1. PREVENTION Kaplan University Capstone NU499 VENTILATOR – ASSOCIATED PNEUMONIA VAP PREVENTION at Sparks Regional Medical Center

2. (Pear, 2008)

3. Learning Objectives: To gain understanding on why prevention of VAP is important To gain understanding on why prevention of VAP is important To gain knowledge about the VAP bundle and its tools of prevention To gain knowledge about the VAP bundle and its tools of prevention To understand the process of pneumonia and why it more likely occurs on a ventilated patient To understand the process of pneumonia and why it more likely occurs on a ventilated patient

4. 2012 National Patient Safety Goal Against VAP: Full Implementation by January, 2013 1) Hand hygiene before after contact with ventilated patients. 2) Position patients consistently unless medically contraindicated. 3) Perform antiseptic oral care consistently. 4) Daily assessment of ventilated patients 5) Sedation vacation of ventilated patients, to evaluate if it is time for extubation (Joint Commission, 2012).

5. Measure and Monitor VAP Prevention: Use evidence based guidelines and/or best practices Use evidence based guidelines and/or best practices Monitor compliance of evidence based guidelines and/or best practices. Monitor compliance of evidence based guidelines and/or best practices. Measuring the effectiveness of the VAP prevention efforts. Measuring the effectiveness of the VAP prevention efforts.

6. Ventilator-associated pneumonia: Ventilator-associated pneumonia (VAP) is defined as a hospital acquired pneumonia in ventilated patients. VAP is the leading cause of death of all nosocomial infections (Tolenino- DelosReyes, Ruppert, & Shiao (2007). VAP increases morbidity, mortality, length of hospital stay, and cost of hospital visit.

7. VAP Continued: The risk for pneumonia in ventilated patients increases over 50% than patients not on a ventilator. The ventilator patient is more at risk for VAP because of bacteria’s accessible portal way, patient inability to cough and clear secretions appropriately, and in addition the patients are usually critically ill (Wip & Napolitano, 2009).

8. Sparks Regional Medical Center VAP Bundle: 1) Elevate head of bed 30 – 45 degrees 2) Daily “Sedative interruption” 3) Peptic Ulcer prophylaxis 4) DVT prophylaxis (unless contraindicated) 5) Oral Care (every 4 hours & as needed) (Sparks, 2012).

9. Our Current Process: The current process at our hospital is to implement the ventilator bundle on all ventilated patients. The current process at our hospital is to implement the ventilator bundle on all ventilated patients. If the patient’s white blood cell count increases, or sputum changes color, or if patient temperature spikes; immediate blood cultures are drawn and a chest X-ray is done. If the patient’s white blood cell count increases, or sputum changes color, or if patient temperature spikes; immediate blood cultures are drawn and a chest X-ray is done.

10. Our Current Process Continued: Once the results are back from the tests, than we find the source of the infection. Once the results are back from the tests, than we find the source of the infection. If the infection turns out to be pneumonia, we treat the infection and rule out whether it was nosocomial or community acquired. If the infection turns out to be pneumonia, we treat the infection and rule out whether it was nosocomial or community acquired. If the infection is VAP we record and report it. If the infection is VAP we record and report it.

11. Our Current Process Continued: If the patient acquired VAP than the unit has a staff meeting and the entire staff is informed and educated on how to prevent this from happening again. If the patient acquired VAP than the unit has a staff meeting and the entire staff is informed and educated on how to prevent this from happening again. Sparks does not get paid from medicare if the patient acquires a nosocomial infection while hospitalized. Sparks does not get paid from medicare if the patient acquires a nosocomial infection while hospitalized.

12. What I Have Learned: That the pneumonia is a leading killer and is not something that we as nurses should take lightly That the pneumonia is a leading killer and is not something that we as nurses should take lightly That the ventilator bundle was a excellent evidence based research tool that has worked wonders at Sparks. That the ventilator bundle was a excellent evidence based research tool that has worked wonders at Sparks. That the education, teamwork, compliance, and nurses are the key in the prevention of VAP. That the education, teamwork, compliance, and nurses are the key in the prevention of VAP.

13. Best Practice: Teamwork Teamwork Compliance Compliance Nurses and Staff Nurses and Staff Joint Commission Joint Commission International Health Information (IHI) International Health Information (IHI) Center for Disease Control (CDC) Center for Disease Control (CDC) Ventilator Bundle Ventilator Bundle

14. Problem Statement: How to prevent ventilator- associated pneumonia in critical care patients? How to prevent ventilator- associated pneumonia in critical care patients?

15. Assessing: Who does the current process look like? Prevent VAP Who does the current process look like? Prevent VAP What are the best practices in use? Compliance and ventilator bundle What are the best practices in use? Compliance and ventilator bundle What evidence-based information do we have? Good success rate so far What evidence-based information do we have? Good success rate so far When and where do we begin to address the problem? During admission When and where do we begin to address the problem? During admission Who needs to comply to the issue at hand? Nurses and health care staff Who needs to comply to the issue at hand? Nurses and health care staff

16. Diagnose cause and identify solution: What is the problem? VAP What is the problem? VAP What is the best solution to the problem? Prevention What is the best solution to the problem? Prevention How do we prevent? Compliance and ventilator bundle How do we prevent? Compliance and ventilator bundle Is it successful? Yes Is it successful? Yes

17. Results: Sparks RMC Cases of VAP in the Past 3 years.

18. References Joint Commission (2012). 2012 National Patient Safety Goals: Hospital Accreditation Program. NPSG.07.06.01 http://www.jointcommission.org/assets/1/ 6/NPSGs_CAUTI-VAP_HAP_20101119.pdf http://www.jointcommission.org/assets/1/ 6/NPSGs_CAUTI-VAP_HAP_20101119.pdf http://www.jointcommission.org/assets/1/ 6/NPSGs_CAUTI-VAP_HAP_20101119.pdf Pear, S. (2008). Prevent VAP with the right tools. Materials Management in Health Care. http://www.matmanmag.com http://www.matmanmag.com Sparks Regional Medical Center (2012). Pneumonia. http://www.sparks.org http://www.sparks.org

19. References Continued Tolentino-DelosReyes, A., Ruppert, S., & Shiao, S. (2007). Evidence-based practice: Use of ventilator bundle to prevent VAP. American Journal of Critical Care. http://www.ajcc.aacnjournals.org http://www.ajcc.aacnjournals.org Wip, C. & Napolitano, L. (2009). Current Opinion in Infectious Disease: Bundles to prevent ventilator- associated pneumonia: how valuable are they? Vol.(22)2, 159-166. Retrieved from http://journals.lww.com/co- infectiousdiseases/Fulltext/2009/04000/Bundles_ to_prevent_ventilator-associated http://journals.lww.com/co- infectiousdiseases/Fulltext/2009/04000/Bundles_ to_prevent_ventilator-associated http://journals.lww.com/co- infectiousdiseases/Fulltext/2009/04000/Bundles_ to_prevent_ventilator-associated