IHS Best of the Best Series: VAP

From: IHI Mentor Hospitals for 100K Campaign

University Health Services Inc. – Augusta, GA

Availability Status: Available to answer requests
Licensed Beds: 551
Teaching / Non-Teaching Status: Non-teaching
Urban / Rural Status: Urban
Start Date of Intervention Work: October 2004
Mentor Contact Name: Heidi Nelson, Dir PI/Patient Safety
Mentor Contact Email: hnelson@uh.org
Mentor Contact Phone: 706-774-7764

Additional Information:
Started intensivist program 8/04 and rolled out daily interdisciplinary rounds along with concurrent
data collection of vent bundle.
Had a significant amount of staff education, devised a data collection guideline tool (had a training
for the charge nurses responsible for the data collection to ensure inter-rater reliability and data
integrity).
Created a sense of urgency when a VAP identified - brought immediately to the bedside RT, Nursing
, IC to drill down (root cause analysis)and identify gaps (elements of the bundle that were not
done) and immediately educate staff what those gaps were.
Daily posting of the overall ventilator bundle compliance for each patient.
If patient at significant risk for a VAP, a bright colored reminder is placed on chart during rounds.
Senior leaders have emphasized the importance of the importance of "all or none" strategy to be
successful.

In 2005, organizational reduction in VAPs by 47%.

In the medical surgical unit in 2005, have reduced VAPs by 30%.
Believe there has been improvement in the overall care of the ICU patient as seen in reduced
median vent times for non VAP patients & VAP patients (approx 10%).
Overall vent bundle compliance now running consistently 98%.
For the organization overall reduced VAPs by 30 (from 2004 to 2005) X $40,000 approx cost of a
VAP for a cost avoidance of $1.2 million.

Sentara HealthCare Norfolk General Hospital – Norfolk, VA

Availability Status: Available to answer requests
Licensed Beds: 649
Teaching / Non-Teaching Status: Teaching
Urban / Rural Status: Urban
Start Date of Intervention Work: May 1998
Mentor Contact Name: Kim Mick
Mentor Contact Email: krsmith3@sentara.com
Mentor Contact Phone: 757 388 5156

Additional Information:
Standardization of ventilator weaning criteria and daily evaluation was started in 1998. Six Sigma
then broadened this to include Ventilator Package or Ventilator Bundle, 2002, and has been
implemented in each of our units and became a focus of Multidisciplinary Rounds at various
intervals throughout our ICU's. In addition, the ventilator bundle or package has transferred itself
into shift handoffs. The bundle/package is posted in each room and is listed on the multidisciplinary
rounding tool. Audits are conducted in units not meeting goal. One of our ventilator rehab acute
care units has gone a step further and implemented a back-to-basics approach, focusing on basic
nursing care in addition to the ventilator bundle which adds an additional arm of tracheotomy care
and early ambulation/mobility.

Progressive Ventilator step Down Unit (PVSU) went 26 months from April 2003 - June 2005 with
NO VAPs; since June 2005 they have again had no VAPs.
GICU, a 16 bed medical surgical ICU, went 21 months (February 2004 - November 2995) with NO
VAPs; since January 2006 they have had no additional VAPs.
12 of our 13 Intensive Care Units within Sentara HealthCare were below goals of the top 10% of
the CDC benchmarked units for VAP in 2005.

Exempla Saint Joseph Hospital – Denver, CO

Availability Status: Available to answer requests
Licensed Beds: 563
Teaching / Non-Teaching Status: Teaching
Urban / Rural Status: Urban
Start Date of Intervention Work: September 2002
Mentor Contact Name: Maria Kinsella
Mentor Contact Email: kinsellam@exempla.org
Mentor Contact Phone: 303-866-8514

Additional Information:
Exempla Saint Joseph Hospital was a participant in VHA's Transformation of the ICU program. Our
facility started implementing the ventilator bundle in 4th quarter 2002. The combined efforts of
Respiratory Therapy, Pharmacy, Intensivists and Nursing have helped to maintain a consistently low
rate of ventilator-associated pneumonia. By including the bundle elements in daily rounds and
providing ongoing data feedback to staff, we have been able to maintain a consistently low rate of
VAP. We have received the Leadership Award from VHA for 6 consecutive months of zero VAP

By consistenly applying the ventilator bundle to our patients, we succeeded by having a total of
only 6 VAPs during 2005. We had a six month zero VAP stretch during that time. Our overall VAP
rate is currently at 2.3 per 1000 patient ventilator days.

Cape Coral Hospital, Cape Coral, FL

Availability Status: Available to answer requests
Licensed Beds: 281
Teaching / Non-Teaching Status: Non-Teaching
Urban / Rural Status: Urban
Start Date of Intervention Work: 9/04
Mentor Contact Name: Annette Forlenza
Mentor Contact Email: annette.forlenza@leememorial.org
Mentor Contact Phone: 239-574-0159

Additional Information:
Cape Coral Hospital began its work 15 months ago with the goal to reduce VAP by 50%.
Early on, we had issues with data collection and validity and were able to resolve these by using
the change package. Our multidisciplinary team worked diligently to identify areas for
improvement using PDSA cycles. Our multidisciplinary team meets daily during the week to
identify goals that are transferred onto a chalkboard for communication. Our staff have initiated
nurse-driven rounds on nights and weekends, where goals and goal attainment are reviewed and
communicated to the oncoming shift.
Changing culture has been the most challenging and the most rewarding. We have learned not to
accept the status quo and continuously seek out the best evidence to provide the safest care.
We have high reliability with the vent bundle and are in the process of spreading to those areas
(PACU, ED) where ventilator patients may spend time.

• Ventilator bundle compliance is greater than 95%.

• We are on our 5th month without a VAP. We reduced the rate by 50%, however we are now
measuring number of days between episodes.