1. CUSP 4 MVP – VAP Content Webinar Data Feedback and Team Presentation on All Sedation Data From Daily Care Processes Wednesday, February 11, 2015, 2:00-3:00 PM EST Nishi Rawat, MD Victorine Achiri, DVM, RN, BSN, CIC  Your phone lines are automatically set to mute.  Use the Chat Panel on the right of your screen if you have questions during the webinar.  Email cusp4mvp@jhmi.edu if you have additional questions and comments after the webinar.cusp4mvp@jhmi.edu  The webinar recording will be posted once it become available. Changiz Fardipour, BA, RRT

2. 2 CUSP 4 MVP – VAP Content Webinar Data Feedback and Team Presentation on All Sedation Data From Daily Care Processes Wednesday, February 11, 2015, 2:00-3:00 PM EST Bill Schreier, RN Ellen Sullivan  Your phone lines are automatically set to mute.  Use the Chat Panel on the right of your screen if you have questions during the webinar.  Email cusp4mvp@jhmi.edu if you have additional questions and comments after the webinar.cusp4mvp@jhmi.edu  The webinar recording will be posted once it become available. Steve Risch, MSN, RN, CCRN, CCNS Rhonda Urbanovsky, RN, BSN

3. Polling Question 3 Who is on the call? IP – infection preventionist RN – registered nurse RT – respiratory therapist PT – physical therapist OT – occupational therapist MD - physician Healthcare executive Educator National project team Other 

4. All Sedation and Delirium Data with Daily Care Processes Nishi Rawat, MD © The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System February 11 th, 2015

5. Outline Why are we collecting these data? Review sedation and delirium intervention data for Cohort 1 Team experiences –Data collection methodologies –Data collection barriers and successes –Intervention implementation barriers and successes

6. Why Are We Collecting These Data? Our goals are: –To reduce the duration of mechanical ventilation –To reduce patients’ length of stay in the unit and hospital –To reduce mortality related to mechanical ventilation –To prevent all VAEs, including VAP 6 Feedback of real-time data reports expedite improvements

8. Click to edit Master text styles –Second level Third level –Fourth level »Fifth level Barr J, et al. Crit Care Med. 2013;41:263–306.

9. Key Interrelated Themes 1. Perform structured assessments of sedation and delirium levels - Use validated sedation and delirium scales 2. Target light sedation - Daily sedation interruption - Minimize sedative use 3. Mitigate and treat delirium 4. Mobilize patients 5. Perform spontaneous breathing trial

10. Click to edit Master text styles –Second level Third level –Fourth level »Fifth level 10

11. Percent Achieving RASS/SAS Target 11

12. Percent of RASS/SAS actual being {- 1,0,1} or {4,5} 12

13. SAT Compliance 13

14. Delirium Assessment Compliance 14

15. Percent of CAM-ICU Negative or ASE <=2 15

16. Percent of Incorrectly Reporting CAM-ICU/ASE UTA 16

17. Percent of Vent Patient Days without Sedation 17

18. SBT Compliance Rate 18

19. SBT with Seds Off Compliance 19

20. Next Steps: Low Tidal Volume Ventilation Reminder - Feb 1, 2015 –Begin collecting and entering Low Tidal Volume Ventilation data March 3, 2015 –Tune into the next content webinar: “The Business Case for Quality Improvement Initiatives” and Team Experiences Using Subglottic Suctioning Tubes, introduced by Brad Winters, PhD, MD 20

21. Team Experiences Steve Risch and Ellen Sullivan: Holy Cross Hosp. (VAP Pilot) Changiz Fardipour and Victorine Achiri: Truman Medical Centers Bill Schreier and Rhonda Urbanovsky: Temple Memorial Hospital, Scott and White Health 21