1. Talking VAP staff identifying risk reduction strategies
Daniel J. Barrieau, RRT, CPFT
Director of Respiratory Care Services
Cooley Dickinson Hospital

2. What we do beyond the bundle
Dual-limb heated wire molecular humidity
Event related/no change ventilator circuit strategy
Event related/no change closed suction
No in-line nebulizers ~ MDI only

3. What we do beyond the bundle
Continuous subglottic suction
No break circuit strategy
Single use manual resuscitators (use & toss)
Pre-flight checklist for transport
Strip, clean, replace ~ no reuse

4. How we got there After bundle implementation, didn’t stop
Knew our CCU was changing
2005 ~ <150 ventilator days
2006 ~ planned start of intensivist program

5. Engaged the Respiratory Therapists
Challenged them to find ways to reduce risk
Philosophy of always asking ‘what else can I do’?
While doing their work ‘keep eyes open’, always look for opportunities
Not reactive, proactive

6. Do the easy things
Technology is nice, but so is washing your hands ~ zero tolerance
Tie VAP to our actions
Talk about VAP

7. Talk VAP Discuss VAP. . .daily Own it.
Do not believe VAP is inevitable
If it is ok to have some VAP’s how do staff know which ones were ok and which ones weren’t

8. Can lead to great ideas Staff looked at intra-hospital transport
Read articles
Thought of as big opportunity
RT noticed, we call ‘time’ on our interventions when we travel

9. A great and easy idea Check sheet
Developed by staff RT from talking VAP
All the steps
Finds approximations for our strategies
Home court advantage on the road

10. Our Opportunities invasive ventilation FY06 = 147 FY07 = 649
FY06 = 147
FY07 = 649
non-invasive
FY05 = 161
FY06 = 209
FY07 = 574

11. Well. . . 15 months without VAP When we had a VAP, we talked about it
Kept looking for risk reduction strategies ~ yep, high risk patients
Vented >19 days each
Transported
Difficult intubations or reintubations

12. What are we talking about now?
Opportunities
Transport
‘emergencies’ (is it really?)
Difficult airways (aren’t they all?)