ICU, eFocus/eICU, and Interdisciplinary Care Rounds (IDCR) Impact on Ventilator Associated Pneumonia (VAP)

Purpose:
ICU staff must keep patients safe and protect them from harm as VAP is a preventable medical condition. This can be done by creating a culture of ownership and responsibility of the bedside clinician. NO VAP is acceptable.

Significance:
VAP is a hospital-acquired infection increasing morbidity up to 50% and raises the cost of health care with additional costs estimated between $5,000 and $20,000 per diagnosis. VAP can be prevented with simple measures but the implementation of putting the measures into practice can be absent.

Strategy and Implementation:
IDCR education is included in orientation to all new ICU RNs in the Alegent Health System. The IDCR process will be communicated to patients & family on admission to ICU. The IDCR will be held at the patient's bedside. The IDCR team is lead by the patient's RN and includes the eFocus/eICU RN. The eFocus/eICU RN will prompt the IDCR team to focus on the ventilator bundle: Elevate head of bed, VTE prevention, Stress Ulcer prevention, Sedation Vacation, and Daily Ventilator Weaning. The eFocus/eICU RN will transcribe the patient's plan of care and print it in the ICU unit to be placed in the patient's medical record. The patient's RN will write the patient's daily goal(s) on the white board in the patient room. The eFocus/eICU has the capability to run a real-time Vent Bundle Report which includes the 5 elements listed above. This report is faxed and communicated to the bedside team at least twice a shift.

Evaluation:
Data collected includes compliance of each Vent Bundle element as well as the number of VAP for each month. The data is communicated to the system Critical Care Committee and Patient Safety and Quality Council as well as the on-site Critical Care Committees and Quality Councils.

Implications for Practice:
Real time assessment, reports, and notification of the defects drives the success for the elimination of VAP. The access to the real time reports help to identify best practices, establish standardize processes, and learn from each other's experiences.