1. The TEXAS Wake Up and Breathe Quality Improvement Initiative: Data Collection Activities Terri Conner, PhD Nybeck Analytics Project Manager Texas Wake Up and Breathe Initiative 1

2. Overall Initiative Purpose Improve care for ventilated patients – Improve sedative weaning – Speed extubation 2

3. Results of Observation Studies Audits from across the country show that Spontaneous awakening trials (SATs) and Spontaneous breathing trials (SBTs) are only initiated 50% of the time SBTs not coordinated with SATs 3

4. Benefits of coupled SATs and SBTs time on ventilation up to 3 days time in hospital up to 4 days 4

5. Texas Wake Up and Breathe Collaborative Structure Designate champion Baseline survey – Please complete this at your earliest convenience and return to Terri Conner at terri@nybeck.net Monthly data submission and surveys Monthly calls with our group 5

6. Three tools Monthly survey Daily data collection tool Monthly data submission

7. Monthly Survey All Teach, All Learn Aim Tests conducted Outcomes Lessons learned Barriers / breakthroughs Plans for next month 7

8. Data Collection Efforts Track performance Measure impact on outcomes – LOS – Mortality – Antibiotic usage – VAC, IVAC, VAP rates 8

9. SAT/SBT Performance Documentation Clinical champions should oversee SAT/SBT documentation Integrate into existing processes – Daily care plans – Checklists Develop your own process 9

10. Daily Data Elements Excel spreadsheet tool Automatic calculation – VAC – IVAC Possible and probable VAP 10

11. Outcome Definitions VAC – Significant respiratory deterioration after >2 days of stability IVAC – VAC – abnormal temp or WBC count – >4 days of new antibiotics 11

12. Outcome Definitions Possible VAP – IVAC – Either purulent sputum OR + sputum/BAL culture Probable VAP – IVAC – Both purulent sputum AND + sputum/BAL culture 12

13. Daily Data Collection VAC Status PatientDatePEEPminFiO2minVAC 11-Apr-1210100 12-Apr-12560 13-Apr-12540 14-Apr-12850 13

14. Daily Data Collection VAC Status PatientDatePEEPminFiO2minVAC 11-Apr-1210100 12-Apr-12560 13-Apr-12950VAC 14

15. Daily Data Collection IVAC Status Tmin, Tmax, WBCmin, WBCmax – Enter for a total of 5 days – Start 2 days prior to VAC onset 15

16. Daily Data Collection IVAC Status PtDateT min T max WBC min WBC max QADSig Temp Sig WBC QAD Flag IVAC 11-Apr3737.568 12-Apr37.537.868 13-Apr3738.3614 14-Apr 15-Apr 16

17. Daily Data Collection IVAC Status PtDateT min T max WBC min WBC max QADSig Temp Sig WB C QAD Flag 13- Apr 3738.3614Yes 17

18. Daily Data Collection QAD Determination QAD – New antibiotic prescribed or continued – Includes days between doses at extended intervals (> q 24 h) – Data are entered for up 10 days (4 days before VAC, on the VAC dx day, and 5 days after VAC) 18

19. Antibiotic Worksheet QAD Determination Dose hour -4-3-2VAC day 0 12345 Levo24YY VancYY level Y 19

20. Antibiotic Worksheet QAD Determination PtDose hour -4-3-2VAC day 0 12345 Levo24YY VancYYY level Y QADXXXXXXX 20

21. Daily Data Collection IVAC Status PtT min T max WBC min WBC max QADSig Temp Sig WBC QAD Flag IVAC 13738.3614Yes113IVAC 21

22. Daily Data Collection Possible/Probable VAP Status Enter sputum/BAL gram stain and culture results – Polys – Epis – Culture – Growth > Threshold 22

23. Daily Data Collection Possible/Probable VAP Status PatientDatePolysEpisCultureGrowth > Threshold 11-Apr-1231 12-Apr-1222 Enterococcus 13-Apr-1221 Klebsiella Yes 23

24. Daily Data Collection Possible/Probable VAP Status POLYS – Sputum or BAL gram stain polymorphonucleated cells, neutrophils, or white blood cells – Enter 0 to 4 0: none 1: few, rare, <10 cells/lpf 2: moderate, >25 cells/lpf 3: many 4: abundant 24

25. Daily Data Collection Possible/Probable VAP Status EPIS – Sputum or BAL gram stain epithelial cells or squamous cells – Enter 0 to 4 0: none 1: few, rare, <10 cells/lpf 2: moderate, >25 cells/lpf 3: many 4: abundant 25

26. Daily Data Collection Possible/Probable VAP Status PatientDatePolysEpisCultureGrowth > Threshold 11-Apr-1231 12-Apr-1222 Enterococcus 13-Apr-1221 Klebsiella Yes 26

27. Daily Data Collection Possible/Probable VAP Status PatientDatePolysEpisCultureGrowth > Threshold 11-Apr-1231 12-Apr-1222 13-Apr-1221 27

28. Daily Data Collection Possible/Probable VAP Status CULTURE – Enter the culture result Growth > Threshold – Yes > 10 5 CFU/mL for endotracheal aspirate > 10 4 CFU/mL for BAL > 10 3 CFU/mL for protected specimen brush Semi-quantitative equivalents also acceptable 28

29. Daily Data Collection Possible/Probable VAP Status PatientDatePolysEpisCultureGrowth > Threshold 11-Apr-1231 12-Apr-1222 Enterococcus 13-Apr-1221 Klebsiella Yes 29

30. Daily Data Collection Possible/Probable VAP Status PatientDatePolysEpisCultureGrowth > Threshold 11-Apr-1231 12-Apr-1222 Enterococcus 13-Apr-1221 Klebsiella Yes 30

31. Daily Data Collection Possible/Probable VAP Status PatientDatePossible VAP Probable VAP Final Determination 11-Apr-12 12-Apr-12 13-Apr-12Probable VAP 31

32. Monthly Data Report Hospital LOS ICU LOS Hospital discharge status Ventilator days SAT days – ‘real time’ data collection SBT days - ‘real time’ data collection Self-extubated / re-intubated (optional) Outcomes (VAC,IVAC, poss/prob VAP) 32

33. Monthly Data Report 33

34. Questions? Repeat webinar on July 16 th, 9am CT Please feel free to contact Terri at terri@nybeck.net or Rachel at rhardegree@tha.org terri@nybeck.net rhardegree@tha.org 34