1. What is So Hard about Preventing VAP in the Intensive Care Unit?
Charles O’Donnell, MS RRT
Director, Respiratory Care
Boston Medical Center

2. Ventilator Associated Pneumonia Process Improvement
Boston Medical Center – 582 beds
Level I Trauma Center
5 adult ICUs, 62 beds
1 pediatric ICU, 6 beds
1 NICU, 16 beds

3. Ventilator Associated Pneumonia Project
Project started at BMC in 2006
Created a Team
Planned the Strategy
Educated the Staff
Stopped blaming the vent

4. Manage the Data Daily Bundle Compliance Quarterly VAP reports
to all disciplines on new VAP
root cause analysis
Weekly from Nursing VP on # days since last VAP
Monthly multi-disciplinary VAP meetings

5. Bundle Compliance Document

7. NOSOCOMIAL Vent Associated Pneumonia MP-SICU Per 1000 Ventilator Days – 7/01/06- 9/30/07
Vent Related Pneumonia Rate per 1,000 Ventilator Days

9. Boston Medical Center Adult VAP Cases and Estimated Cost
2,970,000.00
2,340,000.00
1,140,000.00

10. Quarterly VAP Rate FY08

11. Key Elements Creating a “Sense of Urgency”
Getting buy in from all levels
Setting clear direction and roles
Culture change
Champions

12. Creating the Urgency

13. Buy-In on Reducing VAP

14. Set Clear Direction

15. Understanding Roles
The bedside care givers are critical to the success in reducing VAP
ICU Nurses
Respiratory Therapists
Critical Care MDs

16. Cultural Transformation Program
The Results Pyramid ®

17. Roles In Promoting The Culture Change
Four Ways To Promote The VAP Culture
Agrees
that the transition needs to occur and makes no effort to resist it.
VAP
SUPPORT
Vocally talks about the need to shift and shares a sense of urgency in the need to make it happen now.
VAP
ADVOCATE
Someone who allocates time and/or resources to prioritize the transition high on the list of things to do.
VAP
SPONSOR
Demonstrates
accountability for the
success of the transition
by:
1. Ensuring that their
daily actions visibly demonstrate the
Cultural Beliefs.
2. Consciously creating new experiences for the people they work with.
3. Constantly seeking feedback on their effec-tiveness in doing so.
VAP
CHAMPION

18. Champion for VAP Dr Erwin Hirsch-Chief of Trauma Surgery