Twenty Four Months and Running VAP Free

Purpose:
Auditing concluded that Nursing, Provider and RT ventilator patient care was variable/inconsistent. The goal was to establish and provide standardized multidisciplinary care and achieve high levels of compliance by hard wiring innovations designed to address barriers to implementing the VAP bundle.

Significance:
Between May 2005 and April 2006, VAP rates averaged 2.55 per 1000 vents days. While considered under benchmark, this rate negatively impacted mortality rates, length of stay, and cost per patient day. Striving to exceed benchmarks for patient outcomes concluded that more could be done.

Strategy and Implementation:
In May 2006, multidisciplinary vent bundle re-education commenced. Following this, auditing and root cause analysis of VAP occurrences lead the team to identify recurrent contributors to VAP infections despite implementation of the VAP bundle. Based on this, new and innovative strategies where devised and strategically implemented including: 1.) documentation of oral assessment (and brushing of teeth) on the MAR q12 hours; 2.) documentation of q2 hour oral swabbing on nursing flowsheets; 3.) dedicated suction canisters for oral care separate from tracheal suction canisters to reduce breaking of the closed ET system with corresponding re-education; 4.) standardized daily provider progress note template and standard order set was implemented; 5.) Respiratory Therapists included in daily provider rounds to improve collaborative communication; and 6.) multidisciplinary auditing began to ensure and improve accountability.

Evaluation:
Sequential implementation of strategies with a focus on accountability was deliberate and therefore improved outcomes could be directly correlated to specific interventions. Auditing compliance to practice changes and declining VAP rates following each successive practice change confirmed this.

Implications for Practice:
Since May 2006, implementation of the described tactics have contributed to a 24% reduction in LOS (5.8 to 4.4), a 41% reduction in mortality rate (22% to 13%) and a zero VAP rate since May of 2009.