the texas wake up and breathe quality improvement initiative: data collection activities terri...
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The TEXAS Wake Up and Breathe Quality Improvement Initiative:
Data Collection Activities
Terri Conner, PhDNybeck AnalyticsProject Manager Texas Wake Up and Breathe Initiative
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Overall Initiative Purpose
Improve care for ventilated patients
– Improve sedative weaning
– Speed extubation
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Results of Observation Studies
Audits from across the country show that Spontaneous awakening trials (SATs) and
Spontaneous breathing trials (SBTs) are only initiated 50% of the time
SBTs not coordinated with SATs
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Benefits of coupled SATs and SBTs
time on ventilation up to 3 days time in hospital up to 4 days
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Texas Wake Up and Breathe Collaborative Structure
Designate champion
Baseline survey
– Please complete this at your earliest convenience and
return to Terri Conner at terri@nybeck.net
Monthly data submission and surveys
Monthly calls with our group
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Three tools
Monthly survey Daily data collection tool Monthly data submission
Monthly SurveyAll Teach, All Learn
Aim
Tests conducted
Outcomes
Lessons learned
Barriers / breakthroughs
Plans for next month
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Data Collection Efforts
Track performance Measure impact on outcomes
– LOS– Mortality– Antibiotic usage– VAC, IVAC, VAP rates
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SAT/SBT Performance Documentation
Clinical champions should oversee SAT/SBT documentation
Integrate into existing processes– Daily care plans– Checklists
Develop your own process
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Daily Data Elements
Excel spreadsheet tool Automatic calculation
– VAC– IVAC
Possible and probable VAP
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Outcome Definitions
VAC– Significant respiratory deterioration after >2 days
of stability
IVAC– VAC– abnormal temp or WBC count– >4 days of new antibiotics
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Outcome Definitions
Possible VAP– IVAC– Either purulent sputum OR + sputum/BAL culture
Probable VAP– IVAC– Both purulent sputum AND + sputum/BAL culture
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Daily Data CollectionVAC Status
Patient Date PEEPmin FiO2min VAC
1 1-Apr-12 10 100
1 2-Apr-12 5 60
1 3-Apr-12 5 40
1 4-Apr-12 8 50
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Daily Data CollectionVAC Status
Patient Date PEEPmin FiO2min VAC
1 1-Apr-12 10 100
1 2-Apr-12 5 60
1 3-Apr-12 9 50 VAC
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Daily Data CollectionIVAC Status
Tmin, Tmax, WBCmin, WBCmax
– Enter for a total of 5 days
– Start 2 days prior to VAC onset
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Daily Data CollectionIVAC Status
Pt Date Tmin
Tmax
WBCmin
WBCmax
QAD SigTemp
SigWBC
QADFlag
IVAC
1 1-Apr 37 37.5 6 8
1 2-Apr 37.5 37.8 6 8
1 3-Apr 37 38.3 6 14
1 4-Apr
1 5-Apr
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Daily Data CollectionIVAC Status
Pt Date Tmin
Tmax
WBCmin
WBCmax
QAD SigTemp
SigWBC
QADFlag
1 3-Apr
37 38.3 6 14 Yes
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Daily Data CollectionQAD Determination
QAD
– New antibiotic prescribed or continued– Includes days between doses at extended
intervals (> q 24 h)– Data are entered for up 10 days (4 days before
VAC, on the VAC dx day, and 5 days after VAC)
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Antibiotic WorksheetQAD Determination
Dose hour
-4 -3 -2 -1 VAC day 0
1 2 3 4 5
Levo 24 Y Y
Vanc Y Y
Vanclevel
Y
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Antibiotic WorksheetQAD Determination
Pt Dose hour
-4 -3 -2 -1 VAC day
0
1 2 3 4 5
Levo 24 Y Y
Vanc Y Y Y
Vanclevel
Y
QAD X X X X X X X
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Daily Data CollectionIVAC Status
Pt Tmin
Tmax
WBCmin
WBCmax
QAD SigTemp
SigWBC
QADFlag
IVAC
1 37 38.3 6 14 Yes 1 1 3 IVAC
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Daily Data CollectionPossible/Probable VAP Status
Enter sputum/BAL gram stain and culture results
– Polys
– Epis
– Culture
– Growth > Threshold
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Daily Data CollectionPossible/Probable VAP Status
Patient Date Polys Epis Culture Growth > Threshold
1 1-Apr-12 3 1
1 2-Apr-12 2 2 Enterococcus
1 3-Apr-12 2 1 Klebsiella Yes
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Daily Data CollectionPossible/Probable VAP Status
POLYS– Sputum or BAL gram stain polymorphonucleated
cells, neutrophils, or white blood cells– Enter 0 to 4
0: none 1: few, rare, <10 cells/lpf 2: moderate, >25 cells/lpf 3: many 4: abundant
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Daily Data CollectionPossible/Probable VAP Status
EPIS– Sputum or BAL gram stain epithelial cells or
squamous cells– Enter 0 to 4
0: none 1: few, rare, <10 cells/lpf 2: moderate, >25 cells/lpf 3: many 4: abundant
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Daily Data CollectionPossible/Probable VAP Status
Patient Date Polys Epis Culture Growth > Threshold
1 1-Apr-12 3 1
1 2-Apr-12 2 2 Enterococcus
1 3-Apr-12 2 1 Klebsiella Yes
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Daily Data CollectionPossible/Probable VAP Status
Patient Date Polys Epis Culture Growth > Threshold
1 1-Apr-12 3 1
1 2-Apr-12 2 2
1 3-Apr-12 2 1
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Daily Data CollectionPossible/Probable VAP Status
CULTURE– Enter the culture result
Growth > Threshold– Yes
> 105 CFU/mL for endotracheal aspirate > 104 CFU/mL for BAL > 103 CFU/mL for protected specimen brush Semi-quantitative equivalents also acceptable
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Daily Data CollectionPossible/Probable VAP Status
Patient Date Polys Epis Culture Growth > Threshold
1 1-Apr-12 3 1
1 2-Apr-12 2 2 Enterococcus
1 3-Apr-12 2 1 Klebsiella Yes
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Daily Data CollectionPossible/Probable VAP Status
Patient Date Polys Epis Culture Growth > Threshold
1 1-Apr-12 3 1
1 2-Apr-12 2 2 Enterococcus
1 3-Apr-12 2 1 Klebsiella Yes
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Daily Data CollectionPossible/Probable VAP Status
Patient Date Possible VAP
Probable VAP
Final Determination
1 1-Apr-12
1 2-Apr-12
1 3-Apr-12 Probable VAP
Probable VAP
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Monthly Data Report
Hospital LOS ICU LOS Hospital discharge status Ventilator days SAT days – ‘real time’ data collection SBT days - ‘real time’ data collection Self-extubated / re-intubated (optional) Outcomes (VAC,IVAC, poss/prob VAP)
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Monthly Data Report
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Main Street Hospital 1 20 8 A 5 4 2 n n y y y nMain Street Hospital 2 6 4 A 4 4 2 n n n n n nMain Street Hospital 3 13 9 A 7 6 6 n n y y n n
VAP -Possible
VAP -Probable
SAT days
SBT days
Self-Extubated (optional)
Re-Intubated (optional)
VAC IVACHosp
Discharge Status
Vent Days
Hospital IDPt
NumberHosp LOS
ICU LOS
Questions?
Repeat webinar on July 16th, 9am CT Please feel free to contact Terri at
terri@nybeck.net or Rachel at rhardegree@tha.org
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