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JEAN GILLIS, RN
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Defining VAP
Pre-call Question:
How are people defining/diagnosing a VAP?
Even using the CDC definition, we find there
is room for interpretation. In the end, we
can define it for our organization and just
focus on improving our rate. However, many
folks are reporting rates of zero and payers
may refuse to pay for the care associated w/
VAP.So the definition becomes more
important.
as best we
Implementing Change
THE BUNDLE
Pre-call Question:
To improve, we find measuring the process more
helpful than following the rate (though the outcome is
certainly important!). We have questions about what
and how people are measuring the process. Are folks
just reviewing compliance w/ the bundle? once a day?
Once a shift? Etc.?
Disciplines Required
RN / RT
MD / RN / Pharmacy
MD / RN / Pharmacy
RN / RT / (MD)
RT / RN / MD
leaders
Incorporation of them into data gathering phase
to disseminate change
Supported by Clinical Nurse Specialists (0.5 - 1.0
FTE)
needs.
Oral care kits make implementation easier.
change
18 times a month!
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10
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Results
Process Measure
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Note: We use a temporal bundle for oral care. If you miss one oral care
chance during a 24-hour period, you get a 0 for the day. (We just made
this up, though).
Outcome Measure
Outcomes
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Resource Utilization
Measure
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Throughput Impacts
CAVEAT: LOTS OF OTHER THINGS WERE GOING
ON!
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Summary
(ICU Throughput)
Better
(Three-ICU Sample)
Better
Ventilator Days
No data
(Three-ICU Sample)
Better
VAP Cases
Better
Ventilator Bundle
Compliance
Better
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Conclusions
Conclusions
Defining VAP is complicated and challenging.
Thank you.
Questions? Please email mhowell@bidmc.harvard.edu