CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients Onboarding: Introduction to...

CUSP 4 MVP VAP Improving Care for Mechanically Ventilated Patients Onboarding: Introduction to Daily Care Process Measures & Structural Assessment ARMSTRONG INSTITUTE FOR PATIENT SAFETY AND QUALITY Johns Hopkins University November 12, 2014

2 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment CUSP 4 MVP - VAP Comprehensive Unit-based Safety Program for Mechanically Ventilated Patients and Ventilator-Associated Pneumonia

3 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment

Introduction to Daily Care Process Measures Kathleen Speck, MPH CUSP 4 MVP VAP Improving Care for Mechanically Ventilated Patients

5 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Ask questions! Make suggestions!

6 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Administrative Announcements Webinar access information: https://mhakeystonecenterevents.webex.com/mhakeystonecentere vents/onstage/g.php?t=a&d=669992364https://mhakeystonecenterevents.webex.com/mhakeystonecentere vents/onstage/g.php?t=a&d=669992364 Call in details Dial: 1-877-668-4493 Use code: 669 992 364 Contact your Coordinating Entity (CE) for the presentation slides, if necessary Recording will be available on the project website

7 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Polling Question Who is on the call? IP infection preventionist RN registered nurse RT respiratory therapist PT physical therapist OT occupational therapist Healthcare executive Educator National project team Other

8 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Objectives Introduce the Daily Care Process Measures Describe the required Daily Care Process Measures data elements and their definitions Identify strategies for finding the data elements Navigate the CUSP 4 MVP VAP data portal Enter Daily Care Process Measures data in the data portal Show how to complete the Structural Assessment

9 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment 2014 SHEA Compendium Update 1 Elevate the head of the bed 30-45 Provide endotracheal tubes with subglottic secretion drainage ports for patients likely to require more than 48 or 72 hours of intubation Manage ventilated patients without sedatives whenever possible

10 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment 2014 SHEA Compendium Update 1 Interrupt sedation once a day (spontaneous awakening trials) Assess readiness to extubate once a day (spontaneous breathing trials) Pair spontaneous breathing trials with spontaneous awakening trials Employ early exercise and mobilization Use non-invasive positive pressure ventilation (NIPPV) whenever feasible

11 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment 2013 Society of Critical Care Medicine PAD Guidelines 2 1.Establish an overarching protocolized approach to daily ICU patient management using 2013 Pain, Agitation, and Delirium (PAD) Guidelines 2.Assess and treat pain first (may be sufficient) 3.If patient remains agitated after adequately treating pain Start with PRN bolus sedation (as needed) Use continuous sedation if boluses exceed 3 per hour 4.Avoid benzodiazepines in most patients

12 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment 2013 Society of Critical Care Medicine PAD Guidelines 2 5.Interrupt sedation daily If necessary, restart at lowest dose to maintain chosen target level of consciousness 6.Avoid deep sedation (RASS -4/-5) as it appears harmful; instead, target awake or alert 7.Screen for delirium (CAM-ICU or ICDSC) If delirious, first seek reversible causes and attempt non-pharmacologic management 8.Use the ABCDEs to improve outcomes for your patients

13 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment What Is the Evidence? Tune in to the content webinars for evidence supporting each intervention Content webinars are 90 minutes and occur on the third Wednesday of each month from 11:00 am EST DATETOPIC Jan 21, 2015Science of Safety & Identifying Defects Pain, Agitation, and Delirium (PAD) and Sedation Management Feb 18, 2015Spontaneous Awakening Trials (SAT) and Spontaneous Breathing Trials (SBT) Utility of the Exposure Receipt Assessment Mar 18, 2015Delirium Assessment Training Benefits of Subglottic Endotracheal Tubes

14 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment What Is the Evidence? Tune in to these Infection Prevention webinars for training on the importance and details of ventilator-associated events IP webinars are 60 minutes and occur on the fourth Wednesday in January, February and March at 11:00 am EST DATETOPIC Jan 28, 2015VAE Surveillance Training: An Overview Feb 25, 2015VAE Surveillance Training: Infection-related Ventilator-associated Complication (IVAC) Mar 25, 2015VAE Surveillance Training: Possible VAP (PoVAP) and Probably VAP (PrVAP)

15 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment In God we trust. All others bring data. W. E. Deming

16 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Daily Care Process Measures Data Collection Tool Contraindications & Location Codes Detailed Instructions Data Collection Tool

18 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Contraindications and Locations

19 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Lets Begin Fill Out For All Beds Track by bed, not by patient Include Bed number Was the patient in that bed intubated or trached AND on mechanical ventilation at the time of observation Y = Yes N = No E = Empty bed

21 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Date of Intubation Enter the date the patient was intubated If the date is not available*, enter admission date (either to the unit or to the hospital, as appropriate) If the patient is extubated and re- intubated within 24 hours, use the original date *i.e., when from an outside institution

22 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Sub-G ETT Does the patient have a subglottic endotracheal tube? Y = Yes N = No If your unit doesnt use Sub-G ETTs, enter N C = Contraindicated If C, enter the contraindication code for this patient in the next column

23 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Sub-G ETT Contraindications Why a Sub-G ETT is contraindicated? Find the contraindications on the back or on page 2 of the tool Remember, enter N if your unit does not use Sub-G ETTs

24 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Location of Intubation Enter the location code where the patient was intubated Find the locations on the back or on page 2 of the tool If you are using Sub-G ETTs on your unit, but the patient is admitted with a different type of ETT, this allows you to track where the patient came from

25 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Location of Intubation Where was the patient intubated? Find the locations on the back or on page 2 of the tool

26 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Elevating the Head of Bed Is the HOB elevated to an angle of 30 from the horizontal? Y = Yes N = No C = Contraindicated If contraindicated, choose the reason from the contraindications listed on page 2 of the tool

27 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Head of Bed Contraindications Why was placing the HOB at an angle of 30 from the horizontal contraindicated? Find the contraindications on the back or on page 2 of the tool

28 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Sedation Scale 1 st question What sedation scale do you use on your unit? This question refers to your unit, not to this specific patient

29 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Sedation Scale R = Richmond Agitation Sedation Scale (RASS) S = Riker Sedation- Agitation Scale (SAS) NU = Unit uses neither RASS or SAS If NU, skip to Delirium Assessment

30 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Sedation Scale Choose either RASS or SAS, but not both Choose the value closest to 10:00 am If equidistant, choose the earlier time

31 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Sedation Scale: Target RASS If you use RASS Target: What is the target RASS score for this patient? Enter RASS sedation scale value (-5 to 4) NS means not set NK means target RASS was set, but is not known Enter NK if you dont know whether a target RASS was actually set

32 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Sedation Scale: Actual RASS If you use RASS Actual: What is the actual RASS score for this patient? Enter RASS sedation scale value (-5 to 4) Enter X if an actual RASS sedation level was not scored Enter NK if target RASS was scored, but is not known Enter NK if you dont know whether a target RASS was actually scored

33 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Sedation Scale: Target SAS If you use SAS Target: What is the target SAS score for this patient? Enter SAS sedation scale value (1 to 7) Enter NS if not set Enter NK if target SAS was set but is not known Enter NK if you dont know whether a target SAS was actually set

34 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Sedation Scale: Actual SAS If you use SAS Actual: What is the actual SAS score for this patient? Enter SAS sedation scale value (1 to 7) Enter X if an actual SAS sedation level was not scored Enter NK if target SAS was scored, but is not known Enter NK if you dont know whether a target SAS was actually scored

35 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Sedation Scale: NU If you entered NU NU = Unit uses neither RASS or SAS If NU, skip Target and Actual sections and go to Delirium Assessment

36 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Delirium Assessment C = Confusion Assessment Method for the ICU (CAM-ICU) A = Attention Screening Exam (ASE) NU = Unit uses neither CAM-ICU or ASE If NU, skip to SAT

37 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Attention Screening Exam (ASE) If the CAM-ICU is not yet feasible in your unit, we recommend that patients at least undergo the ASE once per nursing shift The ASE is feature 2 of the CAM-ICU and this 10-20 second test of attention is the cardinal feature of a delirium diagnosis

38 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Delirium Assessment Choose either CAM- ICU or ASE, not both CAM-ICU incorporates the ASE Choose the value closest to 10:00 a.m. If equidistant, choose the earlier time

39 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Confusion Assessment Method for the ICU (CAM-ICU) Society of Critical Care Medicines 2013 Pain, Agitation, and Delirium (PAD) clinical practice guidelines Recommends theses valid and reliable delirium screening tools Confusion Assessment Method for the ICU (CAM-ICU) Intensive Care Delirium Screening Checklist (ICDSC) Screen moderate to high risk patients at least once per nursing shift

40 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Delirium Assessment CAM-ICU Is the patient positive or negative for delirium? Enter P if the patient is positive for delirium Enter N if the patient is negative for delirium Enter UTA if unable to assess Such as RASS = -4 or -5 OR SAS = 1 or 2 Enter X if CAM-ICU assessment was not completed Enter NK if CAM-ICU was completed, but results arent known Enter NK if you dont know whether the exam was performed

41 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Attention Screening Exam (ASE) Determine if patient can follow a simple command (pay attention) for 10-20 seconds Recognize inattention as the cardinal feature of delirium that must be present for diagnosis For centers not using the full CAM-ICU, conducting the ASE is a good barometer of the presence or absence of delirium May yield abnormal results due to disease, drugs or other causes

42 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Attention Screening Exam (ASE) Provider reads one of the following sequences: S A V E A H A A R T C A S A B L A N C A A B A D B A D D A Y Patient squeezes the providers hand when he hears the letter A Error defined as No squeeze with letter A A squeeze on a letter other than A

43 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Attention Screening Exam (ASE) Count the number of errors Inattention is present if the patient commits more than 2 errors If the patient squeezes on every letter, assign an error count of 10 If the patient doesnt squeeze on any letter, assign an error count of 10

44 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Attention Screening Exam (ASE) What is the patients ability to pay attention? Use only if CAM-ICU is not performed Enter the number of errors, 0 to 10 Enter UTA if unable to assess RASS = -4 or -5 SAS = 1 or 2 Enter X if the exam was not performed Enter NK if the exam was performed, but number of errors is not known Enter NK if you dont know whether the exam was performed

45 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Spontaneous Awakening Trial (SAT) Has the patient had a Spontaneous Awakening Trial today?

46 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Spontaneous Awakening Trial (SAT)

47 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Spontaneous Awakening Trial (SAT) Enter NS if the patient is not sedated Enter Y if medications for sedation have been held today Enter N if medications for sedation have NOT been held today Enter C/NI if holding medications for sedation is either contraindicated or not indicated today If C/NI go to next column labeled Reason SAT Contraindic

48 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Spontaneous Awakening Trial (SAT) Contraindications Why is an SAT inappropriate for this patient? Find the contraindications on the back or on page 2 of the tool

49 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Spontaneous Breathing Trial (SBT) Has the patient had a spontaneous breathing trial today?

50 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Spontaneous Breathing Trial (SBT) Remove ventilator support Allow patient to breathe With either a T-tube circuit Or with a ventilator circuit With low levels of PS (58 cm H 2 O in adults) With or without 5 cm H 2 O PEEP No changes are required in FiO 2 or the level of PEEP

51 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Spontaneous Breathing Trial (SBT) Enter Y if the patient had an SBT Enter N if the patient did not have an SBT Enter C/NI if the use of an SBT is contraindicated/not indicated If C/NI, go to Reason SBT Contraindic

52 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Spontaneous Breathing Trials Contraindications (SBT) What is the reason an SBT is inappropriate for this patient? Find the contraindications on the back or on page 2 of the tool

53 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Spontaneous Breathing Trial (SBT) with Sedatives Off Was the SBT performed with the sedatives off? Sedatives are considered off: During an SAT If sedative infusion is stopped If standing order for intermittent sedating meds is held or cancelled If the interval between standing doses is extended

Data Collection Scenarios CUSP 4 MVP VAP Improving Care for Mechanically Ventilated Patients

56 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Collecting Daily Care Process Measures Who should collect this data? Nurse Nurse educator Respiratory therapist How often should this data be collected? Daily How often should this data be entered in the data portal? Weekly As with any new process, it takes some time to find where to extract the data for each field. Once the process is established, it becomes easier and takes less time.

57 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment EMR Charts Bedside Paper tool Spreadsheet Template Collecting Daily Care Process Measures Data Source Workstation or Mobile Device Data Entry Method Direct Portal Entry Upload into Portal

58 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Collecting Daily Care Process Measures Scenario 1: Bedside Observe the collected measures at the bedside Enter data directly into the project data entry portal via mobile computing device Bedside Mobile Device Direct Portal Entry

59 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Collecting Daily Care Process Measures Scenario 2: Patient charts Review physical patient charts Identify the fields for each of the daily care process measures Record data on data collection tool Enter data into the project data portal Direct Portal Entry Charts Paper Tool

60 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Collecting Daily Care Process Measures Scenario 3: Electronic medical records Access the electronic medical records Identify the fields for each of the daily care process measures Note data on a data collection tool Enter data into the spreadsheet template Upload spreadsheet into project data entry portal EMR Paper Tool Spreadsheet Template

Introduction to Structural Assessment CUSP 4 MVP VAP Improving Care for Mechanically Ventilated Patients

62 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Structural Assessment Who should collect this data? Unit lead How often should this data be collected and entered into the data portal? Semi-annually How long does it take to complete? About ten minutes

63 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Semi-Annual Structural Assessment Please answer the following questions regarding your ICU. 1.For intubated/trached patients, how often do you change the ventilator circuit? Not routinely changed unless soiled or malfunctioning Routinely changed at regular interval; please specify in days ____ 2.When used, how often do you change the closed endotracheal suction system? It is not used in this ICU Not routinely changed unless soiled or malfunctioning Routinely changed at regular interval; please specify in days ____

64 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Semi-Annual Structural Assessment 3.In the absence of a difficult airway, how often is an orotracheal route used for elective intubation in your ICU? 4.For patients receiving mechanical ventilation via an endotracheal tube, how often is a closed endotracheal suction system used in your ICU? 5.When mechanical ventilation is required, how often are prophylactic intravenous antibiotics used to prevent ventilator-associated pneumonia in your ICU? 6.In your ICU, how often are patients placed in a supine (flat) position, when there is no contraindication? 7.In your ICU, how often are standard precautions used while suctioning the respiratory tract?

65 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Semi-Annual Structural Assessment 9.In your ICU, how often are mechanically ventilated patients experiencing gastric over-distention? 10.In your ICU, how often is condensate drained away from the patient while the circuit remains closed? 11.In your ICU, how often do healthcare providers perform hand hygiene before contact with respiratory equipment? 12.How often is noninvasive ventilation used in your ICU? 13.In your ICU, how often is an early mobility protocol used for patients receiving mechanical ventilation? 8.In your ICU, how often is tracheal suctioning performed when it is not clinically indicated?

66 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Semi-Annual Structural Assessment 14.Regarding your written ICU, nursing and/or respiratory therapy policies and procedures concerning patients receiving mechanical ventilation, is there guidance to: (YES/NO) Avoid supine (flat) patient positioning unless clinically indicated (i.e. hemodynamic instability, orthopedic injury, etc.)? Use standard precautions while suctioning the respiratory tract secretions? Avoid nonessential tracheal suctioning? Avoid gastric over distention? Periodically remove condensate from circuits? Assure that circuits are closed during removal of condensate to assure that condensate doesnt drain toward the patient? Perform hand hygiene before contact with respiratory equipment?

67 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Semi-Annual Structural Assessment 15.Does your ICU actively promote: (YES/NO) Use of noninvasive ventilation protocol? Early mobility protocol for patients receiving mechanical ventilation?

68 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Data Collection Ideas Where can you find these data? Ideas Suggestions Barriers

69 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Next Steps Where will you find your data? Look for data sources Make plans for data collection processes Practice collecting data for next call After finding your data sources and starting data collection: Collect data daily Enter the data at least weekly

70 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Discussion Question How will using the data portal benefit me?

Next Steps CUSP 4 MVP VAP Improving Care for Mechanically Ventilated Patients

73 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Next Steps: Homework By January 1, 2015 Determine the location of information that is needed to complete the Daily Care Process Measures Determine who will gather the data for the Daily Care Process Measures.

74 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Next Onboarding Call: VAE Overview November 19, 2014 1:00 2:00 PM EST Review the theory supporting the new NHSN VAE surveillance Review basic VAE surveillance techniques Apply techniques to determine whether patients on mechanical ventilation have acquired VAEs

75 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment Mark Your Calendar: Upcoming Onboarding Sessions ACTIONDATE Orientation Webinars 3: Ventilator Associated Events (VAE) OverviewNov 19, 12 pm EST 4: Assessing Patient Safety Culture using the Hospital Survey on Patient Safety (HSOPS) Dec 3, 12 pm EST Project Kick-OffDec 17, 13 pm EST

76 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment CUSP 4 MVP VAP Website Visit: https://armstrongr esearch.hopkinsm edicine.org/cusp4 mvp.aspx https://armstrongr esearch.hopkinsm edicine.org/cusp4 mvp.aspx

77 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment What Can I Find on the CUSP 4 MVP VAP Website? Education materials Toolkits CUSP Daily Process Measures Early Mobility Low Tidal Volume Ventilation (soon) Literature Reviews Fast Fact Sheets CUSP Tools and Guides Archive of webinars led by subject matter experts

78 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated Patients Onboarding: Daily Care, Data Portal, & Structural Assessment References 1.Klompas M, Branson R, Eichenwald EC, Greene LR, Howell MD, Lee G, Magill SS, Maragakis LL, Priebe GP, Speck K, Yokoe DS, Berenholtz SM. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35(8):915-936. PMID: 25026607. 2.Barr J, Fraser GL, Puntillo K, Ely EW, Glinas C, Dasta JF, Davidson JE, Devlin JW, Kress JP, Joffe AM, Coursin DB, Herr DL, Tung A, Robinson BR, Fontaine DK, Ramsay MA, Riker RR, Sessler CN, Pun B, Skrobik Y, Jaeschke R; American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013 Jan;41(1):263- 306. PMID: 23269131. ARMSTRONG INSTITUTE FOR PATIENT SAFETY AND QUALITY

CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients Onboarding: Introduction to...

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