1 © 2009 TMIT Safe Practice 23 Care of the Ventilated Patient NQF-endorsed™ Safe Practices for...

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




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




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




© 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




© 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


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


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

© 2006 HCC, Inc. CD000000-0000XX 24© 2009 TMIT


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


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


Strategies of Progressive Organizations

Set a goal of zero VAPS and visually display their successes in patient care areas

© 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

1 © 2009 TMIT Safe Practice 23 Care of the Ventilated Patient NQF-endorsed™ Safe Practices for...

Documents

Transcript of 1 © 2009 TMIT Safe Practice 23 Care of the Ventilated Patient NQF-endorsed™ Safe Practices for...