1. Reports: Daily Process, VAE, NHSN
Armstrong Institute for Patient Safety and Quality
Presented by: Kathleen Speck, MPH
Linda Greene, RN, MPS, CIC

2. Armstrong Institute for Patient Safety and Quality

3. Armstrong Institute for Patient Safety and Quality

4. Armstrong Institute for Patient Safety and Quality

5. Armstrong Institute for Patient Safety and Quality

6. Armstrong Institute for Patient Safety and Quality

7. Armstrong Institute for Patient Safety and Quality

8. Armstrong Institute for Patient Safety and Quality

9. Armstrong Institute for Patient Safety and Quality

10. Armstrong Institute for Patient Safety and Quality

11. Armstrong Institute for Patient Safety and Quality

12. Armstrong Institute for Patient Safety and Quality

13. Armstrong Institute for Patient Safety and Quality

14. Armstrong Institute for Patient Safety and Quality

15. Armstrong Institute for Patient Safety and Quality

16. Armstrong Institute for Patient Safety and Quality

17. Armstrong Institute for Patient Safety and Quality

18. Armstrong Institute for Patient Safety and Quality

19. Armstrong Institute for Patient Safety and Quality

20. Armstrong Institute for Patient Safety and Quality

21. Armstrong Institute for Patient Safety and Quality

22. Armstrong Institute for Patient Safety and Quality

23. Armstrong Institute for Patient Safety and Quality

24. Armstrong Institute for Patient Safety and Quality

25. I don’t get it. Lots of mumbo- jumbo if you ask me
Surveillance Definition Change - VAP to VAE
What’s with this VAE
Stuff?
I don’t get it. Lots of mumbo- jumbo if you ask me

27. NHSN Data
Total VAE
VAC Only
IVAC
Possible VAP
Probable VAP

28. We have the VAE data; now what?
Comparative Data from NHSN
Other Changes ( Combine Possible and Probable VAP)
Device Utilization Ratios

29. In the Meantime
Review Outcome Data
At the Bedside
In Team Meetings

30. Patient Data Vent Day PEEP min FiO2 Temp WBC Polys Epis Organism 1 10
Anti-micro
agent
Micro
source
Polys
Epis
Organism 1 10 50
37.5
11.6
none 2 5
37.8
11.8 3
12.0
ETA 3+
s.aureus 4 8 70
38.2
15.0
PIPTAZ
Vanco 60
38.5
14.2 6
38.0
12.9 7 40
37.6 1+
Oral flora
Now we have data regarding use of antimicrobial agent, positive culture from endotracheal aspirate.
Moving in to defining a possible or probably ventilator associated pneumonia.
High lighted area provides information needed to complete the algorithm.: positive culture of endotracheal aspirate

31. Looking at the data
My first quarter VAC is per 1,000 vent days The average performance of the group is 5.5 per 1,000 vent days Do I have opportunities?

32. Looking Carefully at the Measures
I notice that my SAT and SBT compliance is much lower than the cohort group. I also notice that subglottic suctioning is lower than the peer group .

33. Looking at Cases
Ms. X is a 26 y.o. vent dependent patient . She has a history anoxic brain injury and is admitted with pneumonia from a long term care facility ( LTCF)
She is placed on antibiotics and after 4 days has stabilized on the vent. She is improving clinically and the plan is to return to the LTCF
On day 7 , she has a significant event and a sustained period of worsening oxygenation.
She meets definition for VAE

34. Case Review
The clinicians have identified that her event was caused by a mucus plug.
What Next?

35. The Analysis
Changes in Nurses and Respiratory Therapy staff- no documentation of secretions
Failure to notice thickened secretions and change in color of secretions
Although Patient was at baseline – did not get her up into a chair
Patient was dehydrated

36. Opportunities Hardwire ambulation protocols
Assure documentation of secretions
Work collaboratively with respiratory therapy to identify subtle changes
Daily huddle

37. Another Case
Mrs. X is a 76 y.o woman admitted to the ICU with septic shock requiring large volume fluid resuscitation.
She is intubated and placed on the ventilator
She is stable on the ventilator until day 6 when she has
progressing oxygenation demands
She has developed a VAC

38. Case evaluation No fever No increased white count No new antibiotics
Diagnosis: Pulmonary Edema
Opportunities for improvement ?

39. Analysis
In another ICU, a large proportion of VAC’s are possible or probable pneumonia
Evaluation:
HOB monitoring?
Suctioning frequency?
SATs?
ET tubes with Subglottic suctioning?

42. Tools

43. The Change Model
“If we could change ourselves, the tendencies in the world would also change. As a man changes his own nature, so does the attitude of the world change towards him. … We need not wait to see what others do”
-Gandhi

44. Conclusion
Analyzing both process and outcome data will lead to new opportunities for improvement VAE gives us an opportunity to take a broader view of patient safety. It’s not about the numbers, it’s about the Patient

45. Next Steps for CUSP Conduct a culture assessment (HSOPS)
Establish an interdisciplinary CUSP team
Partner with a Senior Executive
Review the Science of Safety training
Identify defects
Download results from your culture assessment (HSOPS) and share with team
Meet regularly with your CUSP team
Use the Daily Goals tool in your ICU

46. Next Steps for Data Collection
Unit Lead completes Structural Assessment
Unit staff complete HSOPS
Unit Lead/Data Facilitator enters Daily Process Measures
Unit staff complete Exposure Receipt Assessment via survey link
Unit Lead/Data Facilitator enters monthly VAE rates
Unit Lead/Data Facilitator enters Early Mobility Measures
Data Facilitator contemplates next steps for collecting Objective Outcomes Measures
Unit Lead/Data Facilitator pulls data reports from the data portal and share the feedback with your frontline staff
One person from unit (we recommend the Unit Lead) complete the Implementation Assessment.

47. Questions
Contact the CUSP 4 MVP-VAP Help Desk at for all questions!