAP range from $19.6K to $28.5K in 2007 dollars
Pediatric patients admitted to PICU had a mean additional hospitalization cost of $30.9K
[Warren, Crit Care Med 2003; 31: 1312-7; Foglia, Clin Microbiol Rev 2007 Jul;20(3):409-25; Scott, The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention, 2009]
17© 2009 TMIT
Practice Specifications
Safe Practice 23Care of the Ventilated Patient
Chapter 7: Improving Patient Safety Through
Prevention of Healthcare-Associated Infections
© 2006 HCC, Inc. CD000000-0000XX 18© 2009 TMIT
Additional Specifications
© 2006 HCC, Inc. CD000000-0000XX 19© 2009 TMIT
Safe Practice Statement
Care of the Ventilated Patient
Take actions to prevent complications associated with ventilated patients: specifically, ventilator-associated pneumonia, venous thrombo-embolism, peptic ulcer disease, dental complications, and pressure ulcers.
[Institute for Healthcare Improvement, Ventilator Bundle: IHI Improvement Map, 2009]
© 2006 HCC, Inc. CD000000-0000XX 20© 2009 TMIT
Additional Specifications
Educate healthcare workers about the daily care of ventilated patients
Implement policies and practices for disinfection, sterilization, and maintenance of respiratory equipment
Conduct active surveillance for VAP in units that care for ventilated patients at high risk for VAP based on risk assessment
[Coffin, Infect Control Hosp Epidemiol. 2008 Oct;29 Suppl 1:S31-40; Tablan, MMWR Recomm Rep 2004 Mar 26;53(RR-3):1-36; CDC, An Overview of Ventilator-Associated Pneumonia, 2005; Brito, Crit Care Med 2009 Jan;37(1):350-2; Hortal, Crit Care 2009;13(3):R80]
© 2006 HCC, Inc. CD000000-0000XX 21© 2009 TMIT
Additional Specifications
Provide ventilated patient data to key stakeholders
Educate patients and their families about prevention measures involved in the care of ventilated patients
Institute a ventilated patient checklist and a standardized protocol
22© 2009 TMIT
Example Implementation Approaches
Safe Practice 23Care of the Ventilated Patient
Chapter 7: Improving Patient Safety Through
Prevention of Healthcare-Associated Infections
© 2006 HCC, Inc. CD000000-0000XX 23© 2009 TMIT
Example Implementation Approaches
© 2006 HCC, Inc. CD000000-0000XX 24© 2009 TMIT
Example Implementation Approaches
Incorporate range-of-motion as daily care for ventilated patients per the organization’s protocol
Consider the use of direct antibiogram using E-test strips
Utilize antibiotic de-escalation therapy with critically ill patients who acquire a VAP
[ASHP, Am J Health-Syst Pharm 1998; 55:1724-6; Clavet, CMAJ 2008 Mar 11;178(6):691-7; Trudel, Clin Orthop Relat Res 2008 May;466(5):1239-44; Bouza, Curr Opin Infect Dis 2009 Aug;22(4):345-51; Eachempati, J Trauma 2009 May;66(5):1343-8]
© 2006 HCC, Inc. CD000000-0000XX 25© 2009 TMIT
Example Implementation Approaches
Perform regular oral care with an antiseptic solution, considering a chlorhexidine agent
Remove oral secretions before changing the patient’s position
Provide easy access to noninvasive ventilation equipment
Devise strategies to prevent aspiration Devise strategies to reduce colonization of the
aerodigestive tract Devise strategies to minimize contamination of
equipment
[ Yoneyama, J Am Geriatr Soc 2002 Mar;50(3):430-3; Kollef, Crit Care Med 2004 Jun;32(6):1396-405; Mori, Intensive Care Med 2006 Feb;32(2):230-6; Segers, JAMA 2006 Nov22;296(20):2460-6; Chan, BMJ 2007 Apr 28;334(7599):889; Silvestri, Crit Care Med 2007 Oct;35(10):2468; Chao, J Clin Nurs 2009 Jan;18(1):22-8]
© 2006 HCC, Inc. CD000000-0000XX 26© 2009 TMIT
Example Implementation Approaches
Strategies of Progressive Organizations
Set a goal of zero VAPS and visually display their successes in patient care areas
27© 2009 TMIT
Front-line Success Stories
Safe Practice 23Care of the Ventilated Patient
Chapter 7: Improving Patient Safety Through
Prevention of Healthcare-Associated Infections
© 2006 HCC, Inc. CD000000-0000XX 28© 2009 TMIT
Title of Video
Insert Video this size
29© 2009 TMIT
http://www.shea-online.org/Assets/files/patient%20guides/NNL_VAP.pdf
30© 2009 TMIT
© 2006 HCC, Inc. CD000000-0000XX 31© 2009 TMIT
TMIT High Performer Webinar
Safer Critical Care: Resources to Prevent Ventilator-Associated Pneumonia and Central Venous Catheter-Associated Bloodstream Infections
This program is a webinar presentation designed to help you and your hospital team understand and implement NQF-EndorsedTM Safe Practices 19 and 20*. Renowned educators in the field will guide you in a special informational session about the importance and implementation of these Safe Practices.
Go to: http://www.safetyleaders.org/pages/idPage.jsp?ID=4878
*NQF Safe Practices for Better Healthcare – 2006 Update
© 2006 HCC, Inc. CD000000-0000XX 32© 2009 TMIT
TMIT High Performer Webinar
Healthcare-Associated Infection and You: Cleaner, Safer Care (Safe Practices 19-25)
The National Quality Forum’s (NQF) 2009 Update of the Safe Practices for Better Healthcare and TMIT’s Webinar series provide tools to unite healthcare providers, purchasers, and consumers to more rapidly identify and adopt techniques that will reduce patient harm and improve care.
Go to: http://www.safetyleaders.org/pages/idPage.jsp?ID=4932
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