1. Linda L. Horton, RN, MSN, CPHQ Mercy Hospital Buffalo January 18, 2012

2. About Us Mercy Hospital Buffalo Buffalo, New York
Team Composition
David Durante, MD Director Critical Care
Jarrod Atkinson, RN Nurse Manager ICU
Staff nurses
Respiratory Therapy
Pharmacy
Physical Therapy
Infection Control
Hospitalist
Nurse Practitioner
Radiology
Mercy Hospital Buffalo Buffalo, New York
350 bed tertiary care
Regional transfer center

3. Background
VAP bundle got us started and progress was made relative to outcomes, but Vent days and use of propofol still exceeded project targets.

4. Changes Made Actions Taken physician leader rounding daily **
education to associates on MAAS scores **
daily sedation vacations scheduled by the nurse caring for the patient **
Mobility, dangle, OOB **
support from interdisciplinary team **
pharmacy, respiratory therapy, nurses, physicians, physical therapy
VAP bundle re-education
use of ventilator order sheet
HOB elevation – 300
Implementation of oral care policy & q4h oral care kits
protocol driven sedation tools for propofol (sedation) use
communication
streamline documentation

5. Results
Started ICU
Expedition

6. Lessons, Challenges and Next Steps
Beyond the Bundle
Pain Management versus Sedation
Staff champions support
Leadership support and visibility with the staff in the unit. Keeping in touch with the front line staff
Case review of events like a root cause - lessons learned, barriers, “old habits”
Daily rounds at the bedside

7. Favorite tools/resource to share
CDC Ventilator Associate Pneumonia
IHI Ventilator Bundle
APIC Ventilator Pneumonia Prevention

8. Linda L. Horton lhorton@chsbuffalo.org
Questions?
Linda L. Horton