VAP Rates – Critical Care January 1, 2010 – December 31, 2010

Critical Care Ventilator Utilization January 1 – December 31, 2010 NCH Critical Care Reintubation Rate = 1-2% National Benchmark Average = 5-20%

Bundle Blitz – Education – Poster presentations – Daily compliance rounding/immediate feedback (Nursing) HOB at 30 degrees Oral care Sedation vacation – Physicians DVT prophylaxis Stress ulcer prophylaxis

Nursing bundle revived – Education – Daily rounding for compliance HOB > 30 degrees Oral care Sedation vacation Collaborative Initiative with Respiratory Therapy – Shared oral care – Weaning Protocol EMR Documentation Enhancements Physician Engagement with Weaning Protocol

Team – Physician Champion – Respiratory Therapy – ICU Management Team – Infection Prevention Staff – Information Technology Staff – Microbiology Director

Oct 2012 Jan 2013 Jun 2013 Jul 2013 Jan 2014 VAE CBT for All CC,RT, and IP staff Monthly and prn Meetings with Team Team VAE Surveillance in 2/4 ICUs IP Staff transition at desk to all ICUs Team VAE Surveillance 4/4 ICUs Temporary IT Solution for PEEP and Fi02 monitoring Share VAE data with Quality Organizations Share VAE data with CDC NHSN

RT rounds at 12am/fax potential VAE to IP and notify Critical Care Coordinators VAE confirmed by team VAE added to “white board” in CC Staff area Attention to bundles, overall patient condition Review of process for improvement at Interdisciplinary VAE meeting and via

Collaborative Interdisciplinary approach Surveillance time savings Earlier indication of potential untoward outcome for patient “Real time” feedback compared with VAP

IT complete solution with integrated CDC VAE calculator Collection of APRV days (working on IT solution) VAE more sensitive and less specific than VAP Interpretation of results of surveillance