The Institute of Healthcare Improvement (PHI) and JCAHO have launched several initiatives related to Patient Safety and Best Practice. Some of the initiatives include ICU Glucose Management, Medication Reconciliation, Prevention of Central Line and Surgical Infections, Rapid Response Teams and the Prevention of Ventilator Associated Pneumonia.

Valley Baptist Medical Center-Harlingen, along with Six Sigma, chose to address the Prevention of Ventilator Associated Pneumonia (VAP) in Adult ICUs.

Ventilator Associated Pneumonia (VAP) is a lung infection that can develop in patients who are on ventilators (machines to help them breathe). This infection is very serious – approximately half (50 out of 100) of patients with VAP die from it.

Ventilator Associated Pneumonia is the leading cause of hospital-acquired infection; VAP also has a high rate of mortality. In addition VAP increases ventilator days and ICU Length of Stay.

Some hospital patients need help breathing, either because they have just had a major operation or because they are very ill. These patients are often placed on a ventilator, a machine that supplies regular breaths through a tube inserted in the patient’s mouth, nose, or through a hole in the front of the neck. Most of these patients recover, and the ventilator can be removed. However, there are proven ways to help prevent VAP, and patients and their families can help to ensure this is achieved.

The Ventilator Bundle is comprised of 5 care steps of Best Practice. When implemented together on all patients on mechanical ventilation, the result is a dramatic reduction of VAP.

Doctors and nurses can help prevent VAP by using a bundle of 5 “care steps.” Hospitals find that when all 5 steps are performed, the incidence of VAP is virtually eliminated. The bundle of care steps are:

• Head of the bed elevation 30-45 degrees (Raising the head of the patients bed between 30 and 40 degrees)
  
  
• Daily “Sedation Vacation and Daily assessment of readiness to Extubate” (seeing if patients can breathe on their own when waking up after surgery”)
  
  
• Peptic Ulcer Prophylaxis (PUD) - giving the patient medication to prevent stomach ulcers
  
  
• Deep Vein Thrombosis Prophylaxis (DVT) (Preventing blood clots when patients are lying)
  
  
• Oral Care every 4 hours

Our goal is 100% compliance with the complete Ventilator Bundle on all ICU Ventilator patients unless contraindicated.

We utilize Six Sigma’s DMAIC Process D=Define M=Measure A=Analyze I=Improve C=Control

To learn more about Ventilator Associated Pneumonia as it relates to the 100,000 Lives Campaign, log on to www.ihi.org.