CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients Onboarding: Introduction to...
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CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients Onboarding: Introduction to Daily Care Process Measures & Structural Assessment ARMSTRONG
CUSP 4 MVP VAP Improving Care for Mechanically Ventilated
Patients Onboarding: Introduction to Daily Care Process Measures
& Structural Assessment ARMSTRONG INSTITUTE FOR PATIENT SAFETY
AND QUALITY Johns Hopkins University November 12, 2014
Slide 2
2 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment CUSP 4 MVP - VAP Comprehensive Unit-based Safety Program
for Mechanically Ventilated Patients and Ventilator-Associated
Pneumonia
Slide 3
3 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment
Slide 4
Introduction to Daily Care Process Measures Kathleen Speck, MPH
CUSP 4 MVP VAP Improving Care for Mechanically Ventilated
Patients
Slide 5
5 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Ask questions! Make suggestions!
Slide 6
6 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Administrative Announcements Webinar access information:
https://mhakeystonecenterevents.webex.com/mhakeystonecentere
vents/onstage/g.php?t=a&d=669992364https://mhakeystonecenterevents.webex.com/mhakeystonecentere
vents/onstage/g.php?t=a&d=669992364 Call in details Dial:
1-877-668-4493 Use code: 669 992 364 Contact your Coordinating
Entity (CE) for the presentation slides, if necessary Recording
will be available on the project website
Slide 7
7 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Polling Question Who is on the call? IP infection
preventionist RN registered nurse RT respiratory therapist PT
physical therapist OT occupational therapist Healthcare executive
Educator National project team Other
Slide 8
8 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Objectives Introduce the Daily Care Process Measures
Describe the required Daily Care Process Measures data elements and
their definitions Identify strategies for finding the data elements
Navigate the CUSP 4 MVP VAP data portal Enter Daily Care Process
Measures data in the data portal Show how to complete the
Structural Assessment
Slide 9
9 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment 2014 SHEA Compendium Update 1 Elevate the head of the
bed 30-45 Provide endotracheal tubes with subglottic secretion
drainage ports for patients likely to require more than 48 or 72
hours of intubation Manage ventilated patients without sedatives
whenever possible
Slide 10
10 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment 2014 SHEA Compendium Update 1 Interrupt sedation once a
day (spontaneous awakening trials) Assess readiness to extubate
once a day (spontaneous breathing trials) Pair spontaneous
breathing trials with spontaneous awakening trials Employ early
exercise and mobilization Use non-invasive positive pressure
ventilation (NIPPV) whenever feasible
Slide 11
11 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment 2013 Society of Critical Care Medicine PAD Guidelines 2
1.Establish an overarching protocolized approach to daily ICU
patient management using 2013 Pain, Agitation, and Delirium (PAD)
Guidelines 2.Assess and treat pain first (may be sufficient) 3.If
patient remains agitated after adequately treating pain Start with
PRN bolus sedation (as needed) Use continuous sedation if boluses
exceed 3 per hour 4.Avoid benzodiazepines in most patients
Slide 12
12 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment 2013 Society of Critical Care Medicine PAD Guidelines 2
5.Interrupt sedation daily If necessary, restart at lowest dose to
maintain chosen target level of consciousness 6.Avoid deep sedation
(RASS -4/-5) as it appears harmful; instead, target awake or alert
7.Screen for delirium (CAM-ICU or ICDSC) If delirious, first seek
reversible causes and attempt non-pharmacologic management 8.Use
the ABCDEs to improve outcomes for your patients
Slide 13
13 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment What Is the Evidence? Tune in to the content webinars
for evidence supporting each intervention Content webinars are 90
minutes and occur on the third Wednesday of each month from 11:00
am EST DATETOPIC Jan 21, 2015Science of Safety & Identifying
Defects Pain, Agitation, and Delirium (PAD) and Sedation Management
Feb 18, 2015Spontaneous Awakening Trials (SAT) and Spontaneous
Breathing Trials (SBT) Utility of the Exposure Receipt Assessment
Mar 18, 2015Delirium Assessment Training Benefits of Subglottic
Endotracheal Tubes
Slide 14
14 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment What Is the Evidence? Tune in to these Infection
Prevention webinars for training on the importance and details of
ventilator-associated events IP webinars are 60 minutes and occur
on the fourth Wednesday in January, February and March at 11:00 am
EST DATETOPIC Jan 28, 2015VAE Surveillance Training: An Overview
Feb 25, 2015VAE Surveillance Training: Infection-related
Ventilator-associated Complication (IVAC) Mar 25, 2015VAE
Surveillance Training: Possible VAP (PoVAP) and Probably VAP
(PrVAP)
Slide 15
15 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment In God we trust. All others bring data. W. E.
Deming
Slide 16
16 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Daily Care Process Measures Data Collection Tool
Contraindications & Location Codes Detailed Instructions Data
Collection Tool
Slide 17
17 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment
Slide 18
18 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Contraindications and Locations
Slide 19
19 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Lets Begin Fill Out For All Beds Track by bed, not by
patient Include Bed number Was the patient in that bed intubated or
trached AND on mechanical ventilation at the time of observation Y
= Yes N = No E = Empty bed
Slide 20
20 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment
Slide 21
21 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Date of Intubation Enter the date the patient was
intubated If the date is not available*, enter admission date
(either to the unit or to the hospital, as appropriate) If the
patient is extubated and re- intubated within 24 hours, use the
original date *i.e., when from an outside institution
Slide 22
22 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Sub-G ETT Does the patient have a subglottic
endotracheal tube? Y = Yes N = No If your unit doesnt use Sub-G
ETTs, enter N C = Contraindicated If C, enter the contraindication
code for this patient in the next column
Slide 23
23 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Sub-G ETT Contraindications Why a Sub-G ETT is
contraindicated? Find the contraindications on the back or on page
2 of the tool Remember, enter N if your unit does not use Sub-G
ETTs
Slide 24
24 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Location of Intubation Enter the location code where the
patient was intubated Find the locations on the back or on page 2
of the tool If you are using Sub-G ETTs on your unit, but the
patient is admitted with a different type of ETT, this allows you
to track where the patient came from
Slide 25
25 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Location of Intubation Where was the patient intubated?
Find the locations on the back or on page 2 of the tool
Slide 26
26 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Elevating the Head of Bed Is the HOB elevated to an
angle of 30 from the horizontal? Y = Yes N = No C = Contraindicated
If contraindicated, choose the reason from the contraindications
listed on page 2 of the tool
Slide 27
27 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Head of Bed Contraindications Why was placing the HOB at
an angle of 30 from the horizontal contraindicated? Find the
contraindications on the back or on page 2 of the tool
Slide 28
28 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Sedation Scale 1 st question What sedation scale do you
use on your unit? This question refers to your unit, not to this
specific patient
Slide 29
29 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Sedation Scale R = Richmond Agitation Sedation Scale
(RASS) S = Riker Sedation- Agitation Scale (SAS) NU = Unit uses
neither RASS or SAS If NU, skip to Delirium Assessment
Slide 30
30 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Sedation Scale Choose either RASS or SAS, but not both
Choose the value closest to 10:00 am If equidistant, choose the
earlier time
Slide 31
31 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Sedation Scale: Target RASS If you use RASS Target: What
is the target RASS score for this patient? Enter RASS sedation
scale value (-5 to 4) NS means not set NK means target RASS was
set, but is not known Enter NK if you dont know whether a target
RASS was actually set
Slide 32
32 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Sedation Scale: Actual RASS If you use RASS Actual: What
is the actual RASS score for this patient? Enter RASS sedation
scale value (-5 to 4) Enter X if an actual RASS sedation level was
not scored Enter NK if target RASS was scored, but is not known
Enter NK if you dont know whether a target RASS was actually
scored
Slide 33
33 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Sedation Scale: Target SAS If you use SAS Target: What
is the target SAS score for this patient? Enter SAS sedation scale
value (1 to 7) Enter NS if not set Enter NK if target SAS was set
but is not known Enter NK if you dont know whether a target SAS was
actually set
Slide 34
34 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Sedation Scale: Actual SAS If you use SAS Actual: What
is the actual SAS score for this patient? Enter SAS sedation scale
value (1 to 7) Enter X if an actual SAS sedation level was not
scored Enter NK if target SAS was scored, but is not known Enter NK
if you dont know whether a target SAS was actually scored
Slide 35
35 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Sedation Scale: NU If you entered NU NU = Unit uses
neither RASS or SAS If NU, skip Target and Actual sections and go
to Delirium Assessment
Slide 36
36 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Delirium Assessment C = Confusion Assessment Method for
the ICU (CAM-ICU) A = Attention Screening Exam (ASE) NU = Unit uses
neither CAM-ICU or ASE If NU, skip to SAT
Slide 37
37 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Attention Screening Exam (ASE) If the CAM-ICU is not yet
feasible in your unit, we recommend that patients at least undergo
the ASE once per nursing shift The ASE is feature 2 of the CAM-ICU
and this 10-20 second test of attention is the cardinal feature of
a delirium diagnosis
Slide 38
38 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Delirium Assessment Choose either CAM- ICU or ASE, not
both CAM-ICU incorporates the ASE Choose the value closest to 10:00
a.m. If equidistant, choose the earlier time
Slide 39
39 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Confusion Assessment Method for the ICU (CAM-ICU)
Society of Critical Care Medicines 2013 Pain, Agitation, and
Delirium (PAD) clinical practice guidelines Recommends theses valid
and reliable delirium screening tools Confusion Assessment Method
for the ICU (CAM-ICU) Intensive Care Delirium Screening Checklist
(ICDSC) Screen moderate to high risk patients at least once per
nursing shift
Slide 40
40 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Delirium Assessment CAM-ICU Is the patient positive or
negative for delirium? Enter P if the patient is positive for
delirium Enter N if the patient is negative for delirium Enter UTA
if unable to assess Such as RASS = -4 or -5 OR SAS = 1 or 2 Enter X
if CAM-ICU assessment was not completed Enter NK if CAM-ICU was
completed, but results arent known Enter NK if you dont know
whether the exam was performed
Slide 41
41 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Attention Screening Exam (ASE) Determine if patient can
follow a simple command (pay attention) for 10-20 seconds Recognize
inattention as the cardinal feature of delirium that must be
present for diagnosis For centers not using the full CAM-ICU,
conducting the ASE is a good barometer of the presence or absence
of delirium May yield abnormal results due to disease, drugs or
other causes
Slide 42
42 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Attention Screening Exam (ASE) Provider reads one of the
following sequences: S A V E A H A A R T C A S A B L A N C A A B A
D B A D D A Y Patient squeezes the providers hand when he hears the
letter A Error defined as No squeeze with letter A A squeeze on a
letter other than A
Slide 43
43 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Attention Screening Exam (ASE) Count the number of
errors Inattention is present if the patient commits more than 2
errors If the patient squeezes on every letter, assign an error
count of 10 If the patient doesnt squeeze on any letter, assign an
error count of 10
Slide 44
44 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Attention Screening Exam (ASE) What is the patients
ability to pay attention? Use only if CAM-ICU is not performed
Enter the number of errors, 0 to 10 Enter UTA if unable to assess
RASS = -4 or -5 SAS = 1 or 2 Enter X if the exam was not performed
Enter NK if the exam was performed, but number of errors is not
known Enter NK if you dont know whether the exam was performed
Slide 45
45 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Spontaneous Awakening Trial (SAT) Has the patient had a
Spontaneous Awakening Trial today?
Slide 46
46 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Spontaneous Awakening Trial (SAT)
Slide 47
47 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Spontaneous Awakening Trial (SAT) Enter NS if the
patient is not sedated Enter Y if medications for sedation have
been held today Enter N if medications for sedation have NOT been
held today Enter C/NI if holding medications for sedation is either
contraindicated or not indicated today If C/NI go to next column
labeled Reason SAT Contraindic
Slide 48
48 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Spontaneous Awakening Trial (SAT) Contraindications Why
is an SAT inappropriate for this patient? Find the
contraindications on the back or on page 2 of the tool
Slide 49
49 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Spontaneous Breathing Trial (SBT) Has the patient had a
spontaneous breathing trial today?
Slide 50
50 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Spontaneous Breathing Trial (SBT) Remove ventilator
support Allow patient to breathe With either a T-tube circuit Or
with a ventilator circuit With low levels of PS (58 cm H 2 O in
adults) With or without 5 cm H 2 O PEEP No changes are required in
FiO 2 or the level of PEEP
Slide 51
51 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Spontaneous Breathing Trial (SBT) Enter Y if the patient
had an SBT Enter N if the patient did not have an SBT Enter C/NI if
the use of an SBT is contra- indicated/not indicated If C/NI, go to
Reason SBT Contraindic
Slide 52
52 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Spontaneous Breathing Trials Contraindications (SBT)
What is the reason an SBT is inappropriate for this patient? Find
the contraindications on the back or on page 2 of the tool
Slide 53
53 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Spontaneous Breathing Trial (SBT) with Sedatives Off Was
the SBT performed with the sedatives off? Sedatives are considered
off: During an SAT If sedative infusion is stopped If standing
order for intermittent sedating meds is held or cancelled If the
interval between standing doses is extended
Slide 54
54 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment
Slide 55
Data Collection Scenarios CUSP 4 MVP VAP Improving Care for
Mechanically Ventilated Patients
Slide 56
56 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Collecting Daily Care Process Measures Who should
collect this data? Nurse Nurse educator Respiratory therapist How
often should this data be collected? Daily How often should this
data be entered in the data portal? Weekly As with any new process,
it takes some time to find where to extract the data for each
field. Once the process is established, it becomes easier and takes
less time.
Slide 57
57 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment EMR Charts Bedside Paper tool Spreadsheet Template
Collecting Daily Care Process Measures Data Source Workstation or
Mobile Device Data Entry Method Direct Portal Entry Upload into
Portal
Slide 58
58 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Collecting Daily Care Process Measures Scenario 1:
Bedside Observe the collected measures at the bedside Enter data
directly into the project data entry portal via mobile computing
device Bedside Mobile Device Direct Portal Entry
Slide 59
59 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Collecting Daily Care Process Measures Scenario 2:
Patient charts Review physical patient charts Identify the fields
for each of the daily care process measures Record data on data
collection tool Enter data into the project data portal Direct
Portal Entry Charts Paper Tool
Slide 60
60 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Collecting Daily Care Process Measures Scenario 3:
Electronic medical records Access the electronic medical records
Identify the fields for each of the daily care process measures
Note data on a data collection tool Enter data into the spreadsheet
template Upload spreadsheet into project data entry portal EMR
Paper Tool Spreadsheet Template
Slide 61
Introduction to Structural Assessment CUSP 4 MVP VAP Improving
Care for Mechanically Ventilated Patients
Slide 62
62 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Structural Assessment Who should collect this data? Unit
lead How often should this data be collected and entered into the
data portal? Semi-annually How long does it take to complete? About
ten minutes
Slide 63
63 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Semi-Annual Structural Assessment Please answer the
following questions regarding your ICU. 1.For intubated/trached
patients, how often do you change the ventilator circuit? Not
routinely changed unless soiled or malfunctioning Routinely changed
at regular interval; please specify in days ____ 2.When used, how
often do you change the closed endotracheal suction system? It is
not used in this ICU Not routinely changed unless soiled or
malfunctioning Routinely changed at regular interval; please
specify in days ____
Slide 64
64 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Semi-Annual Structural Assessment 3.In the absence of a
difficult airway, how often is an orotracheal route used for
elective intubation in your ICU? 4.For patients receiving
mechanical ventilation via an endotracheal tube, how often is a
closed endotracheal suction system used in your ICU? 5.When
mechanical ventilation is required, how often are prophylactic
intravenous antibiotics used to prevent ventilator-associated
pneumonia in your ICU? 6.In your ICU, how often are patients placed
in a supine (flat) position, when there is no contraindication?
7.In your ICU, how often are standard precautions used while
suctioning the respiratory tract?
Slide 65
65 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Semi-Annual Structural Assessment 9.In your ICU, how
often are mechanically ventilated patients experiencing gastric
over-distention? 10.In your ICU, how often is condensate drained
away from the patient while the circuit remains closed? 11.In your
ICU, how often do healthcare providers perform hand hygiene before
contact with respiratory equipment? 12.How often is noninvasive
ventilation used in your ICU? 13.In your ICU, how often is an early
mobility protocol used for patients receiving mechanical
ventilation? 8.In your ICU, how often is tracheal suctioning
performed when it is not clinically indicated?
Slide 66
66 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Semi-Annual Structural Assessment 14.Regarding your
written ICU, nursing and/or respiratory therapy policies and
procedures concerning patients receiving mechanical ventilation, is
there guidance to: (YES/NO) Avoid supine (flat) patient positioning
unless clinically indicated (i.e. hemodynamic instability,
orthopedic injury, etc.)? Use standard precautions while suctioning
the respiratory tract secretions? Avoid nonessential tracheal
suctioning? Avoid gastric over distention? Periodically remove
condensate from circuits? Assure that circuits are closed during
removal of condensate to assure that condensate doesnt drain toward
the patient? Perform hand hygiene before contact with respiratory
equipment?
Slide 67
67 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Semi-Annual Structural Assessment 15.Does your ICU
actively promote: (YES/NO) Use of noninvasive ventilation protocol?
Early mobility protocol for patients receiving mechanical
ventilation?
Slide 68
68 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Data Collection Ideas Where can you find these data?
Ideas Suggestions Barriers
Slide 69
69 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Next Steps Where will you find your data? Look for data
sources Make plans for data collection processes Practice
collecting data for next call After finding your data sources and
starting data collection: Collect data daily Enter the data at
least weekly
Slide 70
70 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Discussion Question How will using the data portal
benefit me?
Slide 71
71 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment
Slide 72
Next Steps CUSP 4 MVP VAP Improving Care for Mechanically
Ventilated Patients
Slide 73
73 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Next Steps: Homework By January 1, 2015 Determine the
location of information that is needed to complete the Daily Care
Process Measures Determine who will gather the data for the Daily
Care Process Measures.
Slide 74
74 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Next Onboarding Call: VAE Overview November 19, 2014
1:00 2:00 PM EST Review the theory supporting the new NHSN VAE
surveillance Review basic VAE surveillance techniques Apply
techniques to determine whether patients on mechanical ventilation
have acquired VAEs
Slide 75
75 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment Mark Your Calendar: Upcoming Onboarding Sessions
ACTIONDATE Orientation Webinars 3: Ventilator Associated Events
(VAE) OverviewNov 19, 12 pm EST 4: Assessing Patient Safety Culture
using the Hospital Survey on Patient Safety (HSOPS) Dec 3, 12 pm
EST Project Kick-OffDec 17, 13 pm EST
Slide 76
76 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment CUSP 4 MVP VAP Website Visit: https://armstrongr
esearch.hopkinsm edicine.org/cusp4 mvp.aspx https://armstrongr
esearch.hopkinsm edicine.org/cusp4 mvp.aspx
Slide 77
77 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment What Can I Find on the CUSP 4 MVP VAP Website? Education
materials Toolkits CUSP Daily Process Measures Early Mobility Low
Tidal Volume Ventilation (soon) Literature Reviews Fast Fact Sheets
CUSP Tools and Guides Archive of webinars led by subject matter
experts
Slide 78
78 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated
Patients Onboarding: Daily Care, Data Portal, & Structural
Assessment References 1.Klompas M, Branson R, Eichenwald EC, Greene
LR, Howell MD, Lee G, Magill SS, Maragakis LL, Priebe GP, Speck K,
Yokoe DS, Berenholtz SM. Strategies to prevent
ventilator-associated pneumonia in acute care hospitals: 2014
update. Infect Control Hosp Epidemiol 2014;35(8):915-936. PMID:
25026607. 2.Barr J, Fraser GL, Puntillo K, Ely EW, Glinas C, Dasta
JF, Davidson JE, Devlin JW, Kress JP, Joffe AM, Coursin DB, Herr
DL, Tung A, Robinson BR, Fontaine DK, Ramsay MA, Riker RR, Sessler
CN, Pun B, Skrobik Y, Jaeschke R; American College of Critical Care
Medicine. Clinical practice guidelines for the management of pain,
agitation, and delirium in adult patients in the intensive care
unit. Crit Care Med. 2013 Jan;41(1):263- 306. PMID: 23269131.
ARMSTRONG INSTITUTE FOR PATIENT SAFETY AND QUALITY